Models of Illness & Triggers to Consultation

Question 1

What does the biopsychosocial model believe health is the result of?

Answer 1

An interaction between biological, psychological & social factors

Question 2

WHO definition of health?

Answer 2

A state of complete physical, mental & social well-being, not merely the absence of disease or infirmity

Question 3

What are the 3 ways health can be defined?

Answer 3

• Negative (absence/presence of disease) - emphasises deficit
• Positive (fitness and well-being) - emphasises overall health
• Functional (ability to cope with activities) and/or being fit

Question 4

Why are definitions of health important?

Answer 4

Define how we treat health, determine health, perceive health & when clinicians get involved

Question 5

What are some possible lay perceptions of health?

Answer 5

• More likely about lifestyle - eating well. food, exercise, sleep, checkups (healthy things - make us feel healthy)
• Body maintenance (look good = feel good)
• Sense of physical, mental & social well-being
• Not being ill

Question 6

Differences between illness & disease?

Answer 6

Illness
-Absence of health
-Subjective/opinion driven
-More socially constructed
-Can’t quantify (qual)

Disease
-Can prove
-Objective/scientific proof
-Biological
-Defined symptoms
-Diagnosable
-Quantifiable
-Has beginning & end

Question 7

Define disease.

Answer 7

• A biological part or process is functioning at a level below the norm - an abnormality in structure (sub-optimal functioning)
• Diagnosed by an expert

Question 8

Problems with the disease approach to understanding ill health?

Answer 8

-Disregards individual experiences - undermines patient
-REDUCTIONIST - only accounts for biological view of ill health

Question 9

Define illness.

Answer 9

-‘The experiences of disease, relates to a way of being for the individual concerned’ (Radley, 1993)
-Being/feeling ill - but can’t always diagnose/classify (harder to treat)
-The ill heath the person subjectively experiences & identifies

Question 10

Problems with defining illness as described, in a reductionist way (ill health = no disease) - Engel 1977 (biopsychosocial model)?

Answer 10

-Social learning defines what is abnormal - so if we can’t classify abnormal, are we ill?
-Drs MUST know beh & soc links to clinical aspects of illness (as patients will only be exposed to these - lay)
-Do people report onset initially or wait - links to lifestyle
-Presence of disease not account when patients view themselves or are viewed by others as sick or when patient enters healthcare system
-Patients can still feel ill even after biological alleviation/improvement of disease
-Dr-pat relationship = vital influence on therapeutic outcome

Question 11

How does a diagnosis affect the patient?

Answer 11

-Once diagnosed the patient will change accordingly
-Diagnosis creates illness - being legitimately ill
-(‘allowed to be ill’)
-Dr is expert - will tell us what is wrong

Question 12

What is the social construction of reality (& so illness) & how does it fit into perceptions of illness?

Answer 12

-We become convinced that we are what we are named/labelled (ill)
-Due to social order - beliefs that distort reality (can’t see from how they actually are)
-Society defines meanings for things in our env
-What counts as illness varies between people in society & changes over time
-Results in individual perspectives - subjective interpretations of reality
-So our beliefs of what is healthy varies between people, places, & in time
-Illness has cultural meaning
-Illnesses = socially constructed –> & so too is medical knowledge (society decides what is relevant)

Question 13

Is illness a natural or social phenomena?

Answer 13

Social –> as changes (isn’t fixed)
-We live illness (we don’t just have it) - embodied (illness is expressed - physically) & so social experience plays a part

ALSO because…
-definitions & believed treatments of illness differ between people & cultures (e.g in western society - medicalised - others - see as natural e.g., menopause, ageing)
-people access help for illness differently

Soc, cult, psych systems shape experience & meanings of illness (cultural/religious traditions)

Question 14

What shapes meanings & believed treatments of illness, & what does this mean?

Answer 14

-Regions
-Ethics
-Culture
-Experience
–> illness = dynamic - changes as perceptions do

Question 15

So, what actually counts as an illness?

Answer 15

Anything that an individual perceives as abnormal - perhaps in affecting their ability to function -> fail to comply to societal expectations of them

Question 16

So, what actually counts as an illness (as sub-optimal) - when can we define something as an illness?

Answer 16

Anything that an individual perceives as abnormal - perhaps in affecting their ability to function -> fail to comply to societal expectations of them

Question 17

What is sickness?

Answer 17

The social role a person with an illness or sickness takes or is given in society

Question 18

What is needed for being considered ill - what do we need (social experience of illness)?

Answer 18

-Others to recognise our symptoms
-Dr to label our suffering
–> when are we officially ill enough to be said so?

