Social Science: the Binary Relationship Between Disease and Illness - Essay Example

Approaches to health and social care in contemporary times Unit d Recently, medical education has been emphasising on the patient-centred approaches in the treatment of chronic diseases (Greiner & Knebel 2003; Branch, Pels & Hafler 1998). The main reason for such an emphasis is that patients need to be viewed as individuals with their own unique perspectives, preferences, life goals and values (Duggan et al. 2006). As a result, the medical profession has harkened to hypocrites clarion call that “It is better to know the patient who has the disease, than it is to know the disease which the patient has”. The relationship between physician and patient changed from top-down to down-top in the medical profession (Greiner & Knebel 2003). Traditionally, there were models like biomedical model, which did not consider the human side of a patient. Jewson (1976, p. 235) analysis that in the biomedical model the “patient” was “designated a passive and uncritical role in the consultative relationship and his main function” was to “endure and wait.” According to Doyal (1983, p.31) in the traditional models “the disease had become more important than the person who harboured it.” However, there has been a shift to models that consider other factors such as social, psychological and environmental in shaping the context of a disease and illness. An example is the bio-psychosocial which has sought to understand medical conditions through the analysis of a variety of factors. The model acknowledges that in a disease context, there are many factors such as behavior and attitude towards the illness, social as well as psychological factors (Engel, 2012). The narratives from the patients are today extensively applied to explore the patient experiences with illness (Charon 2001; Kleinman 1988). In this case, the awareness of the binary relationship between disease and illness has revolutionarised the medical practice. This is the difference between the biomedical constructs of the pathophysiological processes and individual’s subjective experience of the patient explored in other models that consider disease as a result of myriad factors (Kleinman 1988). The exploration of patient narrative is relevant in the case of diabetes because patients and physicians have different perceptions, concerns and goals (Anderson 1986; Freeman & Loewe 2000). In this assignment, a patient’s story on her experience with diabetes will be explored with an aim to construct the cultural, social and psychological meaning and locate the facts in contemporary theoretical perspectives. The real names and hospital where the patient, whose narrative is to be used in this analysis, was encountered have been altered to comply with the NMC guidelines and policies of confidentiality (NMC, 2008). During my placement last year, I went on an outreach visit for diabetic campaign and met Mrs. Jones. Born in 1981, Mrs. Jones is diagnosed with type 2 diabetes. She is black American and so were his mother and father. Since her mother and father were separated, she was raised up by her mother for the good part of her life. Her parents separated when she was eleven. Her mother was working as a town clerk. By then, they lived in New York, but they later moved with her mother and brother to Los Angeles. Her brother, Jakes later moved back to New York where he lives today with his wife and three children. Her brother is not diabetic, but he is very understanding and sympathetic of his sister’s condition. He frequently calls her and visits her boys during long vacation for company. Mrs. Jones works as a secretary with one of security firms in Los Angeles. She has worked with the company for the last ten years. Her supervisor is aware of her health status, and he is very supportive and understanding, so she does not have uneasy time at work. She leaves at 6 am for work and comes at 7 pm on weekdays. On weekends, she works from 8 am to 4 pm. On Sunday she is free to go to church and visit her children in boarding school. Mrs. Jones has been under diabetes treatment for the last six years. Blaxter (1983) argues that women, who are working like Mrs. Jones, are likely to hold functional conceptualisations of health. Mrs. Jones was first diagnosed with diabetes at age 17 when she had a serious case of wound in her leg. Immediately she started treatment and therapy as directed by her doctor, the wound healed. With time, she stopped the medication and regimen until she was pregnant for her second child. Pregnant women have high chances of developing diabetes because of their abrupt hormonal chances in their bodies (Blaxter, 1983). That is when her blood pressure went up and a serious recurrence of the disease occurred and she started her regimen. Mrs. Jones believes that this round of a diabetes case will go soon and so, she argues that since her case is not so serious, she does not have to be strict on herself. She says that “keeping up with vegetables and limiting me to a certain food is too harsh on me.” As such, she does not strictly follow the dietary counseling sessions scheduled once in a month with her doctor. Her argument is that she does not have to be harsh on her diet. Although she does not have health insurance, her brother settles the bills. Mrs. Jones has little time left every day for cooking. In most of the days in a week, she comes home exhausted and the only thing she does is buy ready made food. Her boys, like herself, are fond of junk food. Junk food, which is a known poor diet among many populations, has been proved to be the cause of high prevalence of diabetes (Peyrot et al. 2005). However, Mrs. Jones is not alarmed by the quality of food she buys most of the times because she believes that her diabetic case is lenient and not so serious. Recently, Mrs. Jones joined Jehovah’s Witness church and she has not told her pastor whether she takes insulin injection. She believes in teachings regarding God’s healing power and soon she will wholly depend on God’s healing. She has already started by