A Cognitive Research on Doctor Metaphor and Doctor-Patient Relationship Metaphor

From the perspective of "conceptual metaphor" in cognitive linguistics, 11 kinds of doctor metaphors and 6 kinds of doctor-patient relationship metaphors are reached by a tentative study. Based on nearly 300 questionnaires and interviews with 20 doctors and patients, this paper discusses and analyzes: 1) the current situation of doctor-patient relationship; 2) the understanding of "doctor metaphor" and "doctor-patient relationship metaphor" from both perspectives of doctors and patients, and nds out the similarities and differences; 3) the collection of doctor's description of doctor occupation and patient's description of medical experience, and with the combination of 1) and 2), this paper suggests the measures to alleviate the medical disputes. Medical conict is a perpetual and intricate social issue, which involves doctor, patient, hospital, government and etc. It is not supposed to be solved in a short time, whereas requires the endeavor of generation after generation.


Introduction
Conceptual metaphor has been studied with different occupations. Kerr Inkson (2011) introduces nine kinds of metaphors of working lives for young people to have a better understanding about career.
Among the occupation metaphors, the metaphorical analysis of teachers' role stands out. Researches focus on teachers' recognition and development of the teaching process, teaching strategies and their professional roles. Bullough and Stokes (1994) analyzed personal teaching metaphors in preservice teacher education as a means for encouraging professional development. Zapata and Lacorte (2007) illustrated preservice and inservice instructors' metaphorical constructions of second language teachers. Lin et al. (2012) explored personal EFL teaching metaphors in pre-service teacher education.
However, doctor which is as essential as teacher is not widely studied from the perspective of metaphor, which embodies the research signi cance of the present paper. There are only few papers about doctor metaphor. Yang Hui et al. (2007) pointed out that metaphor on doctors, seeing doctors and hospital service of Chinese people are needed to study.
Additionally, there are papers on doctor's role. These papers, super cially, are not related to metaphor, but embody the concept of metaphor which can undoubtedly shed light on the research of doctor metaphor. Clandinin (2010) conducted survey to help develop doctor identity. Chen Xiaoyang and Yang Tongwei (2006) pointed out doctors play dual role in medical practice. Namely, doctors are not only patients' consultant, but also medical treatment supplier. Li Qiang and Han Wei (2002) illustrated that doctors' role varies in different medical modals.
There are merely several papers about doctor-patient relationship metaphor. Childress J. F. and Siegler M. (1984) concluded previous studies and summed up ve metaphor modals of doctor-patient relationships: parent-child, partnership, contractors, friendship and technician, while Rees et al. (2007) perceived doctorpatient relationships as war, hierarchy, doctor-centredness, market, machine and theatre by interviewing patients, medical students and medical educators. Beisecker A. E. and Beisecker T. D. (1993) compared paternalism and consumerism as the two kinds of metaphor modal for doctor-patient relationship. Rifkin (2009) pointed out doctor is a storyteller, and how doctor describe the illness will in uence how patient perceive his condition. Tomelleri (2012) conducted interview on physicians and nurses to nd out the metaphors used in the construction of the doctor's professional identity and in the de nition of his or her relationship with the patient.
Although few papers touches upon doctor-patient relationship metaphor, but fortunately, there are thousands of papers about doctor-patient relationship. Devereux (1992)  In general, there is little information available in literature about both doctor metaphor and doctor-patient relationship metaphor. In addition, most of the studies on doctor identity, doctor metaphor, doctor-patient relationship and metaphors of doctor-patient relationship fall on theoretical level. Therefore, it is necessary to promote the empirical research on it from both doctors' and patients' perspectives.

Research Questions and Hypotheses
The research questions are progressively advanced which are presented below: (1) What is the status quo of the relationship between doctor and patient in China?
(2) How do patients and doctors use metaphors to indicate the role of doctor and their relationships? What are the similarities and differences between their perceptions?
(3) What conclusion can be drawn and what's the enlightenment for easing tensions between doctors and patients?
Based on the research questions, we propose three hypotheses below: (1) Most of the doctor and patient subjects believe that their current relationship is not bad.
(2) As for similarities, the most welcomed doctor metaphor for doctors and patients is angel in white, and the least favored is killer or butcher metaphor; moreover, patients and doctors may both regard their relationship as partner, and the least embraced is foe metaphor. As for differences, most of the patients may perceive doctors as living god or expert. And most of doctors may view themselves as the health engineer or service provider.
(3) The disparity between their perception may suggest the problems in doctor-patient relationship.

Research Instruments
The research is conducted by semi-structured interview and questionnaire survey.

