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The Experience of Illness and the Sick role Seeing health and help

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The Experience of Illness and the Sick role Seeing health and help Powered By Docstoc
					THE EXPERIENCE OF ILLNESS & THE ‘SICK ROLE’
         SEEKING HEALTH AND HELP




                  Monali Ray
            monali.ray@utoronto.ca
                  PHM 120Y
              November 4, 2008
    LEARNING OBJECTIVES


•   Identify factors that influence patients’ experience of
    illness
•   Identify issues associated with patients’ management
    of chronic illness
•   Identify how patients decide when and where to seek
    care
•   Explain concepts: ‘lay health care/hidden healthcare
    system’
•   Explain ‘sick role’; critique aspects of concept
•   Explore models of patient-provider relationship
ILLNESS BEHAVIOUR
•   What is ‘disease’? What is ‘illness’?

•   Illness behaviour
       How people respond (perceive, interpret,
       act) to their symptoms
       Socially influenced

•   Way in which people respond to illness can be just
    as important as the disease itself in their seeking
    healthcare

•   Perspectives on illness behaviour: ‘individualistic’
    and ‘collectivist’
    INDIVIDUALISTIC APPROACH

    Variables influencing an individual’s response to
    illness (Mechanic, 1968):
•   Visibility, recognizability of symptoms
•   Extent to which symptoms are perceived as serious
•   Extent to which symptoms disrupt social activities
•   Frequency of symptom recurrence
•   Tolerance threshold
•   Available information, knowledge, cultural
    assumptions
•   Psychological factors
•   Competing priorities
•   Competing possible interpretations
•   Availability of treatment resources
     COLLECTIVIST APPROACH


    Illness behaviour: culturally learned response

•   Socioeconomic differences: perception of health

•   Gender differences: reporting illness (Kroenke &
    Spitzer, 1998)

•   Cultural differences: management of illness
    (Morgan & Watkins, 1988)
THE SYMPTOM ICEBERG
                  Majority of symptoms not
                  presented to a healthcare
                  professional

                  Response of adults to ailments
                  over a 2-week period (British
                  Market Research Bureau, 1997)
                  • Did not use anything – 46%
                  • Used prescription medicine already
                  at home – 14%
                  • Used an OTC medicine – 25%
                  • Used a ‘home remedy’ – 9%
                  • Saw a doctor or dentist – 10%
                  • Saw a pharmacist – 1%
LAY HEALTH BELIEFS

•   Ideas of non health professionals with regard to
    health and illness (‘Feed a cold, starve a fever’)

•   Multiplicity of ideas about illness and disease
    drawing from a range of sources – both formal
    medical knowledge and informal belief systems

•   Display their own logic, coherence and
    sophistication

•   Healthcare professionals are also noted to draw
    from informal health belief systems
EXPERIENCE OF CHRONIC ILLNESS

    Chronic illnesses are increasingly common:
    cancers, heart disease, diabetes, asthma

    Impacts wide-ranging:
•   Management, coping strategies
•   Social identity
•   Personal sense of identity

    Example: Polycystic ovary syndrome (PCOS)

    Support groups in chronic illness management
    LAY HEALTH BELIEFS (CONT’D)

    Important for healthcare professionals to
    understand lay health beliefs:

•   Enhance the provider-patient relationship

•   Allows the development of realistic strategies
    in health education
EXERCISE 1

The demographics of Toronto make it one of
the most multicultural cities in the world.
Statistics Canada indicates that about 45% of
Toronto’s population is foreign born. Many
people may be likely to cling to their cultural
notions of health and illness.

