The danger of the sick
role!
S
What is the sick role?
S The model of the sick role, which Talcott Parsons designed
in the 1950s, was the first theoretical concept that explicitly
concerned medical sociology.
S Parsons used ideas from Freud’s psychoanalytic theories as
well as from functionalism and from Max Weber’s work on
authority to create an ‘ideal type’ that could be used to shed
light on the social forces involved in episodes of sickness.
What is the sick role?
S ‘Being Sick’ is not simply a ‘state of fact’ or ‘condition’, it is a
specifically patterned social role. In Western Societies the sick
role implies four major expectations which comprise of two
rights and two duties. (Parsons: 1951:436-7).
S Sick person temporarily exempt from ‘normal’ social roles. The
more severe the sickness the greater the exemption.
S Sick person generally not held responsible for their condition
(absence of blame). Illness considered beyond individuals
control therefore not simply curable by willpower.
S Sick person has a right to be taken care of.
What is the sick role?
S Sick person expected to see being sick as undesirable, thus
they have an obligation to try to ‘get well’. In this context
exemption from normal responsibilities is temporary and
conditional upon wanting and trying to get better.
S The sick person has an obligation to seek technically
competent help from a suitably qualified professional and
to cooperate in the process of trying to recover.
Criticisms of the sick role
S These seem to be endless and really simply update it a bit
but to get bogged down trying to understand these to me
misses the point! Within our society and cultures a version
of the sick role permeates through. The real questions are:
S Is it important and relevant to us as Drs?
S If it is important how should it influence our practice?
What if your diagnosis triggers
a sick role?
S Pitfalls of the "Sick Role"What Happens When the Attention You
Get for Feeling Sick Goes Away?By J. Buzz von Ornsteiner, Ph.D
S We all want attention, or love, or at the very least a symbol of
concern. For many people, if we receive any attention at all it is
usually when we are in emotional pain or physical illness.
S it is not unreasonable to wonder what you maybe losing as you
continue to gain your health back and run the risk of losing all
these "payoffs.”
S Some psychologists theorize that illness can be, in part, a
conscious creation.
What if your diagnosis triggers
a sick role?
S In the case of an adult with a life-threatening illness, there
may be concerned friends, parents, social services agencies,
and others who unknowingly contribute to the illness by
developing a structure that makes the person more
dependent on them. By losing independence, some may
develop a love of being dependent and a continued
attraction to being in the "sick role", something we all may
have learned in childhood.
Who’s had an experience of
being in the sick role?
S Lets be honest there is little doubt we have all ‘milked’ being sick
at some point in our life even if we don’t care to admit it!
S Who’s had ‘man flu’ – I haven’t it was real flu.
S The way the ‘sick’ are treated by those around them in our culture
is often counter productive.
S “sit down you need to rest” (hang on no I don’t I need to do the
opposite I’ve been sitting on my backside the last 3 days!)
S (Can Med Assoc J 1997;157 [4]:383-9), by Drs. Anne M. Stiggel-
bout and Gwendoline M. Kiebert, we learn that
“the mere fact of being a patient leads to a shift in preference away
from participation.”
How dangerous is a diagnosis?
S Diagnosing IBS in a 10min consultation could shape every aspect of
a patients life for the rest of their life.
S It may change diet and social interactions around food
S They may gravitate towards different people who are more
sympathetic to their ‘condition’.
S It may influence when and how they socialize
S It may affect their work and relationships.
S Whenever they are nervous they will think they are unwell
S It may be an unhealthy way for them to seek the love and attention
they always wanted
How dangerous is a diagnosis?
S I think the answer is it can be very dangerous – potentially?
S There are of course those cases where patients adopt the
sick role and function poorly despite reassurance but I still
not sure giving them a diagnosis is the right answer are you?
S With great power comes great responsibility (Spiderman)
The message
S Never be afraid to question a diagnosis and look at it in
detail – is there any doubt?
S Before you pronounce the verdict of your considerations for
a second remember the person in front of you and diagnose
to help them only, if there is doubt be open and honest, no
one can ask for more.