Why do people consult?

Question 1

What influences individuals definition of “health” and “illness”?

Answer 1

social factors such as gender, age, culture and social class

the lay and medical definitions may also var considerably

Question 2

What does the bio-medical model suggest?

Answer 2

it suggests that people normally consult a doctor when they cannot cure their symptoms by self-treating. However a large amount of illness is managed informally in the community without reference to health professionals

Question 3

What is Kleinman’s model of healthcare systems?

Answer 3

Sections include: professional sector, folk sector, popular sector

The professional and folk sectors may or may not overlap in particular local settings

Question 4

What is involved in the professional sector of kleinman’s model of healthcare systems?

Answer 4

HCPs and complementary practitioners that are regulated are within this sector

Question 5

What is involved in the popular sector of kleinman’s model of healthcare systems?

Answer 5

When someone seeks advice from family or friends or social media - appears outside OF healthcare system
People start evaluating what is wrong with them
People in the community giving advice - tends to be women not mends because they tend to take the more caring role and read more about health.

Question 6

What is involved in the overlap between popular sector and professional sector of kleinman’s model of healthcare systems?

Answer 6

People may try to self-manage and then go to consult a doctor if they can’t treat it themselves. They will the re-evaluate HCP advice back in popular sector and if someone else says to them they had bad side effects from a certain treatment, this may stop the other person taking the treatment and could cause that person to stop taking advice from their doctor

Question 7

What is involved in the folk sector of kleinman’s model of healthcare systems?

Answer 7

Complementary lay practioners- old wives tales, such as hot toddies.

Question 8

What is a key issue nowadays once a person decides to consult a doctor?

Answer 8

Often it can take a long time to get a consultation and this can lead to the patient finding alternative treatments

Question 9

What is Blaxter (1990) definition of health and illness?

Answer 9

“health can be defined negatively as the absence of illness, functionally, as the ability to cope with everyday activities or positively as fitness and well-being”

Question 10

What factors influence our definition of health and illness?

Answer 10

Duty to be healthy/illness as failure - government keeps communicating about the importance of looking after yourself e.g. getting the flu jab

Emphasis on body maintenance - media cover this all the time

Normal illness/serious illness- e.g. breast cancer can now be seen as something that can be lived with. Attribution - old person having joint pain early in the morning isn’t too alarming whereas in a young person that would be very alarming

Question 11

What is the definition of symptoms?

Answer 11

those feeling states patients experience which alert them to the possibility that all is not well

Question 12

What is the definition of signs?

Answer 12

those pointers the doctor identifies which signify the existence of the underlying pathological lesion

Question 13

What are the stages of illness (model of the processes a patient goes through)?

Answer 13

1. Person experiences symptoms
2. May seek advice from friends and relatives
3. May seek professional advice from a doctor
4. Doctor confirms person is sick (legitimise sick role)- providing a diagnosis - doctor hands over prescription or provides a referral or could sign them off work
   Sometimes doctors are unable to make a diagnosis e.g. ME
5. sick role
6. recovery

Question 14

What did the clinical iceberg study show?

Answer 14

HCPs only see tip of the iceberg as most of it is underwater which is representing all the people that have symptoms within the community but are not altering their GP (study in 1000 adults living in London)
Out of the 1000 adults most of them had a symptoms but most are managed in the community and as a GP you only see a small percentage at one time

Question 15

What ages groups tend to consult more than others?

Answer 15

Elderly and very young children to tend to have higher consultation rates- more at risk groups

• elderly tend to have more co-morbidites
• elderly can sometimes feel lonely, therefore they just want to go in for a chat
• children tend to get sick very quickly
• Parents are well informed about childhood illnesses
• sick children can’t go to school/nursery but parents need childcare

Question 16

Which gender is more likely to consult a doctor?

Answer 16

Women are more likely

• more points in women health which causes them to visit HCP
• women tend to know more about health
• social perception that men need to be strong

Question 17

How does social class influence someone decision to consult a doctor?

Answer 17

Higher social classes tend to consult about more trivial things
Lower social classes have higher consultation rates for more severe issues - don’t want to pay for OTCs so have consultations for prescriptions

Question 18

How do people decide whether or not to consult a doctor?

Answer 18

• are my symptoms normal or abnormal?
• should i go to the doctor on this occasion?
• what else can i do?
• what are the costs and benefits of seeing the doctor?

Summary of decisions people make when deciding whether to consult or not

Question 19

What are Zola’s 5 social triggers which together encompass the way in which symptoms comes to be seen as abnormal?

Answer 19

1. perceived interference with vocational or physical activity - e.g. hobbies
2. perceived interference with social or personal relations e.g. acne
3. occurrence of an interpersonal crisis e.g. family issue, divorce, societal event
4. Kind of temporising of symptomatology - setting a time limit on symptoms
5. Sanctioning - given permission by someone else to encourage them to go

Question 20

How does employment influence someone decision to consult a doctor?

Answer 20

unemployed have higher consultation rate- stressful situation
Physical and mental issues increase

Question 21

What are the mechanic’s (1978) variables known to influence illness behaviour?

Answer 21

• visibility, recognisability or perceptual salience of signs and symptoms
• extent to which the symptoms are perceived as serious
• extent to which symptoms disrupt family, work, and other social activities
• frequency of the appearance of the signs or symptoms their persistence or their frequency or recurrence
• tolerance threshold of those who are exposed to and evaluate the signs and symptoms
• available info knowledge and cultural assumptions and understandings of the evaluator
• basic needs that lead to denial
• needs competing with illness responses
• competing possible interpretations that can be assigned to the symptoms once they are recognised
• availability of treatment resources, physical proximity and psychological and monetary costs of taking action (not only physical distance and costs of time, money and effort but also costs such as stigmas, social distance and feelings of humiliation)

Question 22

What is the patient’s role in the Parson’s sick role?

Answer 22

Obligations and privileges:

• must want to get well as quickly as possible
• should seek professional medical advice and co-operate with the doctor
• allow and may be expected to shed some normal activities and responsibilities - e.g. employment and household tasks
• regarded as being in need of care and unable to get better by his or her own decisions and will

Question 23

What is the doctor’s role in the Parson’s sick role?

Answer 23

Expected to:

• apply a high degree of skills and knowledge to the problems of illness
• act for welfare of patient and community rather than their own self-interest, desire for money, advancement
• be objective and emotionally detached- should not judge patient’s behaviour in terms of personal value system or become emotionally involved with them

Rights:

• granted right to examine patients physically to enquire into intimate areas of physical and personal life
• granted considerable autonomy in professional practice
• occupies position of authority in relation to the patient