Tag Archives: diagnosis

Patient autonomy and the biomedical model

Recently, there have been many suggestions that a backlash against the unilateralism of the biological approach in medicine is on the brink. Perhaps, some suggest, patients have garnered some say in their treatment, even though many researchers suggest that modern medical practice strips patients’ rights to make their own decisions. But where ought the boundary between patient autonomy and doctor totalitarianism be? On the one hand, purely diagnostic, biomedical medicine that does not allow for patients’ own insight into their conditions,  makes patients feel objectified, as if they are nothing more than a disease. On the other hand, doctors have a certain expertise and patients may not always know what’s best for them. After all, medical training is difficult, arduous, and produces a professional with an important and valuable set of skills. Certainly, options beyond the biomedical model would allow patients to have increased autonomy and say in their care. The availability of, for instance, acupuncture and herbal supplements has allowed many patients with a range of conditions from depression to back pain to find relief in a treatment that, at one time, would never have been (and still often isn’t) considered acceptable treatment in a Western medical perspective.

What would it mean for the effectiveness of treatment if patients begin to have more of a say in their treatment? When patients come into doctors’ offices asking for certain procedures, tests, and even medicines, it represents an informed consumer, but also a patient who may be less receptive to the advice of doctors. The question is: how do we find a balance between patients being able to chose the kind of treatment they want and being truly listened to by their doctors (rather than simply diagnosed as a medical object)?

Nathenson (2010, see below) suggests that the biomedical model may not be the dominant lens in the future. While this seems like it is still a distant possibility, Nathenson describes an increasing medical pluralism because of more patient autonomy.  This is a crucial question – how should we study these various ways of treating illness and understand how the dominance of these models are maintained. I say we also need to examine how much autonomy is really useful in medical treatment. I’m not convinced that patients can be fully autonomous in any kind of treatment, though certainly some models preclude much more autonomy than others.

MRI’s as you see to the left, medications, and other medical technologies are powerful tools that reinforce the legitimacy of the medical profession, which is currently dominated by the biomedical model, for better or worse. And there are major benefits of this diagnostic model, even if it tends to ignore the patient’s voice. In the article below, Pauline Chen writes of how useful diagnoses can be in relieving patients’ fears about their symptoms. In doing so, she describes the utility of doctors’ expertise. While the biomedical model is oft critiqued for its cold, objectifying, and even dehumanizing tendencies ( and this is a serious problem), it also trains doctors who have highly specified knowledge that also offers an ability to solve problems that might otherwise be illusive. However, there must be a way to marry some sense of autonomy and humanity with the best that science and medicine have to offer.

Critical Theory and Medical Care in America: Changing Doctor-patient Dynamics

The Comfort of a Diagnosis

If a depression begets depression, will the concept of mental illness be altered?

For the last several decades, depression rates have been on the rise at a rapid pace. At the same time, the economy was in a boom. Socioeconomic status is a variable that has been shown over and over again to affect the likelihood to experience depression; there is an inverse relationship between income/wealth and depression. If the economy was better a few years ago and depression rates were up, it is imperative that we think about what is happening and may happen in the future, as the economy has plunged and unemployment has risen to levels unseen in decades. With the economy struggling, with nearly 1/10 Americans unemployed (by official statistics – the numbers are likely much higher), it is necessary for Americans think about the ramifications for mental health of the looming economic crisis. According to MSNBC, first time jobless claims jumped by 12,000 last month and we know unemployment is certainly not a boon for mental health.

One question to ask is: to what extent will depression (or anxiety, for that matter) actually increase because of the recession (or depression as some suggest we are in)? In other words, how many new diagnoses of this impairing condition will be directly related to these jobless claims, unemployment status and general downturn of the economy? But another equally important line of thinking, especially for sociologists, is about what will happen to “depression,” as a diagnostic category, if the economy begins to affect so many people that much of the American population seems disordered in some way?