Questionnaire
The subjects are divided into doctors and patients. Note that doctors mentioned in the study include both doctors and nurses. Moreover, it is conducted by a ve-point Likert scale. And all the questionnaires will be handed out and collected in electronic version, which will simplify and facilitate the collecting procedure. What's more, the data can be processed automatically on the application of questionnaire collection. As for further analysis, SPSS and Python are optimal choices.
In the rst part, the design of personal information differs. As for doctors, gender, age, education background, working years and working department are considered. And the participants include doctors, nurses and medical technicians. As for patients, gender, age, education background and inpatient department are considered. In the second part, it is the body of the questionnaire that consists of interpretation on 11 doctor metaphors and 6 doctor-patient relationship metaphor, and this part is identical for doctors' questionnaire and patients'. In the last part, there are several semi-open questions and multiple choices for the participants, which can enrich the data analysis.

Semi-structured Interview
Among the four types of interview, semi-structured one is a better choice for this study. The questions are settled before the interview, but the interviewees can answer the designed questions with exibility. The questions for doctors and patients are identical:    Table 2 shows the distribution of working period, the green-hand takes up the majority. As for the working department and medical treating department, from Table 2 and Table 3, it is both medicine department and surgical department that dominate, which is quite reasonable, since where patients ood is where doctors are.

Interviewed Subjects
Page 6/35 Table 4 and Table 5 present the information of doctor and patient interviewees. There are 10 doctors and 10 patients respectively. They give their understandings on doctor metaphor, doctor-patient relationship metaphor and related questions.  The patient interviewees are randomly selected since nearly everyone has medical experience. There are ve males and another ve females. Their age ranges from 22 to 40, with degree varies from under bachelor degree to doctoral degree. Also, their practice department differs, and dental department dominates.

Data Collection and Analysis
The data is collected by questionnaire and semi-structured interview. As for the collection of questionnaire, altogether 200 questionnaires from the patient subjects and 100 questionnaires from the doctor subjects are received, among which 181 of the former and 82 of the latter are valid. In order to facilitate date collection, the questionnaires are given out in e-version in Wen Juan Xing that can collect and analyze the data automatically. To further analyze the data, rstly, we used python to depict the distribution of medical disputes in China in 2018 based on the data from the website of Yi Fa Hui. Then we also applied KMO test to calculate the reliability and validity of the questionnaire. Moreover, chi-square test is applied to verify the similarity on doctors' and patients' perception of doctor-patient relationship metaphor.
As for the collection of interview, altogether, we have 10 interviews with doctors and another 10 interviews with patients. The conversations with the interviewees are recorded by the voice recorder. Then we applied the application of Xun Fei Ting Jian to transfer the voice to text.

Research Reliability and Validity
Before conducting the questionnaire and the interview, we have done a pilot study at the hospital in Hubei Province, from which the questionnaire and the interview question have been optimized.

On Questionnaire
On the basis of the pilot study, rstly and primarily, more doctor metaphors as "living god", "lifeguard" and "killer" and doctor-patient relationship metaphors as "contractor" and "foe" are added. Theses complementary metaphors are given by the research subjects.
Secondly, the personal information has been improved either. As for the doctors' personal information, age under 18 is omitted because this age group is not quali ed as doctor. What's more, except for the xed four working department --Medicine Department, Surgical Department, Gynaecology Department and Paediatrics Department --we add another three: Infectious Disease Department, Technical Department and Logistics Department by the suggestion of a doctor interviewee. As for the patients' personal information, only Infectious Disease Department is added to medical department.   Table 6, which indicates the sampling is meritorious. All in all, the sample of the questionnaire is adequate.

On Interview
The interview questions have also been optimized. For instance, the original Question 2 is-what words would you use to describe a doctor? However, we found that some of the interviewees deviated the topic. They used some adjectives like "hardworking", "tough", "greedy" to depict the character of doctor. Thus we change "words" into "images", and add a hint followed the question-such as doctor is angel in white. Likewise, we also add a hint to Question 3 --such as doctor and patient are friend.
Furthermore, the initial Question 4 is-Have you experienced con icts with patients? Only to nd that some interviewees said they just have not experienced any con icts, which make this question meaningless. Therefore, we change it to "Have you experienced or heard about con icts with patients?" And we add a further question-Do you think who should be blame for?-which brings out more meaningful information.
Lastly, the original Question 5 is "How to improve doctor-patient relationship?", which can only have answers of doctors or patients respectively. Thus it is altered to "How to improve doctor-patient relationship from the perspective of both doctor and patient?" in a bid to acquire their answers toward each other.
Thanks to the pilot study, the design of the questionnaire and the interview questions are optimized which smooths the process of data collection and analysis. All experimental protocols were approved by our Hubei University of Technology and all methods were carried out in accordance with relevant guidelines and regulations, meanwhile, informed consent was obtained from all subjects and/or their legal guardian(s).

