Patient education and counseling · 2026
The Monkey King's dilemma: Metaphorical constructions of physicians' identity and doctor-patient communication in China.
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Wang Jun, Hu Xing
Аннотация
OBJECTIVE: In the context of tense doctor-patient relationships, physicians' understandings of their own roles and relationships may be relevant to clinical communication. This study examines how Chinese physicians construct their understanding of doctors, patients, and doctor-patient relationships through metaphors, and analyses cross domain shifts in metaphorical paradigms.
METHODS: This study used Elicited Metaphor Analysis (EMA) and surveyed 222 frontline physicians in China. The respondents completed three metaphorical prompts about doctors, patients, and doctor-patient relationships, generating a total of 666 statements. The responses were coded into three macro paradigms: Humanistic/Cooperative, Service/Burnout, and Mechanistic. Chi-square tests examined differences by career stage and hospital tier, while Sankey flow mapping visualized within participant transitions across the three elicitation domains (M1-M3).
RESULTS: Humanistic/cooperative metaphors dominated, accounting for 61.1% (407/666); Service/burnout metaphors accounted for 23.3% (155/666); mechanistic metaphors accounted for 15.6% (104/666). Sun Wukong (the Monkey King, a powerful yet constrained Chinese mythic hero) and beasts of burden metaphors embody the tension between expected clinical omnipotence and limited physician autonomy. There were differences in baseline self-metaphors among different career stages, with service/burnout metaphors being more prominent among mid-career doctors; there was no significant difference across hospital tiers. Flow analysis showed that 95 doctors (42.8%) maintained the same paradigm across the three nodes; among 148 doctors who used humanistic/cooperative self-metaphors, 44 (29.7%) shifted to the service/burnout paradigm when describing doctor-patient relationships.
CONCLUSION: Chinese physicians' elicited metaphors were predominantly Humanistic/Cooperative, while some showed a shift toward Service/Burnout framing in the relationship domain, highlighting cross domain variation in physicians' metaphorical conceptualizations.
PRACTICE IMPLICATIONS: Doctor patient communication support could combine empathy and communication skills training with organizational support, particularly for mid-career physicians; reflective support approaches such as Balint groups and clearer medical dispute resolution and occupational safety support may also be considered.
METHODS: This study used Elicited Metaphor Analysis (EMA) and surveyed 222 frontline physicians in China. The respondents completed three metaphorical prompts about doctors, patients, and doctor-patient relationships, generating a total of 666 statements. The responses were coded into three macro paradigms: Humanistic/Cooperative, Service/Burnout, and Mechanistic. Chi-square tests examined differences by career stage and hospital tier, while Sankey flow mapping visualized within participant transitions across the three elicitation domains (M1-M3).
RESULTS: Humanistic/cooperative metaphors dominated, accounting for 61.1% (407/666); Service/burnout metaphors accounted for 23.3% (155/666); mechanistic metaphors accounted for 15.6% (104/666). Sun Wukong (the Monkey King, a powerful yet constrained Chinese mythic hero) and beasts of burden metaphors embody the tension between expected clinical omnipotence and limited physician autonomy. There were differences in baseline self-metaphors among different career stages, with service/burnout metaphors being more prominent among mid-career doctors; there was no significant difference across hospital tiers. Flow analysis showed that 95 doctors (42.8%) maintained the same paradigm across the three nodes; among 148 doctors who used humanistic/cooperative self-metaphors, 44 (29.7%) shifted to the service/burnout paradigm when describing doctor-patient relationships.
CONCLUSION: Chinese physicians' elicited metaphors were predominantly Humanistic/Cooperative, while some showed a shift toward Service/Burnout framing in the relationship domain, highlighting cross domain variation in physicians' metaphorical conceptualizations.
PRACTICE IMPLICATIONS: Doctor patient communication support could combine empathy and communication skills training with organizational support, particularly for mid-career physicians; reflective support approaches such as Balint groups and clearer medical dispute resolution and occupational safety support may also be considered.