Approaches to Health and Social Care in Contemporary Times - Essay Example

Approaches to health and social care in contemporary times Unit d Introduction The traditional foundations of the biomedical model did not actually consider the human side of patients and concentrated majorly on the administration of relevant drugs to the patients according to the experts’ diagnostic results. Jewson (1976, p. 235), analysis of the biomedical model indicate that according to the model, “the patient” was “designated a passive and uncritical role in the consultative relationship and his main function “is to “endure and wait.” This is what Doyal (1983, p.31) refers to when he says that in the traditional models “chronic diseases have become more important than the persons who harbor them.” However, there have been shifts to models that consider other factors such as social, psychological and environmental in shaping the context of a disease and illness. An example is the bio-psychosocial model which acknowledges that in a disease context, there are many factors such as behaviour and attitude towards the illness, social as well as psychological factors (Engel, 2012). The narratives from the patients are today extensively applied to explore the patient experiences with illness (Charon 2001; Kleinman 1988). Management of chronic diseases (Huyse, et al., 1999) require a holistic approach where both the patient and the medical team share feelings and emotional characteristics influencing the conditions experienced in the life of the patient. In this assignment, a patient’s story on his experience with diabetes will be explored with an aim to construct the cultural, social and psychological meaning and locate the facts in contemporary theoretical perspectives. The real names and hospital where the patient, whose narrative is to be used in this analysis, was encountered have been altered to comply with the NMC guidelines and policies of confidentiality (NMC, 2008). During my placement this year, a 52 year old man, Mr. Browns, walked into our clinic to seek medical attention on his wanting chronic condition. Mr. Browns showed symptoms such as occasional tiredness. He passed out a lot of urine and was continuously in thirst. He had a huge body size which made him feel more tired. He occasionally complained to be allowed to prostrate on the coach as he conversed rather than sitting as other patients did. Mr. Browns was born in London where he lives to date. These symptoms clearly linked Mr. Browns’ condition to type 2 diabetes (Blaxter, 1983). Upon further diagnosis, Mr. Browns’ diabetic condition was found to have escalated to almost severe states and required urgent medical attention. It was also realised that Mr. Browns has been put under insulin injection for the past period and has also been on antidepressants. Buchbinder, Jolley, & Wyatt,( 2001) recommend periodic insulin injection to diabetic patients at their chronic conditions. Medical history on his condition showed that he was first diagnosed with diabetes at age 20 after having a serious wound on his left leg. Immediately he started treatment and therapy as directed by his doctor. The wound healed after sometime and he stopped the medication and regime until the time when he begun adding more weight and his condition reversed. Total compliance is a necessary effect on diabetic patients for proper management of the disease (Greiner & Knebel 2003; Branch, Pels & Hafler 1998) since the process takes place throughout ones entire life. Stopping the medication and the regime (Wade, 2001; Duggan et al.2006; Greiner & Knebel 2003) result into the recurrence and even severity of the disease later in the patient’s life. The understanding and participation of the patients in the management of their diabetic conditions, asserted in the sociological approaches, is therefore very critical for a holistic management of the diseases. This aspect as Greiner & Knebel 2003) record is not incorporated in the biomedical models which perceive the patient as quasi in the treatment process. Failing to fully take an active role in managing his condition, Mr. Browns’ blood pressure went up and a serious phase of the disease emerged characterized by frequent collapse. He was then advised to start over his regimen all over again. Huyse, et al., (1999) asserts that the patient centred approaches, also known as the sociological approaches provided just the missing link in the management of chronic diseases, the incorporation of the patients in the treatment process. This is a rather trivial miss in the biomedical models. Most medical experts today prefer the holistic approaches administered through the sociological approaches in managing chronic diseases such as Type 2 diabetes, glycemia. This move was embraced upon the realisation that patients’ contribution towards their recovery, which is lacking in the biomedical models, is of great importance to the success of care giving. In this case, the awareness of the binary relationship between disease and illness has revolutionized the medical practice (Greiner & Knebel 2003). This is the difference between the biomedical constructs of the pathophysiological processes and individual’s subjective experience of the patient explored in other models that consider disease as a result of myriad factors (Kleinman 1988). The exploration of patient narrative is