HLTH101 Lecture Notes - Lecture 4: Rational Basis Review, Occupational Safety And Health, Allopathic Medicine
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Chapter 1 Concepts of Health and Illness
Illness, Sickness, and Disease
-In 1973, Susser, an epidemiologist, proposed that :
-illness refers to the subjective sense of feeling unwell; illness does not define
a specific pathology, but refers to a person’s subjective experience of it,
such as discomfort, tiredness
-The way a patient reports symptoms is influenced by his or her cultural
-sickness refers to socially and culturally held conceptions of health
conditions (e.g., the dread of cancer or the stigma of mental illness), which
in turn influence how the patient reacts
-Disease implies a focus on pathological processes that may or may not
produce symptoms and that result in a patient’s illness.
- For example, a patient complains of tiredness and unease his illness as
he experiences it. He consults a doctor about it because he believes
that he might have a sickness. The doctor might attribute the patient’s
symptoms to a thyroid condition a disease.
-The biomedical mode l’ of disease focuses on pathological processes, and on
understanding, diagnosing, and treating the physical and biological
aspects of disease.
-The goal of treatment is to restore the patient’s physiological integrity and
-Diagnosis involves recognizing and applying a label to a pattern of signs
and symptoms that is at least partly understood in terms of abnormal
structure or function of cells, organs, and systems
Disease or Syndrome?
-As we learn more about the biological basis for a patient’s illness, it may be
reclassified as a disease
-For example, constant feelings of tiredness became accepted as the medical
condition of chronic fatigue syndrome
-Often, however, a set of signs and symptoms eludes biomedical
understanding. If the set is frequent enough to be a recognized pattern, it is
termed a syndrome instead of a disease
-A syndrome refers to a complex of symptoms that occur together more often
than would be expected by chance alone.
-Whereas diseases often receive explanatory labels (such as hemorrhagic
stroke), syndromes are often given purely descriptive labels
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Disease as a Process: Natural History and Clinical Course
-nineteenth-century revolution in thinking brought about by Koch and Pasteur
led to the recognition of distinct stages in the development of a disease.
-If left untreated, a disease would evolve through a series of stages that
characterize its natural history.
-But if an intervention is applied, the natural history is modified, producing a
typical clinical course for the condition
-The clinical course of a disease, from the biomedical perspective represents
the concept of health and disease as processes (rather than states) that
unfold over time in a series of steps, where disease progression may be
interrupted at any stage
-Shortly after a medical diagnosis, therapy is normally begun and short- and
longer-term outcomes can be recorded.
-If the outcome is unsatisfactory or unexpected there may be a loop back to
re-diagnose the condition and alter the therapy
- The move towards thinking of disease as a process, rather than a state,
required new concepts to describe the stages in this process.
The Sequence of Disease Outcomes
-In 1980 the WHO published the International Classification of Impairment,
Disability and Handicap (ICIDH), which proposed standard terms for the
stages in the clinical course of a disease
-In this conception, pathology produces some form of disease and results in
impairment, a deviation from normal function in an organ or system.
-impairments are not always perceived by the patient, and screening tests
are used to identify impairments of which the person is not aware.
- an impairment can, although does not necessarily, lead to a disability.
-A disability is defined as any restriction or lack (resulting from an
impairment) of ability to perform an activity in the manner or within the
range considered normal for a human being
-disability may or may not limit the patient in performing his normal social roles
-Handicap is defined as a disadvantage for a given individual, resulting from
an impairment or a disability, that limits or prevents the fulfillment of a role
that is normal (depending on age, sex, and social and cultural factors) for
-relates the impact of a disease to the social roles of the person with it
The International Classification of Function
-concepts such as disability and handicap focus on the negative
consequences of disease, and may mask the reality that many people cope
very successfully with their condition.
-International Classification of Function, or ICF: activity’ and participation’
replace disability’ and handicap’, which further blurs the distinction between
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