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8 Soc. Resp.: Journalism L. Med. 47 (1982)
Metaphors and Models of Medical Relationships

handle is hein.journals/soresbuj8 and id is 47 raw text is: METAPHORS AND MODELS OF MEDICAL RELATIONSHIPS' JAMES F. CHILDRESS* Numerous metaphors and models compete for dominance in interpreting and directing relationships between physicians (as well as other health care professionals) and patients. Some of these metaphors and models are offered to describe, interpret, and illu- minate what actually occurs in such relationships; others are offered to indicate what should occur in such relationships. Several - if not all - of these metaphors and models have implications for autonomy - the autonomy of patients and the autonomy of pro- fessionals. I want to analyze these metaphors and models in order to determine their adequacy as descriptions of and prescriptions for doctor-patient relationships. My assessment will hinge, in part, on what they imply for patient and physician autonomy. It will also depend on how well these metaphors and models fit the realities of contemporary medicine. There is no single doctor-patient rela- tionship, but a variety of relationships. Thus, it is probable that no single metaphor or model can adequately describe or direct the whole range of relationships in health care, from surgery to family practice and clinical research. Some metaphors and models may be more adequate than others for some relationships in health care and for some aspects of such relationships. Metaphors involve seeing something as something else, for ex- ample, seeing man as a wolf or argument as warfare.2 Perhaps be- cause medicine touches on fundamental matters of life and death for practically everyone and in such mysterious ways, conceptions of relationships in medicine and health care are often metaphori- cal in nature. For example, the physician is often viewed as a par- *James F. Childress is Professor of Religious Studies and Professor of Medical Education at the University of Virginia. 'Portions of this article will appear in different form in a forthcoming article, co-authored with Mark Siegler, in Meta-Medicine. 2The discussion of metaphor in these paragraphs is influenced by George Lakoff and Mark Johnson, Metaphors We Live By (Chicago: University of Chicago Press, 1980).

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