relevant in the case of diabetes because patients and physicians have different perceptions, concerns and goals (Anderson 1986; Freeman & Loewe 2000). Mr. Browns, according to his narrative, has been harbouring his diabetes for the last 32 years. His efforts in monitoring his diabetes were negligible as he narrates during the examination. He records to have stopped his medication and the regimen after he felt that his diabetes is lenient and would not turn out to be severe. The medication alone, which he followed very carefully, he said had worked positively in alleviating his condition. A study by the American Diabetes Association in collaboration with the European Association for the Study of Diabetes has recommended a number of treatments, procedures suitable for glycemic patients. The two associations, (Peyrot et al. 2005), recommend therapeutic observations on the patient’s diet alongside relevant medications such as; metformin, sulfonylurea, thiazolidenediones or glucagon such as peptide 1 agonists (Peyrot et al. 2005). The aim in this case is to prevent the patients from hypoxia and minimize the severity of the patients’ diabetic conditions. These efforts are efficiently facilitated by strict and adherent participation of the patient in regulating their own affairs such as the amount and type of food taken as well as regulating their body sizes to combat weight increase. The biomedical models ignore the patients’ participation in, such as recommendations on dietary regulations. At extremely severe conditions, the associations recommend insulin injection on a relevant interval (Hoffman, 2000). Mr. Browns defied the effectiveness of the nutritional therapy and does not restrict himself from any food at the expense of insulin injection. In an interview with Mr. Browns, he says, “keeping up with vegetables and limiting me to certain foods is too harsh on me.” His argument is that he does not have to be harsh on his diet. Mr. Browns seems not to reasonably understand the importance of dietary restrictions on his condition hence the deferment. A dietary regulation for diabetic patients (Hoffman, 2000) is akin to regulating nutrient intake and resonates with body sizes. Mr. Browns works as an accountant with one of the biggest hotels in London and so spends most of his time in the office. The hotel provides all her employees with free breakfast and lunch services, upon which Mr. Browns solely depend. He lives alone in an apartment away from his divorced wife, who lives with his three children on a different part of the city. Our conversation with Mr. Browns reveal that he finds little time to cook for himself and most of the time, he depends on a fast food restaurant for dinner except on Sundays. Junk food, which is a known poor diet among many populations, has been proved to be the cause of high prevalence of diabetes across the world (Peyrot et al. 2005). Dietary changes are therefore very important in managing glycemia (Peyrot et al. 2005). Failure to comply with such regulations inhibits proper management of such diseases prompting their recurrence later in the patients’ lives as in Mr. Browns’ case. Despite Mr. Browns having full knowledge and understanding on glycemia, and sound aware of the nutritional lifestyle, he has ignored these due to his strong religious affiliations to Jehovah’s Witness, a church he joined some years back. The church teaches the contrary with respect to abstinence from certain foods. The social backgrounds such as religious beliefs, personal perceptions and social backgrounds play a very great role in easing management of chronic illnesses (Buchbinder, Jolley, & Wyatt, 2001). Sociological approaches provide holistic care giving which encompasses all the spheres of a patient’s life, the mental/ psychological and the biological faculties omitted in by the biomedical models hence enables patients to effectively manage their chronic illnesses and hasten their recovery. Blaxter (1983) argues that people, who work in offices like Mr. Browns, are likely to hold functional conceptualisations of health. He gives an array of reasons citing the work atmosphere, type of foods taken by the individuals as well as the amount of exercise that these people get engaged. Mr. Browns spends the rest of his day in the office and goes to work in his car. He doesn’t do much exercise either on Sundays since he spends the whole day in church. As Buchbinder, Jolley, & Wyatt, (2001) note, people engaged in light chores which require less physical exercises and have bigger body weights have high chances of developing type 2 diabetes. Compared to those working in conditions where they need to use a lot of energy, burn a lot of calories, in the process of carrying out their duties (Blaxter, 1983) less weight is accumulated and thus exhibit few cases of diabetes. Mr. Browns has never disclosed his diabetic status to his neighbours in fear of stigmatization. Given that most of his friends are from moderate income levels and well enlightened, he does not want to look less human and diseased thus downgrade himself before his friends. At work, only his supervisor is aware of his diabetes and so he does not feel stigmatized by his colleagues. Stigma according to Goffman, (1963) manifest in various forms, deteriorates the emotional faculties of the patients which resonate closely with their physical health. This affects