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PubMed2001

Barriers to treatment: the unique challenges for physicians providing dementia care.

Evaluating and treating dementia is intellectually demanding and enormously satisfying. However, physicians providing dementia care also confront unique challenges that cause discomfort and overwhelming frustration unless they are recognized and overcome. Physicians must care for individuals who do not adopt the "sick role." They must establish and maintain rapport with patients while also approaching collateral sources to obtain a complete history. They must develop a complex alliance with the patient, caregivers, community agencies, and other health professionals to provide effective treatment. Physicians must relate "bad news" to several people at once who are unequally prepared for it, while dealing with their own diagnostic uncertainty. Furthermore, physicians must honor patient autonomy and balance it with the needs of caregivers. Since the demands of providing dementia care are not typical of most medical practice, the special attributes needed are often not taught to students or adequately reimbursed by health insurance. The quality of dementia care will improve when strategies that address these aspects of care for patients with dementia are widely adopted.

Alzheimer Disease↗

PubMed1991

Gender differences in health related behaviour: some unanswered questions.

To date, no single explanation has accounted for discrepancies between male and female morbidity rates and health care utilization patterns. The sociomedical approach to sex/gender differences in health related behaviour has generated a variety of hypotheses. However, despite extensive study, many unanswered questions remain. The findings of this study fall short of offering conclusive evidence as to the causes of variations in morbidity and health services use between women and men. However, an effort is made to identify the salience of social role and related social status characteristics (e.g. labour force participation) in accounting for variation in health, illness and sick role behaviour. This paper utilizes data from the 1983 Winnipeg Area Study. Findings of this study raise questions about the adequacy of current concepts and measures for studying sex/gender differences in health related behaviour. The study concludes with a critical discussion of conceptual, methodological and theoretical issues which must be considered in our efforts to advance our understanding of why women experience greater longevity, but experience greater morbidity and make more extensive use of health services.

Adult↗

PubMed1979

Primary care and social control.

Role performance in primary care becomes problematic when a disproportionate emphasis is placed on the physician's legitimizing function which is geared to endorse entry into the sick role so that he is less able to devote himself to curative or preventive tasks. Israel is used as an example of a society in which the delivery system of medical care has moved far in this direction as a result of pressures both from consumers and from the wider social system. The former utilize the medical care system for its latent as well as for its manifest functions, while the latter makes use of it for legitimation of role avoidance and for allocation of scare resources on the assumption that universalistic criteria of medical need are used in these processes. Excessive utilization rates of clinical facilities and dissatisfaction among primary care physicians are apparently among the dysfunctional results of these patterns. Some questions are raised as to the implications of placing major social control mechanisms in the hands of the medical care system which in effect is not really geared to handle these tasks.

Consumer Behavior↗

PubMed2002

Factors associated with insight among outpatients with serious mental illness.

This study examined the relationships between insight, severity of symptoms, diagnosis, locus of control, quality of life, and engulfment among 25 patients with a DSM-III-R diagnosis of schizophrenia and 33 patients with a diagnosis of bipolar disorder. Engulfment is the extent to which a person identifies with the patient role. Severity of symptoms and engulfment were significantly associated with insight. These results are consistent with the notion that poor insight is associated with severe illness. The association between development of deviant or sick roles and awareness of illness warrants further attention.

Adult↗

PubMed1993

The difficult to treat insomniac patient.

When a complaint of significant insomnia does not respond to standard interventions, the clinician must reassess the diagnosis with particular emphasis on psychiatric or psychological factors. This article describes the management of patients with 'sleeping pill insomnia,' insomnia associated with affective illness, sleep state misperception, 'sick role' behavior and treatment non-compliance.

Adult↗

PubMed1997

"How could I even think of a job?"--Ambiguities in working life in a group of female patients with undefined musculoskeletal pain.

OBJECTIVE: To explore the meaning of working life for a group of women sick-listed because of undefined, musculoskeletal pain disorders. DESIGN: Repeated thematic interviews, analysed qualitatively according to grounded theory. SETTING AND PARTICIPANTS: Twenty female patients, impaired by biomedically undefined pain and musculoskeletal disorders, were successively recruited at an urban primary health care centre in northern Sweden. MAIN FINDINGS: There were discrepancies between work aspirations and work experiences concerning economic maintenance, social interaction, and personal recognition. The women had low-income jobs in fields threatened by redundancy, such as cleaning, care, and service. Family considerations had a strong impact on organization and priorities in paid work. In a situation of pain and sick leave, family orientation strengthened and work aspirations declined. Social and personal recognition was sought in the unpaid duties at home, and economic refuge in 'the state as supporter'. IMPLICATIONS: To understand women with undefined musculoskeletal pain as patients, we must also understand their aspirations and experiences as workers, mothers, and spouses. 'Family considerations', 'diminishing paid work', and 'the state as supporter' are important concepts for understanding the women's sick role process.

