“Doctor, I hate to tell you this but that shelf is definitely not made of wood,” my patient gently chided me as I knocked on a plastic piece of shelving.
“I know … but you get the point,” I replied with a small laugh.
The Mythic Mind
Superstitions and mythology are integral to the human experience. Even though we associate them with folklore or pseudoscience, both are, at their core, systems to organize knowledge and meaning.1 Mythology attempts to explain uncertainty within complex phenomena, and superstitions aim to exert some degree of control over the inherently uncontrollable. Together, they help entire societies make sense of complex, and often contradictory, realities.2 Even when there is no empiric justification of behaviors, they have significant psychological resonance and, thus, carry meaning in and of themselves.3
In medicine, we are taught to prize objectivity and discard superstition as antithetical to science. Yet this is a misleading dichotomy. Even our most rigorous scientific theories rest on a scaffolding of metaphors, narratives and deeply held beliefs.
As anyone who has written a scientific article may be aware, if you go through citations and see where the evidence originated, chances are you will find the genesis of many of our immunological paradigms within moldy, century-old manuscripts with questionable methodologies. Yet we accept these ancient assertions as truths.
This isn’t to throw shade at our scientific methods. Rather, it’s to show the vital role of myth making and superstitions. After all, superstitions aren’t just artifacts of outdated worldviews; they are practical tools for navigating uncertainty. They fill the spaces between what we know, what we fear, what we predict and what we cannot control. For clinicians dealing with diseases as enigmatic as lupus or vasculitis, it’s only natural that we, too, reach for something—in this case, wooden objects—as we grasp for certainty.
The Immune System as Saga
In my opinion, immunology is uniquely prone to mythologization. If you open a textbook of immunology, there are going to be times it reads like an old Norse saga—great, endless battles waged between sentinels and invaders, powerful weapons like NETs (neutrophil extracellular traps) being deployed with dramatic flair, encoded messages carried across great distances via ligand-receptor interactions and so much more. Betrayals (autoimmunity), exiles (clonal deletion) and heroic reinforcements (memory cells) are waiting for their calls to action.
It’s not a stretch to say the metaphors of mythology are baked into our immunological discourse. Even many of our molecules are named after gods and heroes: Janus-associated kinases and the transcription factor Helios are two examples. These nods to mythic characters seem particularly fitting given how these molecules are both invisible, yet extraordinarily potent.
I should reiterate that this metaphorical richness is not a flaw in our understanding. Narrations help us teach, learn and fundamentally empathize. This mythology reminds us that every immunologic interaction is a unique drama in miniature. Like any good saga, we have space to reimagine and reinterpret as we gather newer information. And, perhaps most tantalizing, it brings a sense of curiosity and wonder that within each of us is a saga waiting to be heard.
Why We Tell These Stories
Mythology and superstition serve other purposes too, beyond explaining the unknown. Even in places where we have a decent understanding, we still generate metaphors, narratives and stories. When we talk about “angry” joints, it’s not necessarily that we don’t know about the broad contours of inflammation. Rather, it’s just more poetic to characterize a joint as having emotion. Similarly, when we discuss immunological “tolerance,” we’re developing a story that places a societal value in the context of our own identities.
To put it another way, when I knock on wood in the clinic, I’m only figuratively invoking an ancient superstition about spirits residing in trees to protect us from misfortune. I don’t believe literally that a spirit will come out of the plastic shelving and protect my patient and me. The act of knocking on wood is storytelling, a shorthand to demonstrate solidarity in the face of disease. It also serves as a way to bridge the gap between rationality and ritual. In that gray area, meaning can emerge that transcends conversation.
Incidentally, there’s also something poetic in using a gesture tied to ancient forest spirits to talk about the immune system. Like trees, our immune responses are rooted, branching and interconnected. Like spirits, they are invisible, powerful and equally capable of harm and healing. Sometimes, the old myths find surprising resonance in modern medicine.
Inherited Behaviors in Evidence-Based Medicine
Similarly, superstitions and mythologies are intrinsically tied to ritualistic behavior in our clinics. Until extremely recently—during the COVID-19 pandemic—we’ve donned white coats, not because they’re hygienic, but simply because they’re iconic of our profession.4 We write our notes in a stylized manner, not only for communication and billing, but also out of respect for tradition.5 So many elements of the physical examination have no empiric basis, but are still expected as part of the clinical encounter.6
Beyond these visual cues, our spoken language is highly ritualistic in clinic. Patterns of fever classically described as “quotidian” or “tertian” seem anachronistic with greater use of pyretics, yet are still found in articles and textbooks. More commonly in our clinics, we speak of “flares” as if our diseases are crackling fires with fuel and smoke, and “attacks” as if there is a hidden invader intent on causing harm. And of course, then there are the words left unsaid, like the five-letter “Q-word” describing the opposite of noise, when we are on consults, and activity seems a little lower than usual. These are all examples of mythic and ritualistic practices that persist in our modern era.
