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
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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