Another aspect omitted from all these models is the illness perceptions of the health professional and the interplay between these and the patient’s own ideas. The opinion of the GP and the patient’s acceptance or denial of this opinion obviously has a large impact on their future behaviour. This is known as ‘compliance’, described by Haynes et al (1979) as the extent to which the patient’s behaviour.

Doctors and health professionals also hold illness cognitions and although these are based on expertise they may still occasionally be detrimental to a patient’s recovery. Studies have also shown there to be a fair deal of variation in doctors’ treatments, in one study for example it was found that doctors had a variation of 15-90% of patients receiving drugs (Mapes, 1980). One way this can be the case is through miss-diagnoses which can occur due to stereotypes or bias held by the practitioner as a result of their previous experiences.

Difficulty can also occur if the patient and the doctor disagree in their diagnosis. Although the doctor will have more experience and knowledge regarding illness, the patient will have the advantage of being able to experience the symptoms first hand. If the patient disagrees with the practitioner then they are less likely again to follow advice.

One way in which GP’s have adapted to the problems outlined above is to use the ‘Self Empowerment’ model when dealing with certain patients (Funnel & Anderson, 2004). Here the doctor will attempt to advise instead of instruct a patient and will encourage their active role in recovery which has proven more successful in encouraging patients to adhere. Evidently the illness cognitions of doctors also play a large part in the recovery of a patient and so it is important to ensure that these are both correct and presented in a way that will encourage compliance.

As well as these indirect effects, beliefs about an illness can actually have a more direct effect on recovery. The strong link between the mind and body has been shown in countless studies such as those using placebos. Here participants have been given sugar pills and told they are some form of drug, many patients then report the drug as working and in some cases their condition actually improves as a result. Haas et al (1959) compiled a list of complaints that have proven responsive to treatment using placebos including asthma, diabetes, insomnia, ulcers, obesity, acne, smoking, dementia, multiple sclerosis, epilepsy, enuresis and even cancer. This seems to suggest that by simply believing the condition will improve one might be able to actually help that become a reality, hence the quote ‘He [the physician] cures most in whom most are confident’ (cited in Evans, 1974). Here then is another example of how illness cognitions play an important role in recovery.

On the other hand however believing the illness to be terminal might also become a self fulfilling prophecy for a variety of reasons. Simply paying more attention to symptoms such as pain for example can exacerbate them, which is why distraction techniques can be partially effective in reducing suffering (Melzack and Wall, 1965).

Negative health beliefs can also lead to stress and/or depression which again are maladaptive and can actually cause further complications. Stress for example triggers the immune system’s ‘fight or flight’ response; which brings a heightened state of arousal and increased heart rate. Some conditions such as heart problems and high blood pressure can be caused by stress in the first place. Believing you have a serious condition can then in turn cause more stress creating a vicious cycle from which it can be difficult to escape. Stress can also cause an illness to progress at a faster rate as it leads to a decrease in hormones used to fight carcinogens and repair DNA (Kiecolt-Glaser & Glaser, 1986).

All these examples show why it is so important to monitor the illness cognitions of a patient, those around them and the health professional dealing with them; they can affect both the patient’s behaviour and likelihood to comply with advised treatment and even affect recovery directly.

Mack LeMouse

Copyrighted material; do not reprint without permission.

 

View all articles by Mack LeMouse