Friday, September 01, 2006

Using and Misusing Health Services

Using health services

Kasi and Cobb (1966a, 1966b) made a distinction between illness behavior and sick role behavior. Illness behavior consists of the activities undertaken by people who feel ill— before they are diagnosed. These activities are oriented toward determining one's state of health and discovering suitable remedies. Sick role behavior is exhibited by people who consider themselves ill, either because they have bee diagnosed as ill or they diagnosed themselves as ill.

Obviously illness behaviours will influence whether you use a health service or not. These can include:

Personal Reluctance: Feldman (1966) found that most people were willing to advise other people to see a doctor but, with the same symptoms, were less likely to go to the doctor themselves.

Social and Demographic Factors: Women are more likely to use health care than men. This difference exists for both frequency of doctor visits and in the number of hospitalizations (Rosenstock & Kirscht 1979). Nor is the difference due to pregnancy and childbirth; it persists even when these two reasons are excluded. One possibility for this discrepancy is that our society allows women to seek many sorts of assistance, whereas men may be taught to act strong and to deny pain and discomfort.

Cultural and social factors also affect how people respond to symptoms. David Mechanic (1978) reviewed several studies that found varying attitudes toward illness in different ethnic groups. Jewish Americans, for example, were more likely to seek professional help, accept the sick role, and engage in preventive medical behavior; Mexican-Americans tended to ignore some symptoms that doctors felt were serious and to inflate others that doctors regarded as minor; Irish-Americans tended to stoically deny pain. These differences demonstrate the powerful effects of socialization on illness and sick role behavior.

Symptom Characteristics: Mechanic (1978) listed four characteristics of the symptoms that determine one's response to illness -

1) Visibility of the symptom

2) Perceived severity of the symptom

3) Extent to which the symptom(s) interefere with the person's life.

4) Frequency and persistence of symptom(s)

The sick role will also affect how health services are used. The Sick role was first conceptualised by Talcott Parsons. He identified three assumptions upon which it is based -

1) Lack of Blame: Parsons's main point was that society relieves sick people from responsibility for their illness, a situation that helps people assume sick role behaviour.

2) Relief from Normal Responsibilities: The second feature of the sick role in our society, according to Parsons, is the exemption of the sick person from normal social, occupational, and family duties.

3) Desire to Get Well: Our society tends to assume that sickness is a temporary state and that sick people should be actively involved in their own cure.

People who adopt the sick role will be more likely to use health services because of the above 3 factors.

Misuse of health services

When we talk about people misusing health services we are often referring to people who are wasting health workers time and resources. Such people may experience the psychological state known as hypochondriasis (magnifying bodily experiences so that extreme illness is thought to be occurring) and also be emotionally maladjusted in some way. Paul Costa and Robert McCrae (1980, 1985) have demonstrated an important link between hypochondriasis and emotional maladjustment/neuroticism. These researchers tested about 1,000 normal adults, using two self-report scales: (1) the Comell Medical Index to assess the Ps' "somatic complaints," that is, medical conditions or symptoms, and (2) the Emotional Stability Scale to measure neuroticism. The Ps were in generally good health and ranged in age from under 20 to over 90. Analysis of the questionnaire responses showed that somatic complaints increased with neuroticism; individuals who scored high on neuroticism reported two to three times as many somatic complaints as those who scored low on neuroticism.


At 7:47 AM, Blogger david said...

In my opinion doctors seem to proscribe tablets far too easily, this is causing the medical practices to spend far too much money on these "pills". The medical industry should take the bill for this seen as though they are the ones issuing the tables without a thought! It could also be considered a type of Medical Negligence

At 3:45 PM, Blogger Aaron Grey said...

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Aaron Grey
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