Talking at cross purposes: Negotiation of the sick role with a MUS patient as a real time social process

Abstract

Tarbel, Christel, Frostholm, Lisbeth & Rehfeld, Emma. (2016). 'Talking at cross purposes: negotiation of the sick role with a MUS patient as a realt time social process, Tidsskrift for Forskning i Sygdom og Samfund, nr. 24, The physician, thus, has to walk a fine line in the interaction with the patient with MUS. In order to provide high quality care for these patients while at the same time gaining their confidence, the GP has to operate at the intersection of 63 Talking at cross purposes several opposing pressures. Observing the specialist consensus on optimal management of MUS, the GP has to avoid embarking on the "somatic path" of investigation and treatment ad infinitum and instead attempt to reframe and reattribute the patient's understanding of the symptoms (Goldberg et al 1989;Mayou 1991;Fink et al 2002). The pitfall of such reframing is the danger of adopting -or being heard by the patient to have adopted -a unidirectional mind-to-body-model of somatisation of the unexplained physical symptoms (Burton 2003). In sum, and at the risk of oversimplifying, the GP must take serious the medically unexplained symptoms without making use of the usual somatic interventions, and at the same time provide emotional support without psychologising. Medically unexplained symptoms (MUS) challenge our perception of illness. As a consequence, a MUS-patient's legitimised entry into the sick role, as defined by Parsons, poses a problem for physicians and patients alike. The encounter between patients with MUS and physicians therefore can be frustrating for both parties. The present study is a single case analysis of such an encounter in primary care. Using the microanalytical method of conversation analysis, this study aims to provide a contextualised description of both the patient's and the physician's different orientations to the purpose of the encounter. This approach locates the source of the frustration in the participants' incompatible interactional projects. The patient is oriented towards the emotional and life world aspects of Theoretical prerequisitesPertinent to the above described difficulties of both patients and physicians in the encounter about MUS, is the problem of legitimacy, i.e. of being recognised as being legitimately ill. This problem was initially formulated by Parsons and crystallised in the now well-known concept of »the sick role« (1951). Taking his point of departure in a capitalist moral economy, Parsons perceived of illness as a dysfunctional disturbance in both a biological and a social sense -the latter because it prevents a person from contributing to the common good (Parsons 1951, p. 430). The sick role, however, is a provision to protect the sick individual in that it "enables conformity within the deviance of illness" (Varul 2010, p. 76) through a set of normative rights and corresponding obligations. Entering the sick role, an individual thus has the right to exemption from normal social duties, e.g. work, but at the same time must resist to take advantage of any "secondary gains", s...

(In)Visibility Online: The Benefits of Online Patient Forums for People with a Hidden Illness: The Case of Multiple Chemical Sensitivity (MCS)

“…Moreover, when a condition is observable and the sufferer earns a socially acceptable diagnosis, society tends to grant them the “sick role,” which permits them ongoing medical assistance, exemption from work, eligibility for financial compensation, and sympathy from friends and family (Parsons ; Tarber et al. ). However, when alleged suffering is invisible or unintelligible to biomedicine, its sufferers are less likely to be readily granted such legitimacy and support (Dumit ).…”

“…)—contestation and mutual misunderstanding remains (Tarber et al. ). Indeed, some sympathetic scientists have argued that, due to the failure of conventional biomedical models to improve our understanding of multifactorial conditions, a paradigm shift is required (Genuis ; Paul ).…”

“…While the patients' accounts of their suffering are constructed as subjective, physicians-equipped with knowledge, experience, and technology that renders disease visible-are deemed to have a penetrative "gaze" with which they can distinguish between the normal and the abnormal in sickness and health (Foucault 1973;Stempsey 2016). Moreover, when a condition is observable and the sufferer earns a socially acceptable diagnosis, society tends to grant them the "sick role," which permits them ongoing medical assistance, exemption from work, eligibility for financial compensation, and sympathy from friends and family (Parsons 1951;Tarber et al 2016). However, when alleged suffering is invisible or unintelligible to biomedicine, its sufferers are less likely to be readily granted such legitimacy and support (Dumit 2006).…”

“…Indeed, in her auto-ethnography of being misdiagnosed with fibromyalgia (a diagnosis much more common among women), Greenhalgh (2001) highlights the ways in which the medical encounter surrounding MUPS is not only powerfully gendered, but also often fails to adequately address the socio-political causes of chronic pain. Although there is a broader scientific consensus that MUPS conditions are multifactorial-i.e., that they have physiological, psychological, and emotional elements, all of which are part of the problem and the solution (Wessely et al 1998)-contestation and mutual misunderstanding remains (Tarber et al 2016). Indeed, some sympathetic scientists have argued that, due to the failure of conventional biomedical models to improve our understanding of multifactorial conditions, a paradigm shift is required (Genuis 2010;Paul 2007).…”