The Medical Issues in China
The key to any successful health care system is the recognition of the inseparable partnerships between the individual patient and their doctor (Margaret Turner, 2008). At rst, the survey on how the subjects (both doctors and patients) view the present relationship between doctors and patients is showed on Figure 1. As we can see, only 3% of them think the present situation is excellent, luckily, 26% of subjects believe it is good, and half is not bad. However, 21% of the subjects still believe the relationship is bad or even worse. In general, the current relationship between doctors and patients are not bad. Nevertheless, con icts are inevitable.
Another gure below depicts medical disputes in China in 2018. Figure 2 is the medical disputes in China in 2018. The data is quoted from Yi Fa Hui, a professional team focusing on medical legal practice in China. The gure they reached is by the advanced retrieval of alpha case database, the overall data statistics of the medical damage liability cases from January 1, 2018 to December 31, 2018. But the gure is generated by Python by the author. Note that the darker the color is, the more disputes the province has.
It is apparent that medical disputes in southeast China is much more severe than northwest area, which may be closely related to the population distribution. From the perspective of geographical distribution, the top ve of medical disputes fall on Shandong Province, Jiangsu Province, Hunan Province, Hubei Province, and Anhui Province, among which the number of medical cases in Shandong Province approaches 900. At the same time, according to the data from Yi Fa Hui, the number of medical disputes in Hunan Province and Hubei Province increased compared with that in 2017, and the number of medical disputes accepted in 2018 ranked third and fourth respectively in the country, based on which and the survey condition, the study mainly covers three provinces: Hubei, Anhui and Jiangxi.

The Description of DM and DPRM
Based on the pilot study and papers collected, 11 doctor metaphors (short for DM) and 6 doctor-patient relationship metaphors (short for DPRM) are reached. Table 7 is the doctor metaphor and the comprehension of each: angles in white, living god, woodpecker, service provider, health engineer, artist, lifeguard, health goalkeeper, expert, butcher and killer. The comprehension part is also given in the questionnaire in a bid to facilitate understanding.

Angle in white
A doctor is like an angel whose duty is to help people in need.

Living god
Doctors are like God, coming to save the world. Especially when they help patients who have been tortured by disease for many years.
Woodpecker The woodpecker exterminates the pests under the bark and "cures" the tree; the doctor treats people like the woodpecker.

Service provider
Patients are consumers, while doctors are providers of medical information and services.

Health engineer
Taking the analogy that doctors are engineers of our health.
Artist Doctors work creatively, especially plastic surgeons.

Lifeguard
Doctors are like lifeguards, protecting people's health.

Health goalkeeper
Like football goalkeepers, doctors are the nal wall to defense against disease.

Expert
Doctors are experts in medical eld.
Butcher A surgeon with a scalpel is like a butcher in a slaughterhouse.

Killer
Few doctors are merciless who don't save the patient heart and soul, like ruthless killers.
According to Lakoff (1980), conceptual metaphor can be classi ed into three groups: orientational metaphor, ontological metaphor and structural metaphor. And the doctor metaphor, doctor-patient relationship metaphor analyzed in the thesis are structural metaphors. Taking the doctor metaphor "angel in white" as an example, it presents the systematicity of the doctor metaphor and shows the reason why we perceive doctor as angel in white. As is showed in Figure 3, rst of all, doctors usually wear white uniform and angels wear white dress which produces visual consistency. Then in our common sense, the kindness and virtue is doctors' initial quality, so do angels. Next, the duty of doctor is to cure patients, and angel's mission is to serve people. In addition, the initial quality of them is kind though, there are bad doctors who are greedy and money-centered, and also there are fallen angels who become evils. All the doctor metaphors can be analyzed this way; thus no more details of other doctor metaphors are presented.
Likewise, Table 8 is the doctor-patient relationship metaphor and its explanation: parent-child, partner, contractor, friend, technician-machine and foe. Furthermore, the feature, situation where it happens and de ciencies of each metaphor has been illustrated in Table 9.

Parentschild
When the patient is seriously ill or even unconscious, like parents take care of their children, the doctor looks after the patient considerately.

Partner
Patients and doctors are partners, and patients' health is the common pursuit of both doctors and patients.

Contractor
The doctor and the patient seem to have signed a contract. They are equal and independent.

Friend
In the long-term process of getting along (especially for inpatients), doctors and patients trust each other and gradually establish friendship.

Technicianmachine
If a doctor is compared to a technician, then a patient is a machine. When a machine needs to be repaired, the treatment process is like a machine repairing process.

Foe
Because of the failure of treatment, sometimes the doctor-patient relationship will fall apart, when the two sides are in a state of hostility.
The doctor-patient relationship metaphor can be classi ed into three groups: intimates, neutral and strangers. Parents-child and friends fall on the intimates group, partner and contractor belong to neutral group, technician-machine and stranger fall on the last stranger group. Table 9 gives an overall understanding of each metaphor. First, it describes positive side of each metaphor, except the foe metaphor which means the relationship of the two sides breaks up. Then, the table presents the situation where each metaphor is prominent, while "contractor" and "friend" have no speci c situation because it may happen in any medical practice. And last part is the de ciencies, which points out the negative side.

Doctors' Interpretations
Based on the statistics and information from the questionnaires and interviews collected. The doctors' interpretations on DM (doctor metaphor), DPRM (doctor-patient relationship metaphor) and doctor occupation are analyzed below.

