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 Anything that seems abnormal to everyday normal physical capability Pain/efferent stimuli

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 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 Do something to get well Problems with what well means

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 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 Patient role Physician/Provider role Interaction Outcomes

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 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 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 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 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 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 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 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 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 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