Likewise, we base many of our more modern clinical practices on assumptions received from authority. The idea that a negative ANA is somehow protective from lupus, the reluctance to contextualize and individualize clinical guidelines, and the use of classification criteria for diagnosis are examples of how we create and perpetuate assumptions based on authority. Admittedly, some of these tendencies can prove useful, but many need to be periodically questioned and, if necessary, unlearned.
An argument can be, and has been, made that all of medicine should be evidence based, but if we stripped all of these rituals, superstitions and myths away from medicine, we would feel so disjointed from our proud traditions, and our patients would be much more disoriented in terms of what to expect.
A Gesture of Humility
The more I think about it, knocking on wood is more than a superfluous throwaway gesture. It’s a signal to the patient and a reminder to myself to engage in humility. Every day, we walk a very delicate line between offering reassurance and acknowledging risk. Contrary to common belief, communication in medicine is not just about clarity. It’s also about managing expectations and about uncertainty. A gesture like knocking on wood communicates this ambiguity in a way we simply cannot do with words.
It also meets patients on common cultural ground. Many patients, especially those from traditions that value such symbolic acts, intuitively understand what I mean when I knock. In the right context, it tells them, “I hope this continues,” without pretending to guarantee it. It invites hope without hubris. It shows that I, too, live in a world where the future is completely unknown and that I am willing to be flexible when it comes to my own beliefs.
Knocking on wood also serves to educate patients about something deeper within the philosophy of science. Although we often think of uncertainty as a failure of science, it can be just as much a foundation for connection because patients and clinicians co-inhabit that vulnerable space of uncertainty. By becoming allies in this uncertain space, we humanize ourselves as scientists and clinicians.
The Power of Belief in a Polarized Age
So where does all of this bring us? Needless to say, we live in a very strange time. Beliefs are hardening in ways that we could not have imagined even a decade ago. Faith, myth and medicine sometimes feel like they are at odds. In this context, it is tempting to look down upon others for the strong beliefs they hold—especially when they conflict with our own evidence-based frameworks.
But perhaps we would do better to begin from a place of mutual respect. Not all myths are wrong, and even myths that appear wrong to us may carry values and significance that we can acknowledge. After all, myths, superstitions and rituals speak to emotional, spiritual and communal realities that our data cannot always capture.7 When we listen for those stories, we honor the symbolic alongside the statistical and become better clinicians, scientists and, ultimately, humans.
Superstition, in this sense, is not the opposite of science. It is a complement and a vital method of situating science within the broader context of lived experience. When I knock on wood—a superstition imported to Midwest America from Northern Europe and one that nobody in my family shares— it means, in a very concise way, that I am willing to reach patients on their own ground.
Conclusion: A Knock, A Gesture, A Truth
When my patient pointed out that I had knocked on a piece of plastic shelving, not actual wood, I smiled, but I didn’t correct course. In that moment, it didn’t matter what the material was. It was the gesture that truly mattered. It was a shared recognition that, in a world guided by evidence, there are still forces we don’t fully understand and that even when we roughly understand them, we prefer to live in a more poetic, story-driven world.
Superstition may not directly save lives, but it often saves conversations. It gives silent language to the certainty of uncertainty, to the limits of the illimitable immune system and to humanistic care predicated upon scientific evidence. In rheumatology and immunology, where “nobody really knows for certain but we’re working on it” appears to be our collective motto, such gestures are reminders that clinicians aren’t alone in struggling to organize the world. It so happens that our patients are doing the same, with their own, distinct myths. By acknowledging and harmonizing these myths, rituals and superstitions, we can build therapeutic relationships and collaboratively advance rheumatology (knock on wood).
Bharat Kumar, MD, MME, FACP, FAAAAI, RhMSUS, is the director of the rheumatology fellowship training program at the University of Iowa, Iowa City, and the physician editor of The Rheumatologist. Follow him on X (formerly Twitter) @BharatKumarMD.
References
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- King KC, Hoffman JR. Myths and medicine. West J Med. 2000 Mar;172(3):208.
- Seitz RJ, Paloutzian RF, Angel H-F. Processes of believing: Where do they come from? What are they good for? F1000Res. 2016 Oct 25;5:2573.
- Gabay G, Ornoy H, Deeb DO. What do physicians think about the white coat, about patients’ view of the white coat, and how empathetic are physicians toward patients in hospital gowns? An enclothed cognition view. Front Psychol. 2024 Jun 11;15:1371105.
- Podder V, Lew V, Ghassemzadeh S. SOAP Notes [updated 2023 Aug 28]. StatPearls [Internet]. Treasure Island, Fla.: StatPearls Publishing. 2025 Jan.
- Seki SM, DeGeorge KC, Plews-Ogan ML, Parsons AS. Physical exam: Where’s the evidence? A medical student’s experience. Fam Med Community Health. 2020 Mar 10;8(1):e000284.
- Nagy P, Wylie R, Eschrich J, Finn E. The enduring influence of a dangerous narrative: How scientists can mitigate the Frankenstein myth. J Bioeth Inq. 2018 Jun;15(2):279–292.
