Why do people respond differently to illness and why is health so hard to define?

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The concepts of health, disease and illness are all very subjective, and thus it is very hard to actually define them. As prospective doctors it is our task to work towards restoring health in patients, so it is essential to understand the idea of health. The problem arises because the concepts of health and illness are very different for each individual; for instance one person might feel a sprained ankle is a major problem because he is a professional rugby player, whilst for someone else it could just be an annoyance. Studies in this area reveal that perceptions of health vary between cultures and communities, due to differences in age, gender, socioeconomic background and ethnicity.

An essential part of discovering why people respond to illness in such different ways was through my placements at a GP's surgery in Barnes and the Hammersmith Hospital. This gave me an excellent chance to gain insight into why people visit their GP. I had a chance to have a quick discussion with patients before they went in for their appointment about why they were there. It was immensely satisfying to be able to combine other aspects of the course with PCC. For example, speaking with the patients allowed me to put into practice my speaking and listening skills that I had learnt in communication skills.

I initially felt quite apprehensive about the reception I would get when I introduced myself as a 1st year medical student and whether people would open up to me. Therefore it was a nice surprise when I found some patients were willing to speak openly about very sensitive topics; one person happily spoke about genito-urinary problems they had been experiencing. As I asked more questions I gained in confidence and the conversations became more natural, creating a more mutual conversation. I also learnt which questions drew out the best responses and I had to be able to adapt to individual patients requiring varying levels of sympathy. I also found that even though I felt I was too inexperienced to talk to patients, it wasn't a problem because I didn't need much medical knowledge since it was mainly my communication skills that I was using.

The GP placement revealed that practically all patients had taken several days, if not a week, to muster enough courage to visit their doctor. Many patients often said this was because they felt that the problem might just go away, or they tried to self-medicate by buying paracetomol from the pharmacy; in particular men were less willing to visit the GPs, because they felt it a weakness to be ill (something we had discussed in our sociology lectures). This was all reinforced by the symptom survey, where we found that in the class 70% of the people surveyed of varying ages chose to self medicate or take no action at all. The theory behind this is described in the symptom iceberg model, which explains that only a small minority of all people with a symptom will see a doctor.

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Zola (17) identified five major 'triggers' that caused individuals to see their doctor (i.e. symptoms were not enough on their on) 1) The occurrence of an interpersonal crisis (e.g. a death in the family); ) Perceived interference with social or personal relations; ) 'Sanctioning' (pressure from others to consult); 4) Perceived interference with vocal or physical activity; and 5) 'Temporalizing of symptoms' (setting a deadline, e.g. "if I feel the same way on Monday"). In the patient interviews I found real life examples of all of these; Patient W was an elderly lady whose husband had just passed away trigger 1, Patient X had bowel trouble which she felt was a social embarrassment trigger , Patient Y had a bad pain in her neck which her family had encouraged her to see the doctor about trigger , and Patient Z had a back problem which he was worried would disrupt his impending water sports holiday trigger 4.

I found that many of the patients who went to their GP were simply there looking for reassurance; one patient had gone to the doctor to make sure her asthma was stable. Another factor was how much prior medical knowledge the patient had especially now with the advent of the Internet. People who had felt pains in their abdomen and had researched them were much quicker to book their appointment than those who had simply suffered from vague troubles. This was highlighted in my patient interviews by the fact that most of those patients who had researched about their problems had almost immediately booked appointments.

Severe illnesses caused quicker responses also; one patient had severe diahorrea and was therefore more inclined to visit her GP immediately. However severe trouble doesn't always mean severe illness, e.g. cancer. Medical knowledge is important for patients in determining the seriousness of their illness, e.g. the media has given a wealth of information about breast cancer, which can sometimes 'scare' people into visiting their GP.

Health has many different definitions. The Oxford Dictionary defines it as "soundness of body" which is quite vague, whilst the World Health Organisation defines it as "a complete sense of physical and mental well being, not just the absence of disease". The Holistic Model of Illness describes how many other factors influence a patient's well-being; Physical, Psychological, Social, Cultural and Environmental factors.

Herzlich (17) observed how people felt that illness and disease were both seen as more external, whilst health is more of an internal problem; this is described by Hellman as "Disease is something an organ has; illness is something a man has." This reinforces the point that health is a very personal and subjective thing; it is entirely dependent on the individual's feelings. Another problem arises with health since a person suffering from breast cancer may feel fine in their day to day life, whilst an elderly person suffering form the common cold might feel they are seriously ill; which one is the more healthy? We would probably say the person with the cold, but the lady with the breast cancer will probably feel better. This is the major concept in medicine; that you are treating not just a patient, but an individual human being with similar worries, aspirations, and perceptions as yourself. Therefore they are people who need the same care and attention that you would expect.

The first module of the PCC course has definitely opened my eyes to the realities of medicine; it is all too easy during lectures to believe that medicine is just about learning to diagnose diseases. There are many more issues involved in establishing a co-operative relationship with your patient. The whole crux of this essay comes down to the fact that everyone is an individual and therefore they feel differently, and that is why they have different perceptions of health and illness.

BIBLIOGRAPHY

Scambler, Graham, Sociology as applied to medicine. 1. Balliere Tindall. London

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