greatly impact on their recovery since they are not able to fully comply with their medication as suggested by their doctors and counselors. Treatment approaches that help patients manage stigma, such as the sociological approaches, are effective for proper management of chronic diseases. Mr. Brown’s mother, Mrs. Lorene Spencer, died of diabetes at 60 about ten years back. His mother had type 2 diabetes, and she was extremely strict on her regimen. Mr. Browns is the second born in a family of three. His mother reported to him that when he was young, he was obese and transferred to many schools because his fellow students made fun of his weight and so felt stigmatized. Most overweight glycemic persons often feel stigmatized due to their weights. Most people feel ashamed of big bodies (Weiss & Brittens, 2003) and the revelation of their diabetic conditions is an additional factor for such stigmatization. The sociological approaches, as opposed to the biomedical approaches provide diabetic patients with the necessary insights in managing stigma on their chronic illnesses. Listening to Mr. Browns, it is clear that he does not understand his role in the disease he has The Health Belief Model, as described by Rana & Upton (2009); Laine & Davidoff (1996); Strechis and Rosenstock (1997) considers the need for public health researchers to demystify the fact that few people must participate in programs meant and recommended to prevent or treat diseases. In this model, patients like Mr. Browns are assumed to consider both health-related and non-health related results of their behaviours. Initially, the model of the theory contained four aspects which include: Perceived susceptibility, Perceived severity, Perceived barriers, and Perceived benefits. The model has been extended to include other components such as perceived cost of adhering to prescribed intervention as one of the core beliefs (Rosenstock 1966). There were also construction of mediating factors, which were added with an aim of connecting the various types of perceptions with the predicted health behaviour and they include: Demographic variables, Socio-psychological variables, Perceived efficacy, Cues to action, Health motivation, and Perceived control. All these aspects play critical roles in contributing to the severity and nature of disease and illness. Irwin Rosenstock’s Health Believe Model (1997) can be applied to understand the patient’s condition based on perceived severity that he may not have knowledge about. Perceived severity is a patient’s opinion of how serious a condition and its consequences are (Cohen et al. 1994), and for Mr. Browns his diabetic case, to him, is not a serious one to strictly limit his diet. He is aware that insulin injection is part of his life, but he does not agree that he will have to sacrifice his junk food as an additional chance to his health improvement. The health belief model (Cohen et al. 1994), also addresses the aspect of perceived benefit in which a patient’s belief in the efficacy of the advised action to reduce risk or seriousness of impact is assessed (Strechis & Rosenstock 1997). In this case the perceived benefits in terms of positive consequences of adopting the desired eating behaviour for Mr. Browns and nutritional lifestyle are important for the alleviation of his diabetic condition and which he utterly ignores. There are many barriers to Mr. Browns’ adoption of the right dietary therapy as recommended for diabetic patients (Freeman & Loewe 2000). Perceived barriers include the influences that facilitate or discourage a patient to adopt the recommended dietary therapy (Peyrot et al. 2005; Freeman & Loewe 2000). This is for example as he states, the type of food he is supposed to be taking. He argues that “keeping up with vegetables and limiting me to a certain food is too harsh on me.” Recently, the health model has encompassed perceived cost of adhering to prescribed intervention to be one of the core beliefs in medication (Rosenstock 1966). To Mr. Browns, adhering to dietary therapy is too harsh on him and he can also not afford to sustain diet when work and his children are chasing on his time. As far as his perceived efficacy is concerned, he is not in a position to juggle all the balls on the air for his recovery process. Mr. Browns reports that his mother died of type 2 diabetes at age 60 although he was extremely strict with medication and does not see the need to be strict with his regimen after all. Her son, Mr. Browns, could have learnt a lot from her through labeling, in what is called a labeling process but which he seems not to take heed of. The fact that he already talks of his mother as being strict with medication is an indication that he developed his illness and sick role model from his mother but seems to have ignored this strictness so far. Labels are social constructions that a society gives to behavioural patterns, events, status and it can be negative or positive (Young 2004). For Mr. Browns, his labeling of his mother’s behavioural pattern or handling of health cases was negative. Research has proved that social class is a key determinant of people’s health and the way they respond to health complications both physically and psychologically (Engel 2012). Unemployment is one of the social causes of illnesses (Senior & Viveash 1998; Anderson 1986). The social determinants that