This essay looks at the sick role and different definitions of health and illness, doctor -patient relationships and how health care systems affect the societies. In the first paragraph, the brief explanation of, how the concept of health differs with time, place and with some factors including age, gender, social class and culture. Then explain different definitions of health, including negative and positive (WHO) health definitions and the three Mildred Blaxter health definitions such as negative, positive and functional definition of health.
At the end of this paragraph discuss about the biomedical and social model of health and evaluate them. The second paragraph analysed the sick role- the patient two rights and two responsibilities- and its criticism. Functionalist theory of doctor-patient relationship and Barber (1963) arguments are explained briefly in the third paragraph. In paragraph four, the main ways that medical profession control society with the evidence of Illach’s theory are explained and evaluated.
Different ways medical professionals affected peoples’ life and supports the Illach’s theory and evaluation of the role of medical professionals in society are included in the fifth paragraph. Finally, the key issue relating to the political economy of the health industry are analysed and the summary of the essay are on the last two paragraphs respectively. Health and illness are terms that almost all people use in everyday life without giving them much thought. However, people define health in different ways because health is an individualised concept.
Therefore, health is not a static but one which is still changing with time and place. There is no universally agreed upon definition of health. According to World Health Organization “health is a complete physical, mental and social wellbeing and not merely the absence of disease and infirmity”(The WHO 1948). The WHO definition of health is a positive definition of health and overcome negative definition of health as “absence of disease” and comprised physical, mental and social realms. The layman understanding and definition of health influence by different factors, including- age, gender, social class, and cultural difference.
Mildred Blaxter (1990) in her case study, she identified the three major public definitions of health. They are a negative definition “absence of pain and discomfort” which is suitable for lower social class; young people define as positive definition “health as feeling fit and well” whereas, old people accept some level of discomfort and physical limitation hence, take a functional definition “health as being able to perform certain, often day-to-day, tasks”. Biomedical model approach was emerged in the 19th centuries with the development of germ theory.
It dominates the modern western medicine of health and illness. Biomedical model inclined toward the negative definition of health because it focused on ill health, rather than wellbeing and also reduced to simple physical cause of illness and treat them, rather than looking into other factors such as cultural and social aspect of health. They see the human body as a machine which would have parts that would need to be repaired and replaced as mechanics do. The WHO definition is perfect example of social model which emphasised on social, economic and environmental factors.
It also takes a holistic approach rather than taking individual parts of bodily systems and focus on what facilities are important for health, rather than what is the cause and treatment. Although it has so many advantages it also has some disadvantage, including clinical iceberg and inability to prevent all disease. Sick Role is, a concept created by American functionalist Talcott Parsons in 1951, the way of explaining the specific right and responsibilities of those the affected. Parsons defined health as an ability to perform the social role.
As a functionalist, he saw society as a set of interconnected parts and depend each other and individuals are productive members of the society. However, illness disturbs the functioning of the society in which they live: the sick are not producing as they deviate from normal social role and may require resources. Parsons believed that for deviance to be sanctioned medical experts must certify that a person is actually ill, a process that legitimated illness otherwise, the person considers as a malingerer.
Once the ill person is in sanction deviance, she has to perform the sick role in order to return her/his social role. Parsons described two rights and two responsibilities an ill person has associated with sick role. To be exempt from the normal social obligation, for example, to go to school, work or any family responsibilities and the sick must be cared for by his family. However, a patient has the responsibility to make getting well a priority and responsibility to seek appropriate treatment and co-operating with medical experts.
The Parsons’ sick role is influential in medical sociology and it was a good idea for many researches. There have been a number of criticisms of the sick role. First, his theory of recovery for all does not apply for chronic illnesses/permanent condition, for example; diabetes, blindness, heart attack and cancer to name but a few. Second, a number of researchers have pointed out that visiting the doctor may be the last stage or decision, especially for lay person groups, for example, according to Scambler (1991),’the majority of patients consult widely with non-medical contacts before deciding to visit a doctor.
Third, stigmatised illness sufferer, for example STD’s, does not visit doctor or is no accepted as legitimately sick. Fourth, there is a biased on the kind of treatment provided- different treatment and doctor-patient relationship variation according to social class, gender, age and ethnicity. The nature of the doctor-patient relationship determines the success of treatment in health care practice (NHS). In a good doctor-patient relationship: a good doctor should use a patient centred approach with caring, full confident, knowledgeable and trustworthy, and interpersonal and communication skill.
The patient also takes responsibility for his condition, do not give up his life or deny his illness and should be interested to acquire knowledge be looked after. Functionalism is the earliest doctor-patient approaches which was conceived by Talcott Parson in 1951. They believe that good health and effective medical care are essential for the smooth functioning and prosperity of the society. Patients must perform the Parson’s model of sick role in order to be recognised as legitimately ill and to be exempt from normal social obligations.
Doctors take on the role of parents and have absolute power on patients (paternalistic): the information/decision flow only from expert to the patient and the patients act as passive participants who follow/co-operate the doctor’s rule this is known as doctor centred approach. Barber (1963) is one of the functionalists who support the importance of medical experts in the society. He argued that doctors are paramount important, especially for people who are in vulnerable positions. They work for social interest to create a better society by providing high standard medical care for the society.