On Doctor Metaphor
According to the 82 questionnaires, how doctors perceive doctor metaphor is presented in Figure 4. Within the 11 doctor metaphors, 7 of which are embraced by the majority, since more than half subjects chose "agree" or "fully agree" with the metaphor. And the 7 doctor metaphor are "angle in white", "woodpecker", "health engineer", "artist", "life guard", "health goalkeeper" and "expert", which are all positive evaluation, because the overwhelming majority of doctors acknowledge the doctor occupation.
The most acceptable doctor metaphor is "life guard"(supported by 90% subjects), which is beyond expectation. Also, it can be seen in the interview (Doctor 8).
The doctor is like a lifeguard, and illness is like drowning. When you are ghting a disease in the river, the doctor will give you a helping hand and save you out of the drowning water. (Doctor 8) Likewise, metaphors as "angel in white", "woodpecker", "health engineer", "health goalkeeper", and "expert" are supported by over 60% subjects. For instance, "angel in white" has been mentioned by several doctors.
Doctors are angel in white, because they wear white uniform and save people in need. (Doctor 3) I think it's of course the angel in white. For patients, when they are sick, they will think of doctors at the moment, so for them, when they encounter these things, doctors can help them a lot. And as doctors, they do their best to help patients. So I think the angel in white is the best way to describe doctors. (Doctor 4) Furthermore, most of doctor subjects do not agree doctors are "butcher" and "killer". Nevertheless, 8% subjects agree with it, so how come doctors view themselves as butcher or killer? Probably, they have experienced or have heard about some case where doctors are relentless killer who haven't give timely treatment to the poor patients. Moreover, half of the subjects view doctor as "living god" and "artist", while another half are not sure about and disagree with it.
Lastly, except for the doctor metaphors mentioned above, doctor interviewees have other different ones, some of which indirectly convey their dissatisfaction with patients.
Doctors are two faced people. There is a classic saying, "when in SARS, doctors are angels in white. After SARS, doctors are ruthless wolves."(Doctor 1) Doctor is a big tree to protect patients from the strong wind and rain. (Doctor 5)

On Doctor-patient Relationship Metaphor
There are altogether 6 doctor-patient relationship metaphors: parent-child, partner, contractor, friend, technician-machine and foe, among which the partner metaphor is most favored and the foe metaphor is least supported.
Among the six metaphors, please see gure 5, "partner" and "friend" are accepted by the majority, with over 80% doctors agree or fully agree with the partner metaphor and about 70% agree or fully agree with the friend metaphor. Surprisingly, no one fully disagrees with the two metaphors, which shows that, from doctors' perspective, the relationship between doctors and patients are not bad.
Moreover, most of the subjects (over 60%) do not consider doctor and patient are foes. However, it's noteworthy that 20% of the doctors agree or fully agree with the foe metaphor, in other words, this group may have unpleasant medical practice and they hold pessimistic view toward doctor-patient relationship.
Furthermore, besides the foe metaphor, above 70% doctors are not certain or disagree with the "technicianmachine" metaphor, that is to say, they do not view the patient as machine, and themselves as technician. Nowadays, with the abundant material, people focus more on humanity. Doctors inject more care and love in their work. For instance, there are approximately 60% of doctors supporting "parent-child" metaphor, when the patient is seriously ill or even unconscious, like parents take care of their children, the doctor looks after the patient considerately.
Moreover, most of the doctors support the "contractor" metaphor. It means that doctor and the patient seem to have signed an invisible contract. Under this metaphor, they are equal and independent. And it has also shown in the interview.
I think the relationship between doctors and patients is contractor, that is the doctor provide with medical service, paid by the patient. But both sides have obligations and rights. Doctors need to listen to patients' demands, and patients should also obey their instructions. (Doctor 3) Additionally, besides these metaphors mentioned in the questionnaire, the doctor interviewees provide different doctor-patient relationship metaphors.
Doctors and patients are teachers and students, where doctors play the leading role, patients play the main role, and they cooperate with each other. (Doctor 4) I think doctor and patient are sh and water. Fish cannot live without water. Then water can also let the sh swim freely.
To sum up, according to the supporting rate of "agree" and "fully agree", the ranking of the doctor-patient relationship metaphor from doctors' perspective is: partner friend contractor parent-child technicianmachine foe.