not limiting herself to a certain food, and she says nothing has changed for worse. She confesses that she is feeling better and that “a child of God should be in a position to eat everything without limitation”. Mrs. Jones has never disclosed her diabetic status to her neighbours in fear that they will stop treating her as a friend. Given that most of her friends are white, she does not want to look less human and diseased. At work, only her supervisor is aware. Her supervisor is black American, and he discovered about her condition during an incident when he took her to hospital after she collapsed in the office the last two years. Suspecting that she has been covering up her health status, he talked to her and declared his understanding and help in case she needed one. She pleaded with him not to tell any other workmate in fear of stigmatization (Goffman 1963). She divorced with her husband George five years ago. She says that her husband complained of her obesity and lack of sexual drive. “He said I was not able to satisfy him sexually” she reports. She further claims that it was indeed his discovery of her diabetic status that made him pack and leave. She still looks overweight, but stable and flexible. From the look of her, it is hard to detect whether she has been diabetic or have had health complications. Mrs. Jones’s mother, Mrs. Lorene Spencer, died of diabetes at 52. Her mother had type 1 diabetes, and she was extremely strict when it came to observing her regimen. Mrs. Jones is the second born in a family of two. Her mother was also a single mother who separated with her father. Her mother reported to her that when she was young, she was obese and transferred to many schools because of stigma. Mrs. Jones does not know more about her father’s health status, but her mother told her that her father left them after he felt that her mother’s condition was too much of a cost for him. Mrs. Jones is convinced she will not leave her family health history dictate her destiny and that of her children. She believes that although she has had what she calls ‘mild’ diabetes case, it is not like that of her mother, which was serious and destructive. She argues that if her mother lived for 52 years with a more serious condition herself can live for more and bring up her children to adulthood because she is aware her type of diabetes is less virulent. The patient narrative approach has been explained by Weiss and Brittens (2003) who argue that today the patient has become an equal partner in which he or she supports the ethos of shared decision making between himself or herself and health professional rather than traditional paternalism in which the patient was a passive participant. Listening to Mrs. Jones, it is clear that she does not understand her role in the disease she has. Mrs. Jones is a diabetic patient with type 2 diabetes and is not ready to continue with her full regimen. She argues that she cannot take medication and then limit her diet because her condition is not as serious as that of her late mother. She has stopped attending dietary counseling sessions, which were initially offered by her personal doctor. Her failure to comply with doctor’s advice and attending counseling sessions is common with other diabetic and chronic illness patients. Recent studies prove that compliance is achieved when the patient’s behavior coincides with medical or health advice (Rana & Upton 2009; Laine & Davidoff 1996). Against the doctor’s advice to check her diet, she believes that the treatment she gets from the drugs is enough to enable her cope with the disease without affecting her diet. The Health Belief Model by Strecher and Rosenstock (1997) considers the need for public health researchers to demystify the fact that few people must participate in programs meant and recommended to prevent or treat diseases. In this model, patients like Mrs. Jones are assumed to consider both health-related and non-health related results of their behaviors. Initially, the model of the theory contained four aspects which include: Perceived susceptibility, Perceived severity, Perceived barriers, and Perceived benefits. The model has been extended to include other components such as perceived cost of adhering to prescribed intervention as one of the core beliefs (Rosenstock 1966). There were also construction of mediating factors, which were added with an aim of connecting the various types of perceptions with the predicted health behavior and they include: Demographic variables, Socio-psychological variables, Perceived efficacy, Cues to action, Health motivation, and Perceived control. All these aspects play critical roles in contributing to the severity and nature of disease and illness. Mrs. Jones assessment of the seriousness of her diabetic condition and her choice to avoid dietary therapy has potential consequences that she needs to be informed about (Cohen et al. 1994). Irwin Rosenstock’s Health Believe Model (1997) can be applied to understand her condition based on perceived severity that she may not have knowledge about. Perceived severity is a patient’s opinion of how serious a condition and its consequences are, and for the case of Mrs. Jones her diabetic case to her is not a serious one to strictly limit her diet. She is aware that insulin injection is part of her life, but she does not agree that she will have to sacrifice her junk food. The health belief model talks of a perceived benefit in which a patient’s belief in the efficacy of the advised action to reduce risk or seriousness of impact is assessed (Strecher & Rosenstock 1997). In this case the perceived benefits in terms of positive consequences of adopting the desired eating behavior for Mrs. Jones and nutritional lifestyle are important. Mrs. Jones looks obese and she says her husband left her because he felt she was not sexually attractive and satisfying. From this narrative, it seems she is aware of the perceived threat, which involves the danger that her avoidance of dietary therapy poses. As such Mrs. Jones is not ready to undertake a recommended health action, which