According to functionalists, true professionals can be identified by the fact that they share a number of ‘traits’. The traits are: they have fully theoretical updated knowledge which allows them to make independent decisions about the cause and treatment of the diseases, doctors are fully trained and have taken the highest standard examination- only the most intelligent can enter the medical professions and success, They follow strict codes of conduct to ensure that no patient is exploited and deal with people at their most vulnerable and the General Medical Council(GMC) regulates and controlled the doctors rights and duties.
Medical professionals and pharmaceuticals may introduce the concept of medicalisation to control society. Doctors gain significant prestige and power through the idea of science, professionalism and medicalisation which play a major role in constricting the idea and redefine the concept of health in the society. There are so many ways medical professionals control the society to ensure their continuity and profits.
The doctors rely on medicines instead of educating how the patient takes personal responsibility for their own health; the patients have no choice except to believe blindly and schools and institutes medical check and vaccinations are the main ways of controlling society. The strength of medical professionals is monopolised their market and medicalisation. Medicalisation can take three forms- first the doctor’s ability to redefine the lay approaches of illness, according to open medical intervention, for example, mental illness was redefined as psychiatric condition and medicalised in the late 18th century.
The importance of advanced and standard quality care and treatment, for example, better drugs, brain scanning, surgical technics and antibiotic to be named but a few are the second element of medicalisation. The last element of medicalisation is marginalisation of alternative medical therapies. However, the actual and the long term possible effect of medicines raised conflicts between the interest of patients and doctors. For example, Ivan Illich (1974) promotes the effect of medicalization on an individual as well as on the society and called medical nemesis.
The sick role and doctor’s rights give absolute power to the doctors to decide people’s life, for example, what is symptom, which pain is need attention and who is malingering and medicine as a moral enterprise which dictates what is normal, proper and desirable. He argues that all deviance has a medical label. For example, to drive a car, to exempt from your responsibility, to be detained, become soldiers you have to get medical status from a doctor. They can also treat unethically, especially in mental hospital doctors give medication for patients without consent and without respect patients’ right and dignity.
An effective, high quality care improves the quality of life and increase life expectancy in the society. However, medical errors from medication and others intervention have an adverse on patients as well as in care sectors. According to The Daily Telegraph headline, one patient in 20 is dying by potentially serious medical errors. Medical error can be inappropriate or incomplete diagnosis and/or treatment of disease, infections, injury, syndrome, inappropriate behaviour and long term effects of medicine.
Illich argues that medical errors/ iatrogenesis, clinical mistakes and harmful effect of medicines, kill/suffer more than from any other single causes, with the exception of malnutrition. Illich’s analysis is built upon three categories of iatrogenesis, namely Clinical, social and structural iatrogenesis. Clinical iatrogenesis is an injury done to the patients with inappropriate and/or inaccuracy treatment/diagnosis. For example, according to German newspaper report (1961), 10,000 people in Germany are born with phocomelia by Thalidomide which cures Morning sickness.
Social iatrogensis is the second type of iatrogensis, transforming social problem to technical problems and try to cure by using medicines. The third one is structural itrogensis, distraction of patient’s independence to cure themselves in traditional ways, become depending on doctors. He concluded that the negative impact of health care greater than the positive one, so we would better off without modern health care. Although medical errors and medicine side effects are the negative impact of health care services, they have so many advantages in human life.
Medical health care increase life expectancy, decrease morbidity and infant mortality and improve people’s life. For example, Polo and smallpox can be eradicated by vaccination; ARVs improves immunity of HIV infected body. All in all without modern health life can be impossible and only imaginary. The health care sectors are business sectors, which has competed and unequally distributed among people. Marxist argues that health professional are agent of capitalism who gives priority for profit rather than health. Doctors treat labours to avoid the disturbance of capitalists’ productivity due to illness and to increase the work productivity.
Poorer people’s health exchange for the capital growth of the riches, commodity work influence of the workforces’ health in different ways, for example, dangerous chemicals from industry , lack of sleep due to overtime and shift work, deskilling ,to name a few. Working class people live nearby polluted industries and use cheap processed foods which have high risks for health, but doctors skewed the cause of illness of the patients rather than telling them the truth. Health is a multidimensional approach which is difficult to define with a single definition.
It is a dynamic concept and different factors influence to define health. There are two main ways of health definition are popular in professional level- WHO definition of health which is suitable for the social model of health and the negative definition of health “ absence of disease” was emerged with germ theory and fit for a biomedical model. Parson’s sick role helps to create integrated relationship between illness behaviour and medical care system. On the other hand, it encourages doctors to drive peoples’ life and take away people’s responsibility to protect themselves and their environment.
They also control the society by using professionalism and medicalisation. There are different criticisms and conflict in biomedical approach which has dominated the world market because of control the society, inequality and medicine side effects. However, its advantage is outweighing the disadvantage. I believe that the high standard medical care system is very important for human life and economic growth of the society. However, the government and medical professionals have to assess and control to avoid the negative impact of health care system.