On Doctor Occupation
The words cloud below, Figure 6, is how doctors perceive their occupation, and they are collected by the questionnaires. Altogether, 40 distinctive words are selected and there is no limitation on the choice of part of speech. The font size of each word varies according to its frequency.
It is known that doctors' work is closely related to the patients' precious lives. Living in the terror of making mistakes, the doctors are under great pressure. The idiom in the center " " (tread as if on thin ice), reappeared 7 times, also words as " (cautious)", " (panic)" and " (fear)" imply that doctors should be extremely careful with their work, otherwise, they may make mistakes and be criticized by their patients, leaders, especially the public.
Also, the intense work not only burdens them with stress, but also drains them. Words like " (hard)", " (tough)", " (exhausted)", "24 (24 hours)", " (night shift)", " (always online)" show the hardship being a doctor. Doctors pass out in the operation room makes the headline from time to time. There is even some news reported doctors sacri ce their heath even dies in order to save patients' lives.
Nevertheless, some words as " (happiness)", " (initial belief)", " (faith)", " (devoted)", " (value)" convey the positive energy. Lately, for example, the novel coronavirus broke out unexpectedly, and in the critical moment to struggle with the virus, it is doctors who do the opposite and rush to danger to save patients in risk.
Above all, doctors bear huge pressure and workload though, they still hold optimistic view and serve heart and soul for the patients.

Patients' Interpretations
As the counterpart of the section above, this section analyzes the patients' interpretations on DM, DPRM and their medical experiences.

On Doctor Metaphor
The Chinese language reveals the honor doctors once enjoyed. Chinese call doctors "Dai Fu" (which also means scholar-bureaucrats) and "Xian Sheng" (master); medicine is seen as protective and authoritive The doctor is a lifeguard. When you are surrounded by disease and helpless, doctor is the person who reaches out to you for help. Sometimes things happen suddenly. At this time, the doctor is like a lifeguard, saving people in the water and re. (Patient 2) Second, the metaphor "service provider" tops the second, which differs from doctors' perception, since "service provider" ranks eighth. it also has been mentioned in the interview with patients (Patient 4).
Compared to life guard, this metaphor is more objective.
Doctors are providers of medical services. Doctors and patients are service provider and the service receiver. (Patient 4) Moreover, metaphors as "expert", "health goalkeeper", "health engineer", "woodpecker" and "angel in white" are all welcomed. Note that angel in white is most frequently mentioned by both doctor and patient interviewees, but it is not the No. Additionally, although "living god" and "artist" are accepted by half of the subjects, but the other half are not sure or even disagree about it. In the past, doctors are widely respected and has high social status and prestige, the description of doctor like "living god" is quite common, but in the modern society, the concept that "everyone is born equally" is widely valued, doctor is not dei ed as before anymore. Instead, they are viewed as ordinary person like everyone else.
Doctors are also ordinary people. I think ordinary people are more suitable for them. (Patient 5) The analysis of the patients' interpretation on doctor metaphor is in a static way. Actually, the way they view doctor changes over time. According to Jinya Cao (2014), over time, there have been major changes in the role of doctors and their perception by patients: from god, emperor, and father to neighbour and friend, to merchant, and in some patients' minds even to greedy liar.
Recently, since the breakout of COVID-19 at the beginning of 2020, doctors from all over the world join the invisible war. They work around the clock, tortured by the heavy protective suits, forced to separate with their beloved ones, and even risk their lives. Everyone, especially the patients, change their attitudes toward doctors. They honor the doctors as great heroes who save the world. Since the survey has been already done in 2019, it is impossible to conduct another one because of the limited time and the peculiar situation.
Nevertheless, we re-interview one of the patient subjects who originally complained about the doctors.
During the ght against the coronovirus, doctors are de nitely the heroes. They are so respectable that I want to take back what I have said before. And I think such changing attitude to doctors will last for a long time. I didn't think doctors were that important before, but now I think they are. I saw many positive examples reported on Weibo. Some doctors don't have protective suits, so they put les on them. I used to think doctors were arrogant, but now I think most doctors are responsible. For example, a friend of mine is also a nurse. Even though there is a lot of pressure from the coronovirus, she is still stick to her position. (Patient 2) In short, "lifeguard" is most supported, while "killer" and "butcher" are most disapproved. Moreover, the perception of doctors could be an important reason for doctor-patient con ict, and doctors should be aware of it. More importantly, patients' interpretations are dynamic. Especially in the peculiar time as the ghting against the horrible virus.

On Doctor-patient Relationship Metaphor
To begin with, see gure 8, according to the supporting rate of "agree" and "fully agree", the ranking is: partner friend contractor parent-child technician-machine foe, which is exactly the same as doctor's perception above. Since patients and doctors have quite similar understandings on doctor-patient relationship metaphor, this part doesn't give no more details, and their comparison is presented later.
To proceed, except for the metaphors mentioned in the questionnaire, there are other different perceptions provided by the subjects. Here is a patient who voices for the doctor (Patient 5).
Doctors are also ordinary people. I think the description "ordinary people" are more suitable for them. For example, if you can't afford for the medical treatment, it's normal that they won't give you medical service. It's like if you can't pay for the tuition fees, the school won't start classes for you. I think it's all up to this mechanism, which is out of doctors' control. Many people may have delicate heart, and they may feel the doctor is relentless if they don't treat patients without enough money, but I think it is quite understandable. (Patient 5) Moreover, a subject gave another novel metaphor. She views the relationship as "frenemy", which is the blend of "friend" and "enemy". The explanation is presented below (Patient 6). Doctor and patient are frenemy. If the process of medical treatment is smooth, they will become friends. If it is not smooth or even triggers con icts, they may become enemies. (Patient 6) To sum up, since the "partner" metaphor and the "friend" metaphor top the ranking, it implies that patients believe or unconsciously hold positive attitude toward the relationship of doctor and patient.