Adult↗

PubMed1989

A clinical analysis of hysteria and psychalgia.

A retrospective study of children presenting with pain to the Child Guidance Clinic, during 1984-85 revealed 101 cases of hysteria and 22 of psychalgia. Children in these two groups did not differ significantly with respect to sex, age, education or occupation of parent. Children with psychalgia presented significantly later, and more frequently complained of headaches and abdominal pain. Children with hysteria presented with seizures, abdominal pain and anxiety symptoms. Pain can be of psychological origin also. Early diagnosis is essential to avoid unnecessary investigations and reinforcement of the "sick role".

Adolescent↗

PubMedDate not supplied

Parsons, professions and the sociology of health care.

The fourth paper in the sociology series examines the work of the American Talcott Parsons. His work has particular relevance to the sociology of health and illness. The concept of the sick role as a means of understanding the effects of ill health, which he proposed, is critically examined here.

History, 20th Century↗

PubMed2003

Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia.

Encountering patients with chronic fatigue syndrome (CFS) or fibromyalgia can cause dilemmas for physicians due to the uncertainty inherent in these illnesses. The aim of this study was to investigate: (1). How physicians in a Swedish sample describe and categorize patients with CFS and fibromyalgia; (2). What the character of CFS and fibromyalgia, with regard to diagnosing, treatment and medical knowledge/aetiology, mean to the physicians in encounters with patients; and (3). Which strategies physicians describe that they use in the encounter with these patients. Semi-structured interviews were carried out with 26 physicians, specialists in various fields who all had some experience of either CFS or fibromyalgia. The results suggest that there is a discrepancy between the ideal role of the physician and reality in the everyday work in interaction with these patients. This may lead to the professional role being questioned. Different strategies are developed to handle the encounters with these patients. The results also illuminate the physician's interpretations of patients in moralising terms. Conditions given the status of illness were regarded, for example, as less serious by the physicians than those with disease status. Scepticism was expressed regarding especially CFS, but also fibromyalgia. Moreover, it is shown how the patients are characterised by the physicians as ambitious, active, illness focused, demanding and medicalising. The patient groups in question do not always gain full access to the sick-role, in part as a consequence of the conditions not being defined as diseases.

Attitude of Health Personnel↗

PubMed1992

Psychological factors in the long-term prognosis of chronic low back pain patients.

This study appraised the significance of psychological factors in the long-term prognosis of patients with chronic low back pain (LBP). The MMPI ratings of 80 long-term sick-listed LBP patients were set in relation to their disability pension status 6 to 12 years later. The number of elevated scales, in combination with the level of certain scales (HS and HY), proved to be a better predictor than profile patterns, advocated in some studies. Moreover, in a review of prognostic studies, the HS and HY scales appeared most frequently as significant predictors. That result also was confirmed in this study of long-term prediction of overall functional level. The results are discussed in relation to the concepts of pain-fear and sick role.

Adult↗

PubMed1995

Effects of the experience of depression: application of focus group and survey methodologies.

The popularity of cognitive theories of depression has not appreciably increased attention to the effects of depression on how its sufferers subsequently think about themselves and structure their lives. As a first step in a program of systematic research, we recruited recent and former depressed psychiatric patients to participate in focus group discussions of their experience of depression and how it has affected them. Statements elicited in two focus groups were classified into eight categories: lack of energy and the loss of self-efficacy, fear of recurrence, fear of taking risks, inability to trust oneself, self-presentation and concealment, concern about being a burden to others, secondary guilt about having been depressed, and reduced involvement in interpersonal relationships. These results were then used as the basis for the construction of a survey instrument, the Self-Appraisal Questionnaire (SAQ), and strong differences were found between recently recovered depressed women and a sample of women without a history of depression. Taken together, results of the focus groups and the survey study support the utility of a limited "sick role" for recovering depressed persons.

Adaptation, Psychological↗

PubMed1975

The future of chiropractic: a psychosocial view.

