Experiencing Illness

1. Experiencing Illness • Stage 1 • Must perceive a state of illness • State of “dis-ease” • Disease is a part of illness If not perceived, does the illness exist?

2. Experience Begins with Perception • How do we perceive illness? • Senses • Failure of function • Change in mental status • Anything that seems abnormal to everyday normal physical capability • Pain/efferent stimuli

3. Stage 2--Options once Illness Perceived • No action—attendant risk to wellbeing/balancing of severity • Self-care • See a professional – may be allopathic/traditional • Allopathic defined • Traditional defined

4. Process • Talcott Parsons and the Sick Role • Roles and identity • “The Social System” • Perception, visit, assumption of the sick role, rehabilitation • Each stage has attendant rules and social roles • Doctor/patient relationship

5. Stage 3 • Do something to get well • Problems with what well means

6. Sick Role • Perception • Sick person absolved from normal responsibilities • Patient must promise to try to “get well” (social contract) • Doctor Diagnoses and Treats • Doctor provides knowledge and physical treatment • Rehab ends with return to normal role and responsibilities

7. Problems with the Sick Role • Not always consensus (Friedson) • Not applicable to chronic illness because people don’t “get well” • Does not include option of self-assignment of sick role and self-care • Social control and negotiation not fully accounted for

8. Doctor-Patient Relationship • Patient role • Physician/Provider role • Interaction • Outcomes

9. Suchman and Zola • Doctor patient relationship varies • Modified concept to vary with social and demographic characteristics • Perceptions of illness and pain vary • Propensity to visit varies with ethnicity and race/sex and education, other social characteristics

10. Friedson • D/P relationship really a matter of conflicting interests and levels of knowledge • Negotiation • Patient Rights • Informed Consent and legal protections of the patient that grew out of the inequity of power and knowledge in the D/P relationship

11. Social Control • Physician given the right to control under old standards • Diagnosis—you are sick and you have… • Control over treatment modalities given/offered • Stigma • Doctor can label you and change others perception of you in society • Examples

12. Doctor/Patient Relationship • Key to understand the basic process of the practice of medicine • Used to be private between doctor and patient • Now encumbered with multiple layers and facets of external control

13. D/P relationship • Can represent other relationships like patient/acupuncturist, patient/pharmacist • Unequal knowledge, unequal access to “cure” • Controlled in part by societies’ interest in right and wrong, fairness and equity • Doctor as double agent

14. Healthcare Access • Various models of what factors determine: • Who goes? • Where they go? • What is the ethical position a doctor should take towards access to HIS?HER care?

15. Andersen and Aday Model • Grew out of discussions of ethnic differences in use to include multiple factors • Predisposing (immutable) • Enabling (mutable) • Need • Healthcare systems • Social networks (Pescosolido)

16. Andersen and Aday • Predisposing, enabling, need and systems factors modulated by social networks produce a calculus of decision on whether to visit and where to visit • Individual decision • Group decision

17. Example • You have a sore throat and fever • You perceive you are ill • You choose a course of action based on ? • You follow that course and the consequences could cause improvement or not

18. Summary • D/P relationship is key to understanding issues of medical care, ethics, and patient rights • Health access, like illness, is a product of SOCIAL causes/statuses