CSI Session 1 (19/10)

2 Freshers Events
Persistent coughing
Bad sleep

History
What has happened to the patient
Listen to what they have to say

Did the symptoms start gradually or quickly?

Do you feel it mainly in your nose and throat, or in other parts of your body too?
Do you have muscle fatigue?

Common things are common – not always the case that it is only flu or common cold. It may be
glandular fever – you need to keep it in the back of your mind

 Covid, Common cold and flu are all caused by viruses

Influenza binds to sialic acid + galactose, which is very far down into the lungs
The common cold (rhinovirus) binds to ICAM1 which is further up the lungs
This is why influenza is a lot worse compared to the common cold, as it affects the lungs deeper
down.

Risk Factors for the Common Cold + Influenza

Age
Immune Disorders
Obesity
Chronic Illnesses
Poor diet
Crowding
Alcohol
Lack of sleep

Moderate exercise is good

Intense exercise produces cortisol which is an immunosuppressant
Stress also produces cortisol which is why more stress can lead to susceptibility to colds and viruses

Illness Behaviour – How you act and what measures you take based on your experiences
E.g. Why do people choose to see the doctor, for family reasons…?

Illness behaviour could include:

Interpersonal Crisis
interference with Social or personal Relations
Sanctioning
Interference with vocation / physical activity
Temporalising

Zola’s Triggers
(Irving Zola, 1973. Zola was an American activist and writer in medical sociology and disability rights)
Key ideas:
 Most people could be found to have a symptom (or symptoms) frequently, if not all the time
 The frequency and/or seriousness of symptoms are not good predictors of seeking medical
attention
 Most people make decisions to seek (or conversely not to seek) help that to them are
rational, when framed in terms of their own beliefs and values (i.e. their own view of
reality).
Zola suggested that health-seeking behaviour for a symptom or illness may be triggered by:
1. The occurrence of an interpersonal crisis
2. Perceived interference with social or personal relations
3. Sanctioning by others
4. Perceived interference with vocational or physical activity
5. Temporalizing (for example setting a deadline, i.e. "I'll go to the doctor if my fever is not
gone by Monday")

Helman’s folk model of illness:

(Cecil Helman, 1981. Helman is a medical anthropologist)
This model suggests that a patient considers the following questions when faced with possible illness
(and more specifically has these questions in mind when seeing a doctor):
1. What has happened? This includes organising the symptoms and signs into a recognisable
pattern, and giving it a name or identity
2. Why has it happened? This explains the aetiology or cause of the condition
3. Why has it happened to me? This tries to relate the illness to aspects of the patient, such as
behaviour, diet, body-build, personality or heredity
4. Why now? This concerns the timing of the illness and its' mode of onset (sudden or slow)
5. What would happen to me if nothing were done about it? This considers its' likely course,
outcome, prognosis and dangers
 6. What should I do about it - or to whom should I turn for further help? This considers
strategies for treating the condition, including self-medication, consultation with friends or
family, or going to see a doctor

Takeaway Points
Respect the patient and think about what they want – you may make a great diagnosis, but they may
reject it
Think about how long term the problem is – did it just start or perhaps it started years ago. Maybe a
year ago they could climb up 5 flights of stairs but now they can only climb up 2