Bill who is 65 years of age lives with chronic hypertension. Bill lives in a small coastal town and describes himself as �semi-retired�. He works part-time at the local golf course as a groundsman. Bill is married however, the marriage has experienced extreme difficulties over the past 5 years following his diagnosis. His wife Betty describes him as �a crabby old man� who is constantly complaining about �everything�. Bill has two grown children and 5 grandchildren who all live in distant states.
He loves to go fishing in his spare time and is a keen gardener however, is finding it increasingly difficult to perform heavy manual labour due to his age and declining health. Bill is also extremely overweight and avoids going to see his GP as much as possible. He likes to eat take away food and makes many poor life style choices such as drinking too much red wine and not exercising enough. Betty is now threatening to leave Bill and is seeking counselling in relation to the unhappy state of this marriage and the consequent stress and anxiety it is causing her. Bill is in denial that there is a problem with the marriage and has started spending a large amount of time at the local Hotel playing the �pokies�. Consequently, the family�s financial status is not solid as money seems to keep disappearing at a rapid rate. Recently, they have not had enough money to pay the rates and are rapidly slipping behind in home loan repayments. Bill has also recently been experiencing problems with his vision, but refuses to seek help to rectify this choosing to buy cheap five dollar spectacles from the local chemist.
Bill is worried that if his health declines further his wife will put him in a nursing home. �That will be the end of me to go into one of those dog box homes� he told his next-door neighbour. Bill also frequently indicates �it�s my life and no one is going to tell me what to do- those young quack doctors think they know it all and just want to pump me with pills�. At the doctors office last week, Bill stated to the registered nurse that since he had been taking the blood pressure pills he was feeling a little better and had been able to work in the garden more on the weekend and did not need to take a �breather� so often at work, He requested a repeat prescription from the doctor. In relation to his weight he also indicated that he�d heard about Dr Slims new weight loss program that was advertised on the TV and wanted to know if �those shakes really work�?. He then admitted he was only trying to loose weight due to his wife�s nagging. �if she could learn to cook better I�d eat at home more� he said.
***Note: Below are supporting summaries for the essay (some theories/concepts have been highlighted in yellow)
Summary 1 � �The Big Picture what is Health�
Term: Self-Efficacy: the perception on the part of the individual that they can influence and control their own out comes
Everybody perceives sickness and health in different ways.� Try out the forum under discussion topics week 1 and post your own personal definition of health. Health perceptions could change based on current life circumstances.� It is interesting to try and identify when someone actually considers themselves sick or ill – was it when they first noticed symptoms – was it when they were diagnosed by someone (who may or may not have been their doctor).�
The second area of importance is the difference between the two models of health:
(i) medical and
Although obviously the ideal model of health is the biopsychosocial model, which looks at a person in an holistic way. If I was acutely ill, I would like to ensure that initially the health care team is looking at me thought the eyes of a medical model.�
The last important area is understanding the differences between the measures of health and illness; morbidity, incidence, mortality and prevalence.� You will come across these terms over and over again, it is important to sort out the differences now.
When you meet a client on your clinical placement or person from within your own social networks or the person you have chosen for your case study �.think about why they consider themselves ill or not.
If they don’t consider themselves ill � why not?�
You could ask them – what was it that alerted you to the fact that you could be sick?�
How do they usually know they are sick?� Do they wait for a doctor’s diagnosis?�
Is there a difference in the way different environments view health? Look at the clinical area that you are placed in or have encountered – what model of health does it largely follow? What model of health does your client usually adhere to?� A good way of understanding your theory is to ask the same questions of yourself.� Then ask yourself why?� Are you a person that rarely visits a doctor?� Why is that?� Is it because
Summary 2 – Reactions to Illness
The first part of this week’s readings is ‘Responses to illness’.
We can study this by looking at Ethel (from the role play) as an example.
The first response is ‘physical’. This includes symptoms of the illness and for Ethel it is her rectal and vaginal bleeding. Her emotional response is ‘anxiety’. She does worry about it.
Her cognitive responses include thinking about what would happen if the illness was severe – to Cyril, the bowls club and her family.
Her behavioral responses include information seeking – talking to her neighbor.
Illness behavior is the process of moving from being a well person to being an ill patient. Your text explains it as moving through a number of decisions. Again we can simplify it by looking at Ethel.
First of all she asks ‘Are my symptoms normal?’ This is the means of Ethel validating that she is not ill. She answers yes – most women have some type of changes down below.
The next question is ‘What choices are available for dealing with the symptoms?’ For Ethel the symptoms have not gone away so she has asked Cyril and her neighbor. Cyril has downplayed her concerns ‘It’s all in your head’ and Mavis has stated that she can’t be sick because her sister had bowel cancer and was skinny whereas Ethel has ‘some weight’.
The next decision to be made is to whether to seek help from a professional.
(i) The first decider is perceived interference of symptoms with vocational, physical or social activities or personal relationships. Ethel doesn’t seem to perceive that her symptoms interfere in the above ways.
(ii) The next possible impetus to encourage a person to seek help is a personal – crisis – again not applicable to Ethel.
(iii) The last – pressure from others to seek help – also is not an impetus for Ethel as Cyril and Mavis reinforce to her that she doesn’t need help. However, the trigger – ‘the symptom has gone on long enough or past a self-imposed deadline’ seem to be being an impetus for Ethel to think that she may need to seek help and allowed her to be easily influenced by myself to do so.
What can the professionals provide? Ethel felt that the doctor was too young and too male for her to be able to comfortably explain her symptoms. So this was a problem for her. You will see later that when the nurse was able to organise for her to see a female – she was much happier.
Use these concepts when you talk to your case study – to reflect on how they initially decided to seek help.
There is little evidence from Ethel that she took a sick role. However, what is important to remember that it a set of rights and obligations. Or another way of putting it – if the person obliges -they are then able to have the rights. As the textbook suggests – there is a number of moral implications with this. For example if a person hasn’t ‘obliged’ with the known ways of preventing illness such as health eating, not smoking etc. and become ill – has this person the right to receive the same care as someone who has taken care of themselves and become ill? This is something to consider later when you look at rationalisation of health resources.