Figurative fault lines in Malaysian healthcare: a cognitive-anthropological framework for multicultural doctor–patient communication.

Effective patient care often hinges on mutual understanding, a goal frequently undermined by ethnic and cultural diversity in contexts like Malaysia, where deeper cognitive and cultural mechanisms shape how illness is conceptualised. Addressing this challenge requires moving beyond general cultural awareness. This paper introduces the Conceptual-Anthropological Framework (CAF), an interdisciplinary model integrating Conceptual Metaphor Theory (CMT) and Explanatory Models (EMs) to systematically analyse miscommunication rooted in figurative language. CAF identifies Figurative Fault Lines as specific sites where patients’ culturally anchored metaphors (e.g., illness as a 'curse' or 'bad wind') clash with biomedical frames, resulting in Metaphorical Clash—a core mechanism that leads to communication breakdown and non-adherence. The framework reframes traditional cultural competence as Figurative Competence: a dynamic, interpretive practice that trains clinicians to recognise, interpret, and respond sensitively to metaphors, using strategies such as metaphorical bridging. By linking micro-linguistic analysis with anthropological depth, CAF offers a comprehensive theoretical and practical tool for empirical research and pedagogical reform in pluralistic societies.