As the total health-care delivery system in the United States has come under increasing public scrutiny, the role of chiropractic has become of interest. An overview of chiropractic, with an analysis of its social functions and a projection of its future indicates that chiropractic is more congruent with the values of its lower-middle-class clientele than is orthodox medicine. Chiropractors function adquately to legitimize their patients' entrance into the "sick role" and to provide an alternative channel to therapy. The marginal role of the chiropractor in the health-care system, as compared to that of the physician, is stable and functional for the chiropractors thenselves, as well as for their patients. Chiropractic likewise serves the physician, both as a boundary-defining mechanism and as a means of disengagement from troublesome patients. For these reasons, we believe that the role of chiropractic within the health-care system will remain stable in the future.

Attitude of Health Personnel↗

PubMed1980

Diagnosis and management of hysteria.

Patients with the diagnosis of hysteria are a perennial management problem for the nonpsychiatric physician. Hysteria is an operationally defined clinical entity characterized by onset before age 30 and by multiple medically unexplainable symptoms. Such patients should be differentiated from those with psychiatric disorders resulting in somatization, especially conversion disorders, and should be managed in such a way as to minimize sick-role incapacitation and reduce injudicious use of medication, medical procedures, and hospitalization.

Adult↗

PubMed1988

Somatic presentations of psychiatric illness in primary care setting.

We have tried to describe somatisation, not as a disease, but as a common and important human mechanism involving both doctor and patient. It is the single most common reason why psychiatric illness goes undetected in general medical settings, and it often occurs in conjunction with physical disease processes. The association with dysphoric affect has been recognised at least since George Cheyne 250 years ago, and the reason for this is that both anxiety and depression serve to amplify pains. However, it seems likely that somatisation can occur in the absence of dysphoria. Once it has been established, it is easy to see how it continues: it secures advantages from spouse, family and employers; and it tends to be encouraged by doctors--who differentially reward somatic symptoms. But why does it occur in the first place? We have argued that it seems to have three functions: First, it allows people who are unsympathetic to psychological illness, or who live in cultures where mental illness is stigmatised, to nonetheless occupy the sick-role while psychologically unwell. Second, it is blame-avoiding: instead of being responsible for the mayhem, one is cast in the role of the suffering victim. Finally, by reducing blame, it appears to save patients from being as depressed as they might otherwise have been.

Humans↗

PubMedDate not supplied

The disease concept of alcoholism: its impact on women's treatment.

The disease concept of alcoholism has had a dynamic impact on attitudes, policies, and treatment orientations. Despite its demonstrable effects on changing behaviors and belief systems, it remains both an acceptable and controversial entity amongst researchers and treatment personnel alike. This report provides a current focus of the disease concept as its applies to the characteristics and experiences of women alcoholics and their treatment. It especially targets the need for empowerment in this population and questions whether this important trait can be developed by the disease concept's emphasis on illness and the sick role, which inadvertently validates the feelings of powerlessness and helplessness of these women who already have been intensively socialized in dependent and subordinate roles.

Adult↗

PubMed1987

Psychogenic pain: a study of marital adjustment.

The marital adjustment of patients with psychogenic pain disorder was evaluated and compared with a matched group of patients with other neurotic disorders. Pain patients spouses were found to have better marital adjustment and less psychiatric morbidity than the spouses of neurotic patients. These findings are discussed in terms of the concepts of "sick role homeostasis" and "tertiary gain".

Adaptation, Psychological↗

PubMed1978

Locus of control and health: a review of the literature.

Locus of control, an individual difference construct from social learning theory, has shown some promise in predicting and explaining specific health-related behaviors. Research is reviewed on the utility of the locus of control construct in understanding smoking reduction, birth control utilization, weight loss, information-seeking, adherence to medication regimens, and other health or sick-role behaviors. Implications for health educators are presented.

Attitude to Health↗

PubMed1998

"Nerves" and tranquilizer use in rural Brazil.

Drawing on data from a morbidity survey of sampled households in 25 small villages in Espirito Santo, Brazil, this article is concerned with reports of "nerves" (nervos) or nerve problems (problema de nervos). Reported cases of nervos (30 percent of all reports of illness) included a variety of symptoms: insomnia, body pains, dizziness, trembling, weakness, and emotional states ranging from feelings of sadness to anger. In one-third of the accounts, "overwork" was mentioned as the main cause, due both to its direct physical effect and to stress related to economic hardship and responsibility. In 88 percent of the cases, the afflicted person regularly used at least one psychotropic drug to relieve symptoms. Daily use of drugs occurred in 68 percent of the cases, and in 47 percent of cases people were reported as "dependent" on the drugs. The extensive use of psychotropic drugs suggests medicalization of nervos, creating a sick role for patients and keeping at an individual level the problems resulting in nervos.

Adult↗