On Medical Experience
The words cloud below, gure 9, is patients' description of their medical experience, which are also collected by the questionnaires. The chosen number (40) is the same as doctor's perception on doctor occupation. In general, it can be divided into three groups: positive, neutral and negative.
Words like " (pleasant)", " (secure)", " (smooth)" fall into the positive group, which shows that the current medical situation is quite nervous though, some of the patients still have pleasant medical practice. The second group holds neutral view, and words as " (not bad)", " (nothing particular)", " (no big deal)" suggest that the patients does not have any special feeling toward medical experience.
The negative group dominates the word cloud, which is far more than the positive one. Words as " (crowded)", " (overcrowded)", " (time-consuming)" reveal the shortage of doctor and the inappropriate distribution of medical resources. Moreover, there are some adjectives: " (impatient)", " (indifferent)", " (cold)", " (machine-like)" that show the bad attitude of doctors which serve as the triggers of medical con icts. In addition, some words convey patients feeling when in hospital, such as " (gloomy)", " (terrible)", " (nervous)", " (passive)", which are thought-provoking for doctors, if they are patients, what expectations they will have for doctors?
Although the medical experience varies from people to people, but it can be concluded from the word cloud that most of patients have unpleasant experience in hospital.

Comparison of Their Interpretations
After doing survey among 181 patients (mainly from Anhui and Hubei province) and 82 doctors (mainly from medical student in Nanchang university and doctors in a level 2 hospital in Hubei province), similarities and differences on the understanding of doctor metaphor and doctor-patient relationship metaphor between doctor and patient participants are reached below.

Similarities
Through comparative analysis, it has three main similarities of perception on doctor metaphor.
First of all, both doctor and patient participants consider "life guard" as the most favorable doctor metaphor which is unexpected. Compared to other metaphors, "doctor" has a lot in common with "life guard", the most distinct similarity of which is they help people in need, especially saving their lives. Also, the two occupations are quite painstaking. They have to be alert all the time, and the intensive work always keep them busy and exhausted. In addition, they are both risky. "life guard" and "doctor" shoulder the responsibility to help others, while they fail to save someone, they may be extremely disappointed and criticized by the public. Furthermore, sometimes they even have to risk their own life to ful ll the task, for example, when the current is turbulent, or the disease is infectious. It can be proved in the interview below: Doctors like those rst responders, such as re ghters, policeman, lifeguard, whose job is to rush through danger without hesitation. (Patient 9) Although people don't view doctor is as risky as policeman or lifeguard, I truly feel this occupation is risky and more dangerous than them. We not only ght with all kinds of disease, but also ght with the patients and the public (sigh). (Doctor7) Secondly, to both sides, doctor metaphor as "woodpecker", "health engineer", "health goalkeeper", "expert" and "angel in white" are welcomed by over 70 percent of subjects. It is worth mentioning that the former three metaphors slightly outnumber "expert" and "angel in white" which are more common. Nevertheless, "angel in white" is frequently mentioned by the interviewees.
I still prefer the old saying "angel in white". For patients, as long as the rst reaction is sick, they will think of doctors, so for them, when they encounter these things, doctors can help them a lot. Thirdly, over 80 percent of the participants disagree with the "killer" and "butcher" metaphor, which is as expected. Nevertheless, there are approximately 20 percent fully agree or agree with it, which is quite thought-provoking. Moreover, compared to doctors' perception, a little more patient subjects support this metaphor. It may be closely related to the medical con icts these years.
Fourthly, doctors' and patients' understandings on doctor-patient relationship metaphor are quite similar in general. Firstly, according to the supporting rate of "agree" and "fully agree", please see Table 10, the ranking of patient's perception is exactly the same as doctor's: partner friend contractor parentchild technician-machine foe.   that media ranks second. In order to catch readers' eyeballs, all kinds of media incline to cover negative news on medical disputes, and they even exaggerate the reality. Therefore, media should cover more positive relationship between doctors and patients.
Above all, doctors and patients have large in common on the understanding of doctor metaphor and doctor-patient relationship metaphor, especially on the later one. Also, based on the two multiple-choice questions discussed above, they reach agreement once again, which sheds light on the solution to intense relationship between some doctors and patients.

Differences
By collecting the data in the questionnaire, the rank of 11 doctor metaphors in doctor's and patient's perception is show in Table 11 below. By conducting contrastive analysis, there are two main differences on perception of doctor metaphor.
Firstly, the proportion on "service provider" differs. Among the 11 doctor metaphors, "service provider" ranks eighth in doctor's interpretation, whereas it tops second in patients list, which supported by more than 80 percent patient subjects. The contradicts can be seen on the selected interview below.
Doctor is not like waiters who can be ordered about. Everyone has dignity, so do our doctors. (Doctor 2) Doctors are providers of medical services. Doctors and patients are service provider and the service receiver.

