Sick Role, Healing Role and Health Seeking Behavior
Sick Role and health seeking behavior: Health: The absence of disease, or the presence of physical, mental and social well being. Disease: Objective diagnosis of pathology by doctors. Illness: Subjective experience of symptoms by patients. Sickness: Expected behaviors of some one who is ill. * The absence of a disease is not a norm, because at any time, about 3/4 of population say to have symptoms and only 1/3 of those are seeking professional advice.Normality: a person position on a normal distribution curve for such measured attributes as blood pressure. Abnormality: when a person position out of a normal distribution curve by cut-off point for such measured attributes as blood pressure. Culture: social legacy, which individual acquires from their group, it is a kind of blue print for all life's activities, learnt through generation, we are all ethnocentric assuming our own beliefs right and belief's of other is bad and vise versa.
Illness and consulting a doctor
Illness is not sufficient for consultation of a doctor. Sometimes disease present without pain, symptoms etc. e.g. cancer, but they do require seeing a doctor. Doctor patient disagreement on what is necessary for a consultation- this is known as TRIVA Iceberg of disease: diseases which do not reach a doctor.Iceberg of disease
Clinical iceberg: the proportion of disease in the community which is not taken to a doctor and accumulates within the population. Symptom iceberg: the proportion symptoms experience by a community which are not taken do a doctor e.g. 1 in 37 symptoms were presented to a doctorTypes of medical belief system: 1. Domestic (popular) medicine: Not-professional and not scientific such as mother treating her children. 2. Traditional (folk) medicine: Not scientific, but professional such as injectionists. Also involves (Alternative medicine & Self-help group). 3. Scientific medicine: Professional and scientific such as modern medicine.
Illness behavior
The ways in which symptoms are perceive, evaluated and acted upon by a person who recognizes some pain, discomfort or other signal organic malfunction, i.e. how patients decide .whether to consultReaction to illness: I- Personal Factors: 1. Disability (ankle sprain in laborer and officer). 2. Pain (perceived pain and pain threshold). 3. The perceived seriousness (purulent sputum in COPD patient and in athletic person). 4. Gender (women diseased more, men die more).
Reaction to illness: II- Socio-Cultural Factors: 1. The family (family language of distress). 2. Social Class (class III are medically more oriented and show more compliance with treatment). 3. Cross-cultural orientation (Irelands VS Italians).
Reaction to illness: III- Economic and Political Factors: Villages Vs Towns).) 1. Availability of health services 2. Accessibility to medical services (economic status and the journey). 3. Public orientation to the available health services (Most people not oriented to their medical rights).
Characteristics of Sick Role: 1. The rest: The patient is exempted from normal social responsibilities, this depends on severity of illness and sometimes he will be given a sickness certificate. 2. The guiltlessness: The patient is not responsible for his illness and can make claims on other for assistance. * The upper 2 points are usually given to ill persons. (Rights)
Characteristics of Sick Role: 3. The responsible behavior: The patient must want to get well because the sick role is regarded as a misfortune. 4. The compliance: The sick person is obligated to seek medical advice and to cooperate with the plan of medical treatment to get well. * The last 2 points usually are needed from the patient. (Duties)
Failure to fulfill the 4 aspects of sick role lead to label that person who play a role of sick man as either; 1. Hypochondria tic. 2. Hysteric person with conversion personality. 3. Malingerer. 4. Neurotic. 5. Psychotic.
Types of Sick Roles: 1.Temporary sick role: As in all short and acute conditions, but in some primitive and poor society chronic and serious illnesses may be considered as transient illness. 2.Chronic Sick Role: as in chronic and debilitating illness e.g. Rheumatoid arthritis, but in affluent country some mild illnesses may be regarded as chronic illnesses.
The Sick Role must be controlled: Because adequate health is necessary for society, and this can be done in 2 ways: 1. Social level: as altering the definition of illnesses, restriction of sickness certificate in war and in other situation. 2. Individual level: When sickness deprive the person from certain enjoyments and special gains.
Healing Role of Doctors: Definition: The expected behavior of someone who is becoming a doctor or physician and it represents the dynamic aspect of the doctor's status in the community.
The Community Expectations from the Doctor: 1. Effective curing ability. 2. Effective caring ability. 3. A respectful role model. 4. A good decision-making.
Preferable Attitudes for Doctors: 1. Affective neutrality: Standing back from the patient and maintaining objectively without becoming emotionally so involved. 2. Universalism: Regarding all patients as being of the same value, so that non-medical details such as race, religion and social class do not influence medical decision. 3. Functional specificity: Doctor should only be concerned with those matters, which are of direct medical relevance to the patient health.
Presentation of illness:1. Usual method: Patient presents actual symptoms and usually affected by socio-cultural variables.2. Conflicting method: Such as- “Symptom choice” in psychosomatic patient learn how to presents real symptoms from frequent consultation, or media.- “4th year syndrome” in medical undergraduates due to stress.- “Symptoms denial” in embarrassing dieses as STDs. - “Mask syndrome” in neurotic patient.
The Explanatory Models (EM): The process by which illness is patterned, interpreted and treated is called the. 1. Lay explanatory models: Characterized by vagueness, multiplicity of meanings, frequent changes, and lack of scientific basis. 2. Medical (Physician's) explanatory models: Characterized by being mostly fixed, rarely changed, and are based on "single causal guide of scientific logic". Consultation lead to transaction between these two EM, and only brilliant physician who can develop logical picture for the disease and illness agreed by both patient and doctor.
The doctor-patient interaction:Communication: “Process by which information and feelings are shared by verbal and non-verbal messages”. Levels of communication:1. Communication on an Emotional and Psychological Plane.2. Communication on a Socio-Cultural Plane.3. Communication on an Intellectual Plane.