Patient – Doctor Interaction

By
Dr A.A. Adejimi
 Learning Objectives
The students should be able to:
• Understand the health beliefs and lifestyles
• Describe the types of doctor-patient
relationships
• Understand the concept of sick role
• Understand the patient-physician role
 Outline
• Introduction
• Health Beliefs and Lifestyles
• Types of Doctor-Patient Relationships
• Concept of Sick Role
• Patient-Physician Role
• Conclusion
 Introduction
• Illness is a social state.
• It is not just a disturbance of body and has social
meanings and impact
– i.e. it is partially the result of disease but is also
determined by social and cultural factors
• Sometimes a distinction is made between disease
(medical definition) and illness (lay person’s
perception) as someone
– Can be sick but no symptoms
– Can feel ill but no disease/condition
 Introduction (2)
• Williams (1983) found that lay definitions of
health consisted of:
– Absence of disease
– Functional fitness
– Health as dimension of strength, weakness &
exhaustion
• Definitions of health vary between social,
geographical & cultural contexts.
• Lay epidemiology is important to perception of
disease prevention and health promotion
 Health Beliefs and Lifestyles
• Sociology of lay health beliefs is of value to public
health:
1. Can contribute to an understanding of professional-
patient interactions
2. Can provide insight into lay conceptualisation which
affect compliance and health seeking behaviours
3. Can give meaning to people’s ideas about health
maintenance and disease prevention which is
crucial to the effectiveness of health promotion
4. Can contribute to our knowledge of informal
healthcare (i.e. carers)
 Types of Doctor-Patient Relationships

Low High
Physician Physician
Control Control
Low Default Paternalism
Patient Control

High Consumerist Mutuality

Patient Control
 Influences on Doctor-Patient
Relationship
• Doctor’s orientation & practice style
• Doctor’s communication skills
• Influence of time
• Influence of structural context
• Patients’ expectations and participation
• Conflicts in doctor-patient relationship
 Concept of Sick Role
• The sick role represents the behavioural pattern of
sick people.
• According to Talcott Parsons (1951), being sick is not
a deliberate choice of the sick person even though
illness may occur due to exposure to infection or
injury.
• The sick person usually is unable to take care of
himself, and that is why it is necessary for him to
seek medical advice and cooperate with medical
experts
 Concept of Sick Role (2)
• The specific aspects of the sick role include the following:
– The sick person is exempted from “normal” social roles. The sick
has an exemption from normal role performance and social
responsibilities because of the state of his or her health. In some
societies, the more severe the illness the greater the exemption.
– The sick person is not responsible for his or her condition. A sick
person’s illness is assumed to be beyond his or her own control.
– The sick person should try to get well. Since being sick is an
undesirable condition, the sick individual must have the desire
to regain normal health.
– The sick person should seek medical advice and cooperate with
medical experts. The desire to get well by the sick person must
inevitably lead to his being desirous to cooperate with the
physician and other health workers.
 Concept of Sick Role (3)
• Reasons for seeking medical help and advice by
the sick include:
– undesirable state of ill health;
– Normal social functioning which is being affected by
illness and disease;
– Illness is a kind of grievance;
– Human potentials, and capabilities can be reduced by
illness; and
– in most societies, illness brings stigmatization on its
victims.
 Functionalism
• Talcott Parsons (1951):
– Physicians main function consisted of normalising
‘deviant’ illness through invasive treatment of the
body
– When physicians assigned the ‘sick’ role to patients,
they legitimatize a temporally limited state of
deviance
– In Parson’s theory, physicians not only treated
people to retake their roles in the labour force and
other institutions but they verified the legitimacy of
illness, defining what qualifies as a bona fide reason
to abandon temporarily responsibilities in society
 Sick Role
Talcott Parsons (1951):
• Illness is disruptive for society as sick people
are not able to fulfill their normal roles. It is a
form of deviance.
• Society instituted a special role for sick people
that functions to control amount of illness in
society and to return sick people back to state
of health as quickly as possible
 Sick Role
• Two Rights
– Sick people are exempt from performing
their normal social roles
– Sick people are exempt from responsibility
for their own state
• Two Obligations
– To get better as soon as possible
– To consult and co-operate with medical
experts whenever severity of condition
warrants it
 Components of Sick Role
• Promotes individual health
• Social control of occupancy of status ‘sick’
– Doctor as gatekeeper (legitimates illness
and occupancy of sick role)
– Privileges dependent on duties
• Promotes health of society
– Controls number of people opting out of
normal roles & responsibilities
– Returns sick people to health
 Difficulty with Sick role
• Difficult to apply the sick role theory to
chronic illness
– Permanent state
– The requirement is to enhance functioning and
not encourage dependency

• Friedson (1960) pointed out that physicians’

social functions extend far beyond the policy
of sick role and process
 Patient-Physician Role
• The Patient-Physician role involves mutual
relations between two parties with the patient
on one side of the party while the physician
on the other.
• Each participant in this social situation is
expected to be familiar with his expectation as
well as the expectation of the others in the
same social situation.
• The patient usually has a conception of what a
physician is in terms of the social role.
 Patient-Physician Role

• Also the patient is expected to recognize the

fact that being sick is undesirable and that he
has an obligation to get well by seeking the
physician’s help.
• The physician in turn has an obligation to return
the sick person to his/her normal state of
functioning.
• The patient-physician relationship should be
mutual as a kind of behavioural expectation.
 Conclusion
The patient- physician interaction is a social
situation which is intended to serve some
therapeutic functions in most societies and
promote some significant change in the health
of the patient.
Thank you for listening