A lot of people don’t know much about how the body works. One of my jobs as a physician is to explain how things work in order to empower my patient to choose how to deal with it when the body isn’t working right.
On my blog I have written about this many times, for example in the 2010 post GUY TALK:
Guy Talk
One of the first challenges I faced as a foreign doctor from an urban background practicing in a small town in this country was finding the right way to explain medical issues to my male patients. They were farmers and fishermen without much experience with illness, medications or medical procedures. Most of them came to see me reluctantly at their wives’ insistence.
Gradually, I found my voice and a style that has served me well over the years. As a Boy Scout and grandson of a farmer with more than an average interest in automobiles, I have found enough analogies from my own experience to be able to cross the cultural barriers I have encountered in my new homeland.
I may explain risk aversion by talking about why some men wear both a belt and suspenders. Heart attacks and angina are, obviously, related to plugged fuel lines. Beta blocker therapy is similar to shifting your manual transmission into fifth gear. Sudden discontinuation of beta blocker therapy is like releasing an inadvertently engaged emergency brake while driving with your gas pedal fully depressed. Untreated hypertension is like driving down the highway in third gear, and orthostatic hypotension is a lot like getting poor water pressure in an attic apartment.
Other, perhaps less obvious, analogies I have perfected over the years include the following:
Finasteride to slow progression of benign prostatic hypertrophy:
You buy a new car and the dealer sells you a rust proofing job. Five years later, your car is rust free. Is it because you paid extra for the rust proofing, or would the car have been OK anyway?
Why carotid artery stenosis up to 80% can be asymptomatic:
If you water your plants with a garden hose and compress the hose by 80%, the water will actually squirt faster and further than if you just stand there with a soft grip on the hose.
What to do when a test result and your judgment conflict:
When the terrain and the map disagree, follow the terrain.
Why some people with high cholesterol escape heart disease while others get more atherosclerosis than expected because of inflammation, as measured by C-reactive protein (CRP):
Some people’s arteries are like Teflon, nothing sticks, and other people’s arteries are like a scratched-up aluminum pan, everything sticks to the bottom.
Why skipping just one dose of your antihistamine can cause a major allergy flare-up:
If your townspeople are trying to discourage out-of-towners from stopping in and causing trouble at your local hangout and your strategy is to make the place look filled to capacity, be sure you get there as soon as they open, and don’t you all take a break at the same time, or the place will look empty and they’ll be sure to stop in.
Why some people can take an antibiotic several times before they get a rash from it:
Just because your neighbor’s pit bull doesn’t bite you the first time you see it, do you really know it won’t bite you the second time?
Our job as doctors is to meet our patients “where they’re at”, as people say around here. That’s not the English I learned in school, just like the explanations and analogies I use with my patients aren’t exactly the ones I learned at Europe’s second oldest university. But all the book knowledge in the world won’t help you be a better doctor if people don’t like or understand the way you speak.
Today, a nurse I work with at the nursing home gave me the nicest compliment. Her husband had, reluctantly, been in to see me a few weeks ago. She told me that her husband thought that now, for the first time ever, he had a doctor he could talk to – one that talked the way he did and laid things out plain and simple without putting on airs or making things complicated.
Comments like that always make my day, just like hearing that people forget I am a foreigner and “from away”.
Two years ago I made a bunch of videos where I explain medical things. I’m gearing up to do that again and I would love to hear if my readers have topics they would want me to cover. I welcome comments and ideas.
A Country Doctor Writes: 
I love this! Gonna re-watch your videos & I’m looking forward to seeing any new ones you make. There’s no point prescribing meds & treatments if your patients don’t understand the point of them & won’t follow your advice; it takes a great doctor to emphasize patient-doc communication as you do.
Please suggest topics.
– what do you recommend to your pts for intermittent, no-red-flags, bothersome low back pain? i see folks who’ve been rx’d tylenol, nsaids, muscle relaxants, gabapentin, even opioids, along with lidocaine patches or nsaid gel (voltaren): none really works. some folks swear by cbd oil under the tongue, have you heard of that? it seems like focusing on posture (slumping on sofa with computer) & doing regular movement of some sort might work best long-term. what’s your LBP spiel?
PT, NSAIDS or even prednisone muscle relaxants (which work on the brain) Chiro if they believe in it (I describe it as a different religion and I don’t believe the dogma but sometimes it works).
thanks, re LBP! for one of your upcoming vids: – can you do a video on anemia – especially how you work up iron deficiency anemia in a young male?
Thanks. Anemia would be a good one.
one more: we’ve given suboxone for opioid use disorder for some years now, but more & more we’re giving it for OUD/chronic pain – ie where ED used to send a pain pt out with fentanyl patch & 3 days of oxy, now they’re sending them out with 5 days of bup & saying see your pcp. Are you using suboxone for pain only? as well as OUD/pain combo? (not sure if this is of interest to your vid viewers but it’s HUGE where i work)
The buprenorphine patch is FDA approved for pain, the same chemical in pill form or the strips with both bupropion and naloxone are only FDA approved for opiate use disorder. I am a big fan of the Buprenorphine patch. It is the last stop for people who seem to require opiates but can’t manage them because of their addictive properties. Buprenorphine is a partial agonist on the mu receptor and doesn’t really give any jollies.
Good analogies! I also work in a rural area and use farm analogies frequently. One of my favorites is how having poor functional reserve is like being an old farm truck. You might be fine for the day-to-day stuff like hauling hay bales out to the field, but if you hitch up a load and try to drive up the canyon you’re not going to make it.
Here is a longer version: https://medicineandfaith.com/2021/06/01/your-brain-is-an-old-truck/
These are clever ways to explain things. I recall my years of trying to teach biology in a community college. I found out the hard way that my students had not have chemistry, particularly organic chemistry, in high school. Some didn’t know what a vitamin, an enzyme, amino-acid or cell receptors are. They didn’t know what CO2 or H20 stood for. My first semester of teaching passed way over their heads. It got me thinking, how can these people seat in front of a doctor to discuss a medical problem, l decide over treatments? I have noticed that doctors these days avoid giving advice. It’s hard for people to make informed choices, when they don’t know some very basic things.