Experiencing illness
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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?. Experience Begins with Perception. How do we perceive illness? Senses Failure of function Change in mental status

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Experiencing Illness

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Experiencing illness

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?


Experience begins with perception

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


Stage 2 options once illness perceived

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


Process

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


Stage 3

Stage 3

  • Do something to get well

  • Problems with what well means


Sick role

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


Problems with the sick role

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


Doctor patient relationship

Doctor-Patient Relationship

  • Patient role

  • Physician/Provider role

  • Interaction

  • Outcomes


Suchman and zola

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


Friedson

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


Social control

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


Doctor patient relationship1

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


D p relationship

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


Healthcare access

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?


Andersen and aday model

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)


Andersen and aday

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


Example

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


Summary

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


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