is supportive so as to achieve curative results. Mrs. Jones is also a mother of two who are also fans of junk food. She argues that she has no time to prepare them breakfast because she leaves early and she prefers buying food from the nearest fast food outlet for her sons and herself. There are many barriers to her adoption of the right dietary therapy as recommended for diabetic patients (Freeman & Loewe 2000). Perceived barriers include the influences that facilitate or discourage a patient to adopt the recommended dietary therapy (Peyrot et al. 2005; Freeman & Loewe 2000). This is for example as she states, the type of food she is supposed to be taking. She argues that “keeping up with vegetables and limiting me to a certain food is too harsh on me.” Recently, the health model has encompassed perceived cost of adhering to prescribed intervention to be one of the core beliefs in medication (Rosenstock 1966). To Mrs. Jones, adhering to dietary therapy is too harsh on her and she can also not afford to sustain diet when work and her children are chasing on her time. As far as her perceived efficacy is concerned, she is not in a position to juggle all the balls on the air for her. Mrs. Jones reports that her mother died of type 1 diabetes at age 52 although she was extremely strict with medication. Her daughter could have learnt a lot from her through labeling, in what is called a labeling process. The fact that she already talks of her mother being strict with medication is an indication that she developed her illness and sick role model from her mother. Labels are social constructions that a society gives to behavioral patterns, events, status and it can be negative or positive (Young 2004). For Mrs. Jones, her labeling of her mother’s behavioral pattern or handling of health cases was negative. Mrs. Jones is a black-American born in 1981 and lives in Los Angeles. Black Americans falls in the category of a race that faces discrimination (Hoffman 2000). Research has proved that social class is a key determinant of people’s health and the way they respond to health complications both physically and psychologically (Engel 2012). Mrs. Jones was born at a time when such discrimination was being advocated against, but her mother did not have enough to provide all what a middle class family could have needed. She was born at a time when her mother was a working woman and she did not have all Baby Jones could have needed as a child. Unemployment is one of the social causes of illnesses (Senior & Viveash 1998; Anderson 1986). The social determinants that have been examined by the current research include stress, work, social exclusion which was there for black Americans when Mrs. Jones was growing up (Engel 2012; Rosenstock 1966). The fact that race is was highly institutionalise at that time may have contributed to her family’s social class, which highly shaped her future (Kumagai et al. 2005). She is now a part time working woman and has to juggle between work and her two kids for whom she is both mother and father. This is explained by working women’s material circumstances as well as the fact that their social responsibility has to be fulfilled. Mrs. Jones has self imposed stigma and she is aware that stigma is prevalent in the society. For example, she does not want her supervisor to disclose her health condition to her workmates or any other person. This is understandable given that those individuals who possess traits that damage their identity for a lifetime in a way that prevents their full participation in the society, they carry a stigma; an attribute that destroys ones identity in the society (Goffman 1963). Stigma labels a person as being unacceptably different from the other people considered as normal in the society. For example, Mrs. Jones considered herself as abnormal and thus, she has to attain her normal status by not disclosing her abnormal side and pretend to be normal. Stigma is also understood and explained by Heatherton et al. (2000) as a social process; a feature of how people relate socially and reflect their tensions, conflict, silence as Mrs. Jones preferred, subterfuge and hypocrisy that is common in every human being and society. Mrs. Jones has joined a Church which is a significant factor in determining whether her treatment will be successful or not. Jehovah’s Witness followers are known to defy conventional medication, which Mrs. Jones needs the most. Therefore, her faith can affect her compliance and adherence to the treatment and regimen required of her (Hoffman 2000). Religion and belief is one among the six strands in the personal, cultural and structural (PCS) model according to Equality and Human Rights Group (2007). Duggan et al. (2006) analysis that understanding a patient’s social, economic and religious status will help doctors have the best approach to health situations. In conclusion, the biomedical model of approaching illness and disease is not sufficient in helping patients with chronic health conditions. The health narrative of Mrs. Jones proves that there are many factors that should be considered in order for her to be helped. Her family background, her race and social class, her psychological status, her economic status and her religion are just some of the explicit factors that comes into play when it comes to her compliance and attitude towards her diabetes treatment therapy and regimen. Modern approaches to medication based on patient narrative has proved to apply in her situation and based on belief model, bio-psychosocial model and other patient centred models, any physician will understand where she is coming from, where she is; and be in a position to predict her situation should she take a variety of choices. This way, a physician will be able to know the best approach to help Mrs. Jones continue with her therapy. Moreover, her narrative presents already researched cases of stigma, concordance and compliance, lay beliefs and others can help a doctor to know the best way to handle her case. References Anderson, R. M. 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