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LETTERS: Adrian Edwards Communicating risks through analogies BMJ 2003; 327: 749 [Full text]

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Analogy in medicine: Is it evidence based?

Amit Ghosh   (30 September 2003)

Analogy in medicine: Is it evidence based? 30 September 2003
Amit Ghosh, Assistant Professor Mayo Clinic Send response to journal: Re: Analogy in medicine: Is it evidence based?	I read Dr. Edwards complilation of analogies with great interest.Analogies though appealing to the intellect of the physician may prove to be bothersome and even scary to a patient. The analogy of a diabetic with complication and jumping from different levels of a building in particular maybe very distressing to patients. Most risks are partially modifiable and only few risks are completely modifiable. The development of complications despite the most astute management of diabetes remains a fact of the matter( i.e, development of nephropathy,etc. in the treatment arm of a protocol is less but never 0%). These analogies are highly subjective and are not evidence based. It adds a level of subjectivety to treatment in an era of evidence based practice. Also there can be several analogies for the same disease depending on which one appeals to the physicians more and may be more 'frightening.' One could apply the analogy to one self and see if one would truly accept the thruthfulness or accurateness of these analogies. In an era of practicing near exact science we risk in mingling literature with science, thereby making our practice all the less evidence based when we use analogies without due consideration on the effect it has on our patients. I have had patients complain about a surgeon who only spoke in analogies! Maybe we should check with our patients if they would like to listen to analogies before we start using them. Competing interests:   None declared