1. 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?

2. 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

3. 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

4. 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

5. Stage 3
Do something to get well
Problems with what well means

6. 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

7. 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

8. Doctor-Patient Relationship
Patient role
Physician/Provider role
Interaction
Outcomes

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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?

15. 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)

16. 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

17. 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

18. 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