Definitions Of Health, Disease, And The Doctor-Patient Relationship: A Sociological Perspective

Health, disease and the sick role

Explain the definitions of health and critically evaluate ways in which the midical profession exercise social control with reference to the sick role the doctor/patient relationship and how the medical profession contribute to ill health.

It is very important to have a clear idea about health, disease and illness for those who associated with the healthcare field. The lay definition of health vary and factors like culture, gender, age and social class are variables that impact the insights of health. The concept of sick role shaped by an American sociologist Talcott Parsons in 1951, plays a vital role between the patient behavior and care givers.  Medical profession experiences many social influences and the ways in which medical profession exercises social control is a matter of concern. There are my sociological approaches that affects doctor and patient relationship. The fundamental principles of biomedical model and social model provides two different frameworks of healthcare system. Not only the social determinants affects medical profession but also political economy has a great influences on this sector. Health becomes a political and ethical issue. There are many vital theories and models that have changed people’s perspective towards health industry and also helped to evaluate medical profession’s contribution of ill health.

Health is a condition of entire physical, mental and social comfort and not just the non-appearance of illness or disability. Health is soundness of body which can be disrupted by any physiological, psychological or biochemical deviance. Disease is a specific anomalous state, a malady of a function or structure that distresses body and mind. The study of disease is known as pathology. Disease is often interpreted as a medical situation associated with particular signs and symptoms (Lupton 2012). The sick role is the set of rights and responsibilities that surround sickness and shape the behaviour of physicians and patients (Frank 2013). According to Bowling (2014), social and biomedical models also help doctors to improve the practise of patient care. The biomedical model of health emphases on the biological or physical aspects of illness and disease. This model is associated with diagnosis, treatment, cure and practiced by healthcare professionals. The social model of health is conceptual structure within which developments in wellbeing and safety are attained by aiming efforts towards the social, economic and environmental factors of health. These models can be better understood by the research findings of Mildred Blaxter. She investigated fluctuating explanations of health-describing it as ubiquity, normativity, functionality, biomedical and social.  Her work demonstrates the essence of association between organization and structure which culminates in the elevation of individuals’ self-advocacy in matters of wellbeing. Blaxter used ill health and the stigma of mental illness as examples of reactions for identification of nonconformity in health. Her discussions focus on the structures that influence health outcomes for individuals, causes and extent of social, environmental and structural inequalities of health. Blaxter continues to view health as a social and political subject and shows the relationship and complex interplay between gender, social class, ethnicity, age and experience. She highlighted the area of biomedicines, novel technologies and new ways to understand the human physiology (Jutel 2015).

The doctor-patient relationship

The doctor-patient relationship is fundamental to the healthcare practice and is vital for the supply of superior quality of healthcare for improved diagnosis and treatment of diseases. The healthier the relationship in terms of mutual respect, trust, familiarity, communal values and perceptions about life and disease, the better will be the volume and quality of information about the patient’s sickness, improving correctness of diagnosis and growing the patient’s understanding about the disease (Purtilo et al. 2014). According to the functionalism approach, improved health and advanced medical care are needed for the even running of society. As stated by Cockerham (2014), patients should accomplish the sick role in order to be perceived as legitimately ill and to be freed from their standard obligations. The patient-doctor relationship is hierarchical: The doctors delivers guidelines and the patients need to maintain them. Marxism construed the doctor-patient relationship within the milieu of capitalism. In the Marxist analysis, the doctor-patient relationship is accustomed by the “medical-industrial complex”, profit-maximization drives the improvement of technologies and drugs and compels physician’s decision-making. This approach can create conflict between patient-doctor relationships. Parallel to, and often incorporated in the Marxist approach, has been the developing feminist literature on medicine. Feminists have concentrated on the patriarchal nature of the male doctor-female patient relationship, recording the account of medical science that has depicted females as congenitally fragile. Female practitioners tend to take poorly rewarded primary care arenas over the more profitable, male-oriented surgical specialties, are more likely to be working as divergent to in private practice, and are less likely to be in loci of authority. Women physicians are also better communicators. Thus, the feminism approach may have a positive effect on doctor-patient relationship (Jackson and Neely 2015).

In connection to healthiness, sociological approach would draw upon quantifiable data resulting from community surveys, epidemiological investigations and relative studies in order to point out the influence of sociological structures and procedures in determining health outcomes for social groups. One sociological approach is the symbolic interactionist approach highlights that health and illness are social constructions. This proposes that several physical and psychological disorders have minute or no objective certainty but instead are deliberated healthy or diseased state only if they are described as such by a community and its people. This approach has also delivered significant studies of the interface between patients and health-care specialists. Critics said that this approach neglects the consequences of social inequality for health and sickness. In spite of these probable faults, the symbolic interactionist approach reminds people that health and illness do have a subjective as well as an objective reality (Cockerham 2014).

Ways in which medical profession exercises social control

It is believed that the physicians are the agents of social control in relation to the patient. The sick role includes a suspension of performance potentials allied with an individual’s routine social life such as potentials of working productively, caring for family or attending the meeting of a community association. It becomes the physician’s responsibility to provide guidance and treatment to return patient’s health and facilitate them to achieve expectations of everyday life. Therefore, the doctor becomes an agent of social control (Tuckett 2013). Many author claimed that the means by which the diseases are defined and labelled is a form of social control. Problems of the patients are individualized instead of being seen as societal in origin and failure to adapt to social standards may lead to a label of being sick or diseased (Tuckett 2013 and Cockerham 2014).

