ILLNESS BEHAVIOR: Patient Thinking & Feelings

Illness behavior can be defined as ―How a person feels, thinks and reacts to his illness‖. The patient health understanding influences the way symptom is perceived, and what prompts a person to consider himself in need of medical advice is a complex decision. It does not correlate with the true seriousness of the illness or the doctor‘s perception of a need to consult. In other words, patients are poor judges of illness and take decisions often at variance with what doctor believe to be the correct use of the services. The likelihood of deciding to visit the physician depends on many factors, which are going to be discussed in this session.

 

Objectives:

•  To increase learners understanding of patient's suffering

•  To increase learners understanding of human behavior.

•  To help learners to see the full picture of patient's problems (Bio-psychosocial dimensions)

•  To identify the factors, which affect patient's health believes and illness behavior.

 

Question: A young healthy man has a low-grade fever.

He may react to it by:

1.  Neglect

2.  Taking time off work

3.  Self medication

4.  Visiting his Family Physician

Answer: 20% of the patients neglect their illness.

 

Question: A young healthy lady has a high fever.

She may react to it by:

1.  Neglect

2.  Taking time off work

3.  Self medication

4.  Visiting her Family Physician

Answer: 75% of the patients they may try to help them selves by rest & self medications

Why self-care increased these days?

•  Shift from acute to chronic diseases

•  Public dissatisfaction with medical care

•  Recognition of limitations of modern medicine

•  Increased visibility of alternative medicine

•  Increase awareness about the effects of lifestyle on health

•  Desire to exercise personal control Question 3.

 

Question: A young healthy lady has a high fever for two weeks.

She may react to it by:

1.  Neglect

2.  Taking time off work

3.  Self medication

4.  Visiting her Family Physician

Answer: 5% of the patient visiting their Family physician only

1% of them need referral to hospital out patient

5 per 1000 need hospital admission

The real reasons of patient attendance:

Symptoms (presenting complaint) is not the only reason for patient seeking medical help; the real reasons are:

•  Patient‘s believes & worries

•  Factors affect patient‘s believes & worries Fact 2.

The psychological dimension of any illness: As health is the most precious thing anyone can have, so anyone who comes to a doctor with a problem is in a disadvantageous position, worried, vulnerable, weak, forced to acknowledge that a problem exist which cannot be coped with unaided … . The state of illness is also a threat to self-esteem (Balint 1957). Fact 3

The Tip of The Iceberg: Many minor conditions are extremely common and it is normal for people to feel ill a lot of the time, but only small proportions (about 20%) consult their physician. This 20% of the patient are called the clinical tip of the iceberg

Speculate possible causes of denial of illness?

• It is not easy for the patient to show his/her weakness

•  ……………………………………………………………………………..

•  …………………………………………………………………………......

 

What does patient want from his/her physician?

Cecil Helman (1981), an anthropologist, suggested that a patient with a problem comes to the physician seeking answers to six questions:

1. What has happened?

2. Why has it happened?

3. Why me?

4. Why now?

5. What would happen if nothing were done about it?

6. What should I do about it and whom should I consult for further help?

 

Factors Affecting Illness Behavior:

Discuss how these factors affecting illness behavior

1. Gender

2. Age

3. Race

4. Learned behavior

5. Accessibility to health services

6. Previous experience

7. Lay beliefs

8. Social Class

9. Symptom presentation

10. Trigger factors

11. Locus of control

 

The Research Evidence

• (Meichenbaum and Turk 1987, Butler et al (1996) 40% to 80% of patients who received recommendation do not follow them; in many cases the recommendation may not fit the question, need, or priority the patients brings to the encounter.

• (Kindelan and Kent 1987) has shown that most patients want to know about the prognosis, causation and diagnosis of their condition, whereas doctors underestimated patients’ needs for this sort of information, and overestimated the need for information about treatment and drug therapy.

• (Eisenthal and Lazare 1976) Discovering patients’ expectations leads to greater patient adherence to plans whether or not these expectations are met.

 

Exercise 1. Read the following patient scenarios, and speculate the possible perspective of patient's illness 1) Mrs. Salma is a 28-year-old, divorced, living with her 5 children, and working as a teacher. Over the last 12 months, Salma has had intermittent episodes of soreness and stiffness in her knees.

•  Possible ideas

•  Possible concern

•  Possible expectation

•  Possible effect of the problem

 

Exercise 2.  Mr. Naser, is a 42-year-old teacher. He has chest pain

•  Possible ideas

•  Possible concern

•  Possible expectation

•  Possible effect of the problem

Think of how you might phrase questions to ask patients directly about their Ideas Concerns Expectations Feelings

 

Final Message:

•  Try to see the full picture of your patient (disease and illness)

•  Try to see the invisible feelings and to hear the unspoken suffering

Illness makes patients worried, vulnerable and weak.

Illness is also a threat to self-esteem.