(Patient 4)
But an interviewee from the Medical Ethic O ce voice support for the "service provider" metaphor.
I think a good doctor is the one who can provide medical services and have "temperature". We often say that doctors are not waiters, hospitals are not restaurants, but in fact, medical treatment also is a kind of service, just on the technical level. (Doctor 10) The difference on the choice of "service provider" indicates that in patients' eyes, medical treatment is a kind of service, so it is reasonable to conclude that doctor is "service provider". However, doctor subjects don not agree with it. Based on the fact that doctor metaphor "service provider" ranks eighth, it is apparent that they do not view themselves as "service provider", because it undervalues their occupation. Therefore, the positive and superior metaphor as "life guard" and "health engineer" top their choice.
Secondly, the proportion on "living god" and "artist" differs. Generally speaking, the two metaphors are positive and supportive. Over 60 percent doctors view themselves as "living god", and over 70 percent as "artist", which reveals the self-identi cation and self-a rmation of doctors. However, only half of patient participant support these two doctor metaphors. The perception gap undoubtedly re ects some problems.
For instance, some doctors hold arrogant attitude and think they are superior to the patients.
Thirdly, on the basis of the data from questionnaire, it suggests that doctors and patients have great differences on the interpretation on their relationship. In general, patients' view on doctor-patient relationship is positive than doctors'. As it can be seen on Figure 11, on the one hand, the proportion on "excellent" (2.44% / 2.76%) and "not bad" (51.22% / 48.62%) is quite close. On the other hand, over 40% of patients agree that the relationship is good, whereas only 10% of doctors believe so. Moreover, merely 7% of patients think the relationship between doctors and patients is bad or worse. However, it is noteworthy that about 34% of doctors believe their relationship is bad or even worse.
Therefore, it is quite thought-provoking that the reason why doctors is more pessimistic toward the doctorpatient relationship than patients. In a bid to gure out the reason, we tracked the questionnaire and interviewed one of the doctor subjects on the phone. He gave two reasons. For one thing, more and more news on hurting or even killing doctors are frequently reported, which threatens doctors and leaves them a bad impression on doctor-patient relationship. For another, the reason why patients hold positive view is that they are facing one doctor at a time, while doctors have to treat plenty of patients every day, which is easier for them to suffer medical con icts. It means that more doctors believe that doctors and patients are equally participate the medical treatment, while patients think it is doctors who play instructive role, and patients' role is to cooperate with doctors.
All in all, doctors and patients have a lot of discrepancies on the understanding of doctor metaphor, doctorpatient relationship and the mode of it. Since it is sensible that doctors prone to describe themselves with positive images, while patients are more objective. But it is noteworthy that patients hold more positive attitude toward doctor-patient relationship than doctors. However, surprisingly, they are consistent in the doctor-patient relationship metaphor, especially on the ranking of six different metaphors.

Measures to Improve Doctor-patient Relationships
Base on the analysis of doctors' and patients' perceptions of DM and DPRM, there are some related measures below. Besides, efforts from government and medical school are also mentioned.

