Illness versus Disease
Lawrence Pike
Illness and Disease
Introduction
Topics discussed include:
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The Clinical Iceberg
The Differences between Disease and Illness
Doctors and Patients Agenda
Illness Behaviour
The Sick Role
Assessing Illness
Illness and Disease
Irritable Bowel Syndrome and Dyspepsia,
have been associated with stress and
anxiety in medical textbooks. In fact,
control studies show that this is not the
case. However the more anxious sufferers
consult their doctor.
It is important to consider how this
misunderstanding has come about.
The Clinical Iceberg
90% of people declare themselves to have
been ill in the last 2 weeks
1 in 37 of symptom episodes will be
declared to Primary Care. This is the
Clinical Iceberg
Disease
What is Disease?
The biological process that doctors use to
explain and understand illness
Illness and Disease
The process of diagnosing disease is
central to medical education. This
becomes the doctor’s agenda
However in at least 25% of GP
consultations, no disease specific
diagnosis is available
We must understand then what the illness
means to the patient – the patient’s
agenda
Illness
What is Illness?
Definitions vary and patients and doctors will
disagree!
The patients experience of a physical or
psychological disturbance
Illness Behaviour
Symptoms of Illness may be differently
perceived, evaluated and acted upon by
different kinds of people.
This is sometimes called “Illness
Behaviour”
Illness Behaviour
Culture
Presentation
Health beliefs
Sex
Social Class
Access to health care
Learned behaviour
Triggers (home, work, TV, family and friends)
The Sick Role
Obligations
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Must seek professional help
Make an effort towards recovery
Privileges
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Exempt normal social obligations
Not responsible for incapacity
Assessing the Illness
Patient Centred Approach
Understanding the illness in the patient’s
terms
Responding to patient’s cues
Exploring Ideas, Concerns, Expectations
and Affect on daily living
Guard against making assumptions