ABSTRACT
Analogies are the oldest recorded form of medical reasoning; an account of ‘how to recognize leprosy’ is given in Leviticus. Analogies include metaphors and resemblances or similes, in which noting that one thing is like something else increases appreciation for, or understanding of, that thing through cross mapping. Sometimes thought to be a ‘simple’ metaphor, a simile or resemblance is actually complex, and is the ground for the basic clinical reasoning process of experts – pattern recognition. Resemblances in medicine are most commonly employed in the ‘visual’ specialties – pathology, radiology and dermatology. Here, specimens, images and the expression of the body’s largest organ, the skin, afford symptoms as patterns that in turn realize ‘readings’ – such as a ‘raspberry tongue’ denoting a certain progression in the course of scarlet fever.
Resemblances based on foods are often thought of as ornamentation in medical education, and extensively archived without critical analysis. But, as illustrative examples of clinical reasoning, such similes are more complex and deserve greater critical attention and systematic mapping. For example, food analogies are culture specific, yet Western versions tend to dominate in medical education as a form of imperialism. Further, resemblances often present a troubling ethical dilemma. We are fascinated by, and then drawn to, the aesthetic of medical images as beautiful, even sublime; but behind these images are diseases, illnesses and individual suffering. The generation and use of resemblances is a reminder that medicine is both art and science, where a ‘feast’ of resemblances offers a poetics of clinical practice.