Efforts of Doctors and Patients
First, when doctors choose doctor metaphor, they tend to describe themselves with positive words. Such as "artist", "living god", "expert", etc. whereas the patient's perspective is more objective. Through the differences in the selection of the above "service providers", it can be seen that doctors have strong selfawareness (even with pride and arrogance). Through the author's own medical experience and observation during the hospital interview, the doctors are impatient with patients now and then, sometimes doctors even shout at the poor patients. But doctors are also ordinary people (Patient 5), so doctors should put down their attitude and communicate with patients more equally and patiently.
Doctors are also ordinary people. I think ordinary people are more suitable for them. (Patient 5) Second, "killer" and "butcher" are at the end of selection, but nearly 20% of patients still choose these two doctor metaphor. From the perspective of doctors, the medical ethics and professional skill of some doctors remain to be improved. In recent years, the construction of medical ethics has been widely concerned. In an interview with a manager of medical ethics o ce, she told us: The competition in the medical market is quite erce. For example, our hospital is the best hospital here, but we have Chinese medicine hospital and several private hospitals. In the face of our hospital, a strong competitor, how do they survive The key is to improve the quality of medical services and strengthen the construction of medical ethics. (Doctor 10) Third, it can be seen from the doctor's description of his medical experience that this profession is quite tough and risky. Therefore, patients should be more concerned and understandable. We do know that it's not easy to be a responsible doctor. In recent years, the news that doctors passed out on the operating or even lost their lives due to overtime work. Doctors recognized as "lifeguards" should be valued, understood and cared by the society.
Fourth, as can be seen from the previous description of patients' medical experience, the process of medical treatment is tedious, time-consuming and crowded. It also has been frequently mentioned in the Similar view has also been pointed out by Lin Zhao et al. (2014). On the one hand, the government should optimize the allocation of medical resources, improve current social insurance systems, continue to rein back drug prices, protect patients' rights, improve medical technology and the quality of service, and take effective measures to guide patients to use adequate channels for complaint. On the other hand, medical knowledge should be made available to the community to improve people's understanding of the risks of medical practice. Chinese media should assume their social responsibility.
Fourth, rational and patient-oriented medical education cannot be ignored. According to an editorial in The Lancet (2014), Medical education can certainly do more to shape a solution. With the exception of elite schools such as the Peking University Health Sciences Center, there is little attention to the humanities, ethics, the social context of illness, or practical training in communication and con ict resolution. One of the questionnaire subjects, the graduate medical students wrote that: It's true that we medical students are well taught on dealing with various diseases, but we are not taught how to be a good doctor, say, how to get along with patients, let alone how to tackle con icts with them.
After all, salaries for doctors is based on quantity of patients seen, investigations ordered, and drugs prescribed, rather than quality of diagnosis, treatment, and care. Thus, it is de nitely necessary that medical students should have moral guidance before they step into the occupation.
Last but not least, as it is shown in gure 10, according to the choice of who should be to blame on medical disputes, media ranks second, which means media also play an essential role in doctor-patient relationship. A doctor in the interview give a case she encountered: I think negative media reports can also lead to medical con icts. In order to gain popularity and attract readers, some unfriendly media tend to report various medical con icts, sometimes even exaggerate or distort the facts. Such negative reports will have a very bad impact on patients. For example, there was a time when the media was full of reports of medical con icts, including the news that patients fought against doctors and even stabbed doctors with knives. Once our department came a middle-aged patient, his attitude was very arrogant. He said in a threatening tone that he had read the news that the patient killed the doctor, thus we should provide him with considerate health care. In fact, our doctors are really helpless and have no alternative but to give him medical treatment. (Doctor 9) Therefore, media ought to abide by professional ethics, and stop covering reports that do not conform to the facts. Also, some commendable case between doctors and patients should be known by the public, which can have a positive guidance to society.
Above all, there is an urgent need for patients, doctors, government, medical schools and media to work together, mutually respecting and trusting each other. Efforts of these groups alone has not and will not resolve the problem. As the old saying goes, many hands make light work.

Conclusion
Based on the comparative analysis of doctors' and patients' perception of doctor metaphor and doctorpatient relationship metaphor, the paper attempts to gure out the similarities and differences between their interpretations and suggest some relevant measures to improve their relationship.
First, in general, from the analysis above-mentioned, it indicates that the current relationship between doctors and patients are not bad. Nevertheless, con icts are inevitable. Hunan, Shandong and Jiangsu province have high frequency in medical con icts in 2018. Furthermore, it is noteworthy that doctor metaphors like "killer" and "butcher", and doctor-patient relationship metaphor as "foe" have been chosen by 20 percent of the participants respectively.
Second, doctors and patients have a lot of discrepancies on doctor metaphor, but they are consistent in the doctor-patient relationship metaphor, which is against the hypothesis. But within the hypothesis, both doctors and patients view the doctor-patient relationship as partner, since it tops NO. 1 on their choice. And the least embraced is foe metaphor. Moreover, from the patients' perspective, the most favored doctor metaphor is not "angel in white", and in doctors' view, the most embraced doctor metaphor is not "expert". Surprisingly, the top doctor metaphor is "lifeguard", which is also beyond the hypothesis. Furthermore, most doctors tend to choose positive doctor metaphor, such as "lifeguard", "health engineer", "artist", "living god", etc. In contrast, patients' choice is more objective. It is worth mentioning that doctors' metaphor "service provider", which tops second on patients' choice, while ranks eighth on doctors', which reveals doctors' attitude that they do not agree that they are service provider as waiters.
Third, according to the doctor's description of doctor occupation, negative words like "exhausted", "panic" dominate, which remind patients that they should know the hardship as a doctor, and try to stand in their shoes and be more understandable. In addition, according to the patient's description of medical experience, the process of medical treatment is "time-consuming" and "tedious", and some doctors are "indifferent" and "arrogant", so the doctors should be more patient and give necessary mental support, like using some tender words. Also medical and health system should make efforts to modernize and simplify medical treatment.
Fourth, besides the effort of doctors and patients. Government should optimize the relevant medical policies which can truly bene t the patients. Also, the crucial role of medical education is always neglected.
Since medical students ought to not only be equipped with professional skills, but also how to get along well with patients. In other words, they should learn how to treat patients physically and mentally.
In short, the disparity of doctors' and patients' perception do indicate the problems in their relationship. And the improvement of the relationship between doctors and patients should involve the joint effort of different sides. We believe that the road to excellent relationship is full of twists and turns, but the future is looking promising.
Status Quo of Doctor-patient Relationship by the Subjects Doctors' and Patients' Interpretation on Doctor-patient Relationship Mode