Ivan Illich subjected modern medical science to detailed attack. He discussed that the medicalisation in recent decades frequently caused more harm than good and affected many people as lifelong patients. He introduced people with the concept of iatrogenic diseases (Goldenberg 2013). The theories of Illich is a step backword in nature. His arguments are on a high, abstract level and when brought down to reality of practical patient care, they turn into obscure and meaningless thoughts. Some of his points are coming into focus more and more, that there is basically not adequate money to make technological medicine viable for all. Thus, concern must be grown and physician must lead the way (Davis 2012). The public must be fully informed and the medical profession must select what people need from medicine and how much they are prepared to pay for it. An active health education program is essential and the public must accept, focus on modifying life-style and habits to escape serious diseases (Goldenberg 2013).

The role of health providers is diverse with the changing environment of care giving (primary, secondary and tertiary care) and a range of subspecialties. Healthcare professionals evaluate, diagnose, and treat the physical problems and behavioral dysfunctions resulting from physical and mental distress (Peabody 2015). In addition, they perform a critical part in the advancement of health status, preventing diseases and improving quality of life of patients. Healthcare professionals perform their clinical roles according to demanding ethical values and code of conduct (Macdonald 2013).

The term iatrogenesis is known as doctor-made diseases and can be categorised into three major types:

1. Clinical Iatrogenesis: It comprises all medical conditions for which hospitals, physicians and treatments are the pathogenic or sickening agents. It is known as overabundance of therapeutic side effects (Davies 2012, Hinze and Taylor 2016).
2. Social Iatrogenesis: Medical practice promotes sickness by emphasising a morbid civilization that not only industrially conserves its defectives but also exponentially breeds demand for the patient role. This type of iatrogenesis finds its manifestation in countless symptoms of social over medicalisation (Davies 2012 and Goldenberg 2013).
3. Structural Iatrogenesis: It is the eventual reaction of hygienic development and involve the paralysis of healthy reactions to suffering. It assaults when public receive health management planned on the technological model, when they collaborate in an effort to create superior health which certainly consequences in heteronomous conservation of life on high intensities of sub-lethal level (Davies 2012, Hinze and Taylor 2016).

The most important part of health care industry is to maintain the political economy. Mooney (2012) stated that healthcare offers a typical model of political economy because it lies at the heart of the evolution of capitalism. The political economy of health is a body of analysis and a standpoint on health policies which explores to recognise the environments which form population wellbeing and development of health services within the broader political and macro-economic background. Though, the relations between economic growth and healthcare advancement are complex and can be evaluated in terms of diverse linkages such as economic development increases the resources for healthcare, improves living environments and enhanced health amenities.

Marxian theory accounts from a specific social theory conjoining health industry with conceptions such as class, ideology, commodification and objectification to show the exploitation  and inequalities of  healthcare industry  in  capitalist  society,  and  the  ability  of  medicine  to  harness  the newly shaped complications to construct new markets and gain profit from human sufferings (Collyer 2015). Commodification (Marx’s political theory) is used to define the practice by which something which does not have an economic importance is assigned a value and hence how market values can swap other social standards. Furthermore, with commodification, health becomes a product to be sold and brought. It often becomes a commodity. Interactions between health authorities and patients are purchased on the market and new requirements are constantly formed in chase of profit. According to Marx, the health care is not commodity and making it as such can be deleterious to the ethics of patients care. Health care industry is holistic approach towards human good and moral societies should have a responsibility to protect it from the market ethos.

Conclusion

The contribution of medical profession to ill health is enormous. Health care professionals devote themselves for patient care and improvement of the healthcare industry. It is very vital to evaluate the importance of sick role, doctor-patient relationships, medical social controls and political economy of health industry. The medical social theories provide help to understand the complications of health industry and ways to overcome them. A clear viewpoint of medical professionals towards these issues can enhance the holistic approach of healthcare.

References

Bowling, A., 2014. Research methods in health: investigating health and health services. McGraw-Hill Education (UK).

Cockerham, W.C., 2014. Medical sociology. John Wiley & Sons, Ltd.

Collyer, F., 2015. Karl Marx and Frederich Engels: Capitalism, Health and the Healthcare Industry. In The Palgrave Handbook of Social Theory in Health, Illness and Medicine (pp. 35-58). Palgrave Macmillan UK.

Davies, R., 2012. Ivan Illich on medical nemesis. Nurse education today,32(1), pp.5-6.

Frank, A.W., 2013. From sick role to practices of health and illness. Medical education, 47(1), pp.18-25.

Goldenberg, S., 2013. Discovering medical nemesis. Journal of Continuing Education Topics & Issues, 15(1), pp.10-13.

Hinze, S.W. and Taylor, H.L., 2016. medIcal socIology. Institutions Unbound: Social Worlds and Human Rights, p.9.

Jackson, P. and Neely, A.H., 2015. Triangulating health Toward a practice of a political ecology of health. Progress in Human Geography, 39(1), pp.47-64.

Jutel, A., 2015. Beyond the sociology of diagnosis. Sociology Compass,9(9), pp.841-852.

Lupton, D., 2012. Medicine as culture: Illness, disease and the body. Sage.

Macdonald, J.J., 2013. Primary health care: Medicine in its place. Routledge.

Mooney, G., 2012. The health of nations: Towards a new political economy. Zed Books.

Peabody, F.W., 2015. The care of the patient. Jama, 313(18), pp.1868-1868

Purtilo, R.B., Haddad, A.M. and Doherty, R.F., 2014. Health professional and patient interaction. Elsevier Health Sciences.

Tuckett, D., 2013. An introduction to medical sociology. Routledge.