When the economy is good, those who are depressed because of unemployment or poverty are considered disordered, even if they are responding to a normal, stressful social situation – or position in the social structure. However, what happens when increasingly large numbers of people are “disordered” because of that same situation? It’s no longer a social anomaly, or residual deviance. Now, it’s actually normal. Will we be diagnosing and likely medicating large quantities of the population for symptoms related to the stress of home foreclosure, unemployment and poverty more broadly? Or, will it become more normal and acceptable to experience symptoms of sadness because of socioeconomic status or economic distress, as increasing numbers of people experience these problems? These are important questions to investigate, both because of the distress associated with increased experience of depression and because of the problems associated with diagnosing illness where it does not truly exist – the over-inflation of illness estimates and the over-prescribing of medications, just to name two.

Of course, there are myriad factors to consider here. One other is the price of treatment and medication for mental illness. Generally, wealthier people get the best mental health treatment. It is usually not the people who actually need help the most that get good treatment – or any treatment at all, for that matter. If this is the case, then we might assume that a great deal of the people who are unemployed, underemployed, losing their homes and in general economic ruin, will not necessarily be the ones who seek (or are able to search out) help for depression. If this is the case, then we might actually see a decrease in the rates of depression, as people who might once have been able to afford help for a mild form of depression may not be able to seek help for more intense symptoms. And, the population that is likely to still be employed (minus some wall street execs) are the people who can afford treatment. They are not affected by the economic crisis in the same way.

Jobless Filings at Highest Point Since November

Depression, in The Blackwell Dictionary of Modern Social Thought

Health insurance for millions more and the future of medicalization

A bill to extend health insurance to millions more Americans and to cut premiums and force coverage for pre-existing conditions for all Americans passed the house this week. President Obama will sign the bill today. At the Eastern Sociological Society conference in Boston this past weekend, I attended a panel on resistance to medicalization where Peter Conrad, who one might call the father of contemporary medicalization theory,  presented a new project on the medicalization of chronic pain. The overarching theme of this panel was what seems to me a fascinating potential backlash to medicalization – the desire to keep certain experiences, behaviors, emotions from definition by the medical community. As I listened to the panel last Saturday, I began to wonder, as I have increasingly, whether insuring more people will propel medicalization. In the last several decades, there has been some backlash against or resistance to the dominant conceptualization of things such as depression, ADHD, alcoholism and even childbirth as medical (see the article below), but, if we insure more Americans, which is  a great victory for our society, there may be an unintended consequence of maintaining the medical definitions of these and many other conditions, since insurance companies base their decisions to pay for treatment of any condition on whether or not it is a genuine medical/biological illness. If it is, coverage is more likely. If it is not, denial more likely. Therefore, we will now have perhaps an even greater reason to maintain our medical thinking. We want more coverage for ourselves and our fellow citizens. So the question I pose is this: what will happen to medicalization in an America where even greater numbers of Americans feel they need to conceptualize human experience as medical in order to get treatment or relief? If health insurance is easier to come by, will this fuel medicalization because more people will be insured and therefore, as a society, there is a greater push to get things paid for? What does this mean for the future of the human condition – will we come to be seen as nothing more than the bearers of symptoms? Of course, it is equally possible that insuring more people will only make insurance companies attempts NOT to pay for whatever they can get away with more likely, in which case the effects on medicalization could be little to none. We shall soon see. In either case, medicalization is an important area of focus within medical sociology and one that we will likely have renewed interest in as the American health care system is modified, even if the changes are not overarching or particularly radical.

Obama to Sign Health Bill from MSNBC

Medicalization, Natural Childbirth and Birthing Experiences

What does calling something a disorder do? the case of Chronic Fatigue Syndrome.

tired manBy Dena T. Smith

This week’s Science Times reported that Chronic Fatigue Syndrome, (which causes the symptoms one might imagine, given the name of the condition) a set of symptoms with unidentified etiology, has been linked to a virus. This possible cause may potentially shed some light on the mysterious derivations of the syndrome, which many sufferers would like to see conceptualized as an illness or disease. While the story of Chronic Fatigue Syndrome is a fascinating and sometimes disturbing one, for sociologists, is is important to step back and take note of these moments in which new illnesses make their way into our medical vocabulary. These instances shed light not only on the process by which things become medicalized, but also on the consequences of medicalizing conditions for those who suffer their effects, often for long periods of time - and it is often only after the medical word claims a condition as a legitimate “disease” that suffers finally feel as though they are being taken seriously.

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