Question 19

Impacts of sickness on society?

Answer 19

= disruptive
-So have ways to manage -> sick leave work absence - but this is disruptive to social order
-Sick people are given social roles - where certain things are expected of them
–> so illness = deviance - threatens social order (which is why we manage)

Question 20

What is the sick role?

Answer 20

-Social response to sickness/illness
= patterns of beh expected of ill people

Question 21

What are the rights of people with the sick role?

Answer 21

-Excused from normal activities & responsibilities (e.g., work)
-Need caring for
-‘Forgiven’ for having their illness

Question 22

What are the obligations/expectations of people with the sick role?

Answer 22

-A want to get better - temporary role
-Seek prof advice & cooperate (only ill if require prof help = new view)
(only get sick role privileges if follow the set obligations)

Question 23

-ves of sick role?

Answer 23

-Temporary - not applicable to chronic illnesses (not able to return to normal responsibilities)
-‘Blame’ person for own health - ind responsibility
-People may refuse to participate in sick role
-Ind diffs in seeking help for symptoms
–> other ways of dealing w/ than medical advice

Question 24

Why do people behave differently - some go to Drs v. early on (minor symptoms), late on (severe symptoms), not at all - for symptoms?

Answer 24

-Symptoms are NOT cues
-Individual perceptions of when they are able to be legitimately ill & need help
-People don’t always know they are ill

Question 25

Proportions of people seeking medical help for symptomatic diseases?

Answer 25

1/3 = do nothing
1/3 = self-medicate or seek alternative therapies
1/3 = consult Dr

Question 26

Why might some people delay going to Drs?

Answer 26

Feeling ill/having symptoms is a requirement before can go

Question 27

What determines a person’s course of action - seeking medical advice & when?

Answer 27

If they have a disease
-How they/others respond to their symptoms

Question 28

Why is it a +ve that not all people go to Drs for all symptoms of ‘illness’?

Answer 28

-Health services would be overwhelmed

Question 29

What are sectors of health care systems?

Answer 29

-Popular sector = media, google, news
-Folk sector = non-mainstream NHS service e.g., home remedies

Question 30

What is the popular sector - what is its place in healthcare?

Answer 30

-Lay non-profs & their social networks
-Recognise & cope will illness
-Large pert involves - self-care & self-medicating
-Decide whether to start & end these treatments
-Unpaid care = defining feature

Question 31

What is the lay referral system?

Answer 31

Seeking help from systematically from family to more distinct laymen until reach professionals
-Network of who we live with & their opinions, what is in media, past experiences, societal expectations

Question 32

What are some socio-demographics to describe likelihood of people accessing healthcare?

Answer 32

-More women than men
-More men in relationships than men not
-More children & elderly than young adults, middle aged
…–> others regard: social class, ethnic origin, marital status, family size related to utilisation
(lower socioeconomic groups = more to worry about - less emphasis on health (view their health as undeserving), vs more affluent - more time for health –> worries hierarchy

Question 33

What are the social triggers to consultation - what makes people go to Drs/triggers help seeking?

Answer 33

-Interpersonal crisis occurs e.g. divorce or job loss - more focussed on symptoms
-Symptoms interfere w/ vocational or physical activity
-Symptoms interfere w/ social or personal relations
-Sanctioning e.g. ‘I didn’t want to bother you but xxx insisted I should come’
-Temporalising of symptoms e.g. ‘if this symptom has not disappeared by Monday, I’ll go to the doctor’

Question 34

Other triggers to consultation…?

Answer 34

-Media stories - pandemic - hospital = where people catch covid, overwhelmed hospitals - don’t want to be burden
-Politics - political changes influencing healthcare systems - e.g., USA - contraceptive pill had to be paid for
-Economy

Question 35

What is delay behaviour in terms of accessing healthcare?

Answer 35

-People delaying accessing medical help

Question 36

Why might people show delay behaviour?

Answer 36

-Anxiety - don’t want bad news, don’t want covid - so won’t go
-Embarrassment/stigma of certain diseases - e.g., STIs, mental illness
-Lack of awareness/uncertainty about meaning of symptoms
-Competing social demands e.g., ignoring
symptoms due to work/family/social responsibilities
-Problematic doctor-patient interaction
e.g., fear being labelled ‘hypochondriac’ or ‘worrier’/Not being taken seriously (don’t want to be told are making stuff up)
-Structural barriers e.g., inadequate
transportation, geographical distance,
health care professional shortages
-Normalising symptoms if can e.g., just old age