Whether an illness is stubbornly resisting home remedies or its symptoms are debilitating to the point they interfere with the sufferer’s everyday responsibilities, the advice given to the sick person is often the same: ‘Go and see a doctor’. On the surface, visiting a physician is the most logical next step. Doctors possess a vast wealth of medical knowledge on countless different diseases and medical conditions, and combined with the ability to authorise specialised treatment in the form of prescriptions or surgery, it is easy to assume that the doctor-patient relationship exists purely for the benefit of the patient. However, the difference in social power and end goals between the physician and the sick person can create tension between the two participants of the relationship, and a recent increase in the amount of lay knowledge found online only increases this divide. The barrier this creates between doctor and patient threatens to damage the ill person’s physical and mental health, which raises the question of what can be done to solve the ongoing dispute and improve how healthcare is experienced by the ill.
Acute Illness and Talcott Parsons’ Sick Role
Since acute illness typically involves a sudden onset of symptoms that last only a short duration, the sick person is heavily incentivised to rely on the existing healthcare knowledge of a doctor. These traits of acute illness actively contribute to the dissatisfactory doctor-patient relationship, and this is accurately demonstrated by Parsons’ idea of the sick role. Parsons theorises that when an individual incurs an illness or disease and assumes the sick role, in exchange for being exempt from his regular social responsibilities, the sick person carries a moral obligation to adhere to appropriate medical care to exit the sick role as swiftly as possible (Parsons, 1951). The sick role can be generally understood as a type of controlled deviance. Although the ill person enters the sick role through no fault of their own, the avoidance of social duties is only tolerated if the individual is willing to submit to whatever treatment the doctor prescribes (Parsons, 1951).
It is in this way that the physician gains social power over the patient not only from the gap in specialist medical knowledge between them, but also due to the patient being expected to agree with the proposed treatment as part of an unwritten agreement between the sick person and wider society, stripping them of their agency in the process (Burnham, 2013). Once the doctor becomes established as an authority figure, it is then difficult for the patient to bring up any helpful information about symptoms and their personal life that they would consider embarrassing or to provide an honest account of whether they would follow through with the suggested treatment (Byrne, 2012). While the majority of the social power is in the hands of the doctor, their superior medical expertise won’t be used to its full potential if the patient doesn’t feel comfortable enough to provide an accurate summary of their experiences.
The Search for Empathy in Lay Knowledge
The main reason the aforementioned power dynamic causes strain in the doctor-patient relationship is because it emphasizes on removing the symptoms of the illness over what would help the patient most as an individual, causing dissatisfaction for both the doctor and the patient (Parsons 1951). As the physician takes an instrumental approach and focuses on how to treat the patient’s condition as if it were in a vacuum, the sick person is dehumanised and feels as though they are seen as a medical problem to be solved rather than a person in need of help (Habermas, 1984). Further frustrations arise from a difference in expectations between doctor and patient. While the doctor’s ideal patient would wholly trust their judgement and have low expectations for improvement in the condition, in reality the patient expects significant results after treatment and a degree of personal freedom in managing their own illness (Korsch & Negrete, 1972).
In the worst case scenario, the doctor may alienate their patient by putting too much pressure on the sick person to conform to a treatment plan they aren't comfortable with. When this happens, the patient gives up on using scientific knowledge to find relief for their illness, and resorts to using lay knowledge to provide a more realistic solution for their problems. Lay information on the internet is appealing as it is quicker and easier to access than attending a doctor's appointment, and in bypassing the need for a physician’s approval the patient gains agency on how best to handle their own illness (Hardey, 1999). Additionally, lay knowledge can commonly be found on community run websites that include forums or message boards that allow visitors to discuss their problems with others who share their concerns, thus becoming an effective way to manage the stress accompanying their medical condition (Beck, 1994). Yet although lay knowledge has certain benefits, it lacks scientific proof and usually relies on anecdotal evidence, making it very dangerous when used to treat serious illnesses. It is also rare for this type of information to be used in conjunction with medical treatment in acute illness, as without a properly established doctor-patient relationship, the physician is likely to interpret the use of lay knowledge as an attempt by the patient to undermine their medical expertise.
How Chronic Illness Necessitates a Change in Perspective
While chronic and acute illnesses may present similar symptoms, the long-term nature of chronic conditions affect both the doctor-patient relationship and the validity of lay knowledge. Firstly, as Parsons’ clearly indicates that the sick role should be a temporary phase, it is no longer applicable to chronic illness. The sick person can't forgo his social responsibilities forever, and without the benefits of that role they have no reason to adhere to the constraints of obeying the doctor’s orders regardless of their own opinion.
The doctor-patient relationship is also altered by the fact that chronic illness and its symptoms manifest differently from person to person. As chronic conditions are a more unique experience, the doctor must rely on the patient’s individual experiences and situation to make a more informed decision on how to tackle the condition best, as opposed to the one-size-fits-all approach that is commonly used for acute illness (Varul, 2010). Additionally, the permanence of chronic illness means that the doctor-patient relationship also becomes long term, and this works in the patients favour twofold. The doctor is encouraged to nurture the social relationship to ensure the patient follows their advice, and because the sick person consistently engages with their physician in working through their illness together, he gains practical knowledge of their condition, thus weakening the gap in medical knowledge between doctor and patient over time (Young, 2004). In recentering the goal of treatment towards the needs of the patient and keeping the sick person well informed of their own condition, the rate of satisfaction in the doctor-patient relationship appears to be higher for chronically ill patients (Hellin, 2002).
Lay knowledge also becomes more useful in managing chronic illness for a few reasons. For one, chronic conditions need to be managed over a long period of time, which encourages the need for the sick person to have people they can relate to and share their experiences with (Hardey, 1999). Furthermore, the unique variables of many long-term conditions means that anecdotal evidence is more useful, and as the patient is usually in constant communication with their physician, the doctor is more willing and more readily available to advise the patient on which lay knowledge is safe or useful for them to use (Hellin 2002). In the same vein, the cooperation between the doctor and the patient results in an improved treatment plan and in a sense of well-being for the ill person, a combination of lay beliefs and medical knowledge can be helpful in treating chronic illness (Busby et al, 2014).
A doctor-patient relationship may struggles mainly due to the contrast regarding what both parties wish to accomplish. While the doctor seeks to treat the symptoms of illness above all else, the patient feels ignored in worrying about how medical treatment will affect the rest of their life, resulting in a search for an alternative solution in the form of lay beliefs. Yet the compulsory shift in this relationship that occur when treating chronic illness shows that it is possible for physicians to be more open to the patient’s needs and incorporate lay beliefs, while the patient has no trouble agreeing with scientific evidence if they believe it is in their best interests to do so. Therefore, improving the relationship between doctor and patient for the future doesn’t require any kind of revolution. It instead encourages a redistribution of social power between both parties, so that they may effectively collaborate in finding optimal treatment for the sick person no matter the type of illness they suffer from.
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Cover Image: BryanVectorArtist. (2020). A doctor and patient holding hands [Image]. Retrieved 17 October 2022, from https://cdna.artstation.com/p/marketplace/presentation_assets/000/360/628/large/file.jpg?1588310854.
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