As a community pharmacist in this city, what
are two measures you can take to learn about
the illness behaviours of your community?
Explain.
SEEKING HEALTHCARE

Responses triggering help seeking (Zola, 1973):
• Occurrence of interpersonal crisis

• Perceived interference with social or personal
  relations
• Sanctioning by others

• Perceived interference with vocational or
  physical activity
• Temporalizing of symptoms
SEEKING HEALTHCARE (CONT’D)
                           Lay culture
               Compatible with   Incompatible with
                 profession         profession
Lay referral
 structure
               Medium to high      Medium to low
Transitory     use of services     use of services


                Highest use of      Lowest use of
 Stable            services           services


                                     (Freidson, 1970)
HIDDEN HEALTHCARE SYSTEM

•   Laypersons involved in provision of primary
    healthcare – hidden healthcare system

•   Laypersons taking responsibility for chronic
    illnesses and complex medication regimes

•   Pharmacists have important role in education of
    patients as well as carers
PARSONS’ SICK ROLE (1951)
• Sickness could lead to
  societal breakdown
  resulting from the inability
  of the sick to fulfill their
  necessary social roles

• ‘Sick role’ concept: way
   for society to manage
   sickness

• Healthcare professionals
  legitimize ‘sick role’
FOUR COMPONENTS OF THE SICK ROLE

         •   The sick person is exempt from
RIGHTS
             ‘normal’ social roles
         •   The sick person is not responsible
             for his condition
DUTIES   •   The sick person should try to get
             well
         •   The sick person should seek
             technically competent help and co-
             operate with the healthcare
             professional.
CRITICISMS OF THE SICK ROLE CONCEPT

    Rigidity of rights and duties:
•   Extent to which a person is allowed exemption
    depends on the nature of the condition
•   Sick person may be held responsible for certain
    types of conditions
•   There are illnesses from which a person cannot
    recover
•   Alternative forms of treatment

    Parsons’ sick role is biased in favour of
    healthcare professionals.
BREAK!
MODELS OF PATIENT-PROVIDER
RELATIONSHIPS

Paternalistic model :

•   Guardian, parent, priest: provider role
•   Provider discerns what is in the patient’s best
    interest
•   Limited patient participation
•   Criticism: Patient and provider can have different
               ideas about what constitutes a benefit
MODELS OF PATIENT-PROVIDER
RELATIONSHIPS (CONT’D)
Informative model:

•   Technical expert: provider role
•   Provider presents all relevant factual information
•   Patient selects course of action (‘consumer’)
•   Criticism: Less room for benefiting from
               provider’s experience
               Assumes patient values are rigid
    MODELS OF PATIENT-PROVIDER
    RELATIONSHIPS (CONT’D)
Interpretive model:

•   Advisor, counsellor: provider role
•   Provider: helps patients interpret their values,
    provides relevant information so that patients can
    realize their values
•   Patient: may not necessarily know or be clear about
    their values. Ultimately decides course of action
•   Criticism: Provider may unwittingly impose their
               own values
               May be limited attempts to persuade
               patients to adopt other values
MODELS OF PATIENT-PROVIDER
RELATIONSHIPS (CONT’D)
Deliberative model

•   Friend, teacher: provider role
•   Provider and patient: through discussion
    determine the best health values that can be
    achieved
•   Criticism: Is it proper for providers to judge
                patient values and promote particular
                health values?
EXERCISE 2

 Pharmacists are approached not only on
 medicine-related issues, but increasingly they
 are consulting on general health issues such
 as contraception, smoking cessation, healthy
 eating, stress, diagnostic tests, etc.


 As a community pharmacist, what are two
 ways by which you can enhance adherence
 among your patients?
REFERENCES

Mechanic D (1968) Medical Sociology: A Selective View, New York, Free Press
Kroenke K, Spitzer RL (1998) Gender differences in the reporting of physical and
somatoform symptoms. Psychosomatic Medicine 60(2):150-155.
Morgan M, Watkins CJ (1988) Managing hypertension beliefs and responses to
medication among cultural groups. Sociology of Health and Ilness, 10, 561-578.
British Market Research Bureau Ltd (1997) Everyday healthcare study of self-
medication in Great Britain, London, The Proprietary Association of Great Britain.
Kitzinger C, Willmott J. (Feb 2002) ‘The thief of womanhood’: women’s
experience of polycystic ovarian syndrome. Social Science & Medicine,
54(3):349-361.
Zola IK (1973) Pathways to the doctor: from person to patient. Social Science
and Medicine, 7, 677-689.
Freidson E (1970) Profession of Medicine, a study of the sociology of applied
knowledge, New York, Harper Row.

				
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