have been examined by the current research include stress, work, social exclusion which was there in London when Mr. Browns was growing up (Engel 2012; Rosenstock 1966).The fact that income levels were highly institutionalise in the region at that time may have contributed to his family’s social class, which highly shaped his future (Kumagai et al. 2005). He is now a full time working man and has to juggle between work and his two kids. This is explained by working men’s material circumstances as well as the fact that their social responsibility has to be fulfilled. Mr. Browns has self imposed stigma and he is aware that stigma is prevalent in the society (Hoffman 2000). For example, he does not want his supervisor to disclose his health condition to his workmates or any other person. This is understandable given that those individuals who possess traits that damage their identity for a lifetime in a way that prevents their full participation in the society carry a stigma; an attribute that destroys ones identity in the society (Goffman 1963). Stigma labels a person as being unacceptably different from the other people considered as normal in the society. For example, Mr. Browns considered himself as abnormal and thus, he has to attain his normal status by not disclosing his abnormal side of life and pretend to be normal. Stigma is also understood and explained by Heathiston et al. (2000) as a social process; a feature of how people relate socially and reflect their tensions, conflict, silence as Mr. Browns preferred, subterfuge and hypocrisy that is common in every human being and society. As Buchbinder, Jolley, & Wyatt, (2001) note, people suffering from chronic diseases are prone to developing stigma and Mr. Browns’ case is just one among the salient examples explaining the circumstances associated with this. Stigma development is derived from the fact that chronic illnesses have a long history of occurrence in different persons gradually but surely alienating them from the society. The development of the disease, the process of finding its cure as well as the emotional and psychological torture culminates to the development of stigma in various individuals as Wade, (2001) records. Mr. Browns has joined a Church which is a significant factor in determining whether his treatment will be successful or not. Jehovah’s Witness followers are known to defy conventional medication, and which Mr. Browns needs the most, on the basis that their faith in God has the ability to heal them. Therefore, his faith can affect his compliance and adherence to the treatment and regimen required of him (Hoffman 2000). Religion and belief are one among the six strands in the personal, cultural and structural (PCS) model according to Equality and Human Rights Group (2007).Duggan et al. (2006) analysis that understanding a patient’s social, economic and religious status will help doctors have the best approach to health situations. Belief systems have a very great role in determining the recovery process and even the induction of a chronic disease in the life of an individual. Religion according to Huyse, et al., (1999) determines ones eating habits as well as other emotional and cognitive behaviours which are integral in the recovery process of the individuals’ illnesses. Reasoning on the lines of religion puts one at a state of understanding the fundamental beliefs and facts behind the development of their conditions. Type 2 diabetes, glycemia, has a very close link with emotional and feeding habits in the individuals that suffer from it. Certain foods and escalations in the emotional characteristics of the individuals greatly enhance the glicemic conditions making it rather challenging to arrest easily. Mr. Browns’ condition is probably at stake due to this fact and the administration of biomedical model in his treatment requires, in addition, a strict understanding of the sociological and emotional concepts underlying the patient’s recovery. The inadequacy of the biomedical models comes in at this point where the social aspects of the treatment procedures is not followed and incorporated into the treatment process. Conclusion In conclusion, the biomedical model of approaching chronic illness and disease is not sufficient in helping patients with chronic health conditions. The health narrative of Mr. Browns proves that there are many factors that should be considered in order for him to be helped. His family background, his social class, his psychological status, his economic status and his religion are just some of the explicit factors that come into play when it comes to his compliance and attitude towards his diabetes treatment therapy and regimen. Modern approaches to medication based on patient narrative has proved to apply in his situation and based on belief model, bio-psychosocial model and other patient centred models, any physician will understand where he is coming from, where he is; and be in a position to predict his situation should he take a variety of choices. This way, a physician will be able to know the best approach to help Mr. Browns continue with his therapy. Moreover, his narrative presents already researched cases of stigma, concordance and compliance, lay beliefs and others can help a doctor to know the best way to handle his case. References Anderson, R. 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