make sure you are reading the information given. pls ! Patient-health care provider role paper Read pages 170-175 in Chapter 7 of the du Pre

make sure you are reading the information given. pls ! Patient-health care provider role paper
Read pages 170-175 in Chapter 7 of the du Pre textbook about the five different types of patient and caregiver roles.
Briefly describe a health care interaction in which you were a patient (do not disclose anything in which you are not comfortable but provide enough detail for someone to analyze
the roles of the participants in the interaction; e.g., scenario, dialogue). Then, the most important part of the paper is to analyze your role as a patient and the role of the health
care provider (remember to use concepts from du Pre chapter 7). Which one of the five role categories did both participants enact? Provide a rationale for why you believe those
were the roles (e.g., use examples from your experiences to support your reasoning that illustrate the concepts). Be sure to bold the course concepts you are using.
. No more than two double-spaced pages
. 12-point Times New Roman font
. 1-inch margins 170
roles are collaborative achievements, sup
its, supported by
participants’ mutual efforts. This does not
the participants always like the roles they assume
They may be motivated by a sense of cultural appen
. Are there ways in which the military metaphor
priateness or the perceived need to "play the scene" my
Dealing to you? if so, how?
the other person is playing it.
here ways in which the peace and flexibil-
ity perspective is appealing to you? If so, how?
. On balance, which feels more familiar to you?
More appealing?
The traditional Muslim diet forbids the consump-
tion of pork or alcohol. This can make hospital
food, including foods fried in animal lard, unac-
Sick Roles and Healer
ceptable and can be an issue with medications,
such as some forms of insulin that are derived
from pigs, and cough syrups that include alcohol.
Culturally speaking, th
king, there are right and wrong ways
to "do" being ill and providing assistance, For exam-
ple, members of some Arab cultures expect women
to cry out in pain during labor and delivery (Ahmad,
2004), whereas members of some spanic cultures
believe that pain should be endured stoically because
From one perspective, caregivers are similar to me-
it is God’s wish (Duggleby, 2003). Likewise, people
chanics and patients to machines. The implication is
might be expected to remain "respectfully" quiet in
that patients are relatively passive and care providers
medical encounters or to take a "responsible" role by
are expected to be analytical and capable of fixing the
sharing their thoughts. The rules for being a good pa-
problems that are presented.
tient and a good caregiver may be contradictory and
This perspective does not encourage emotional
confusing. Nevertheless, with people’s health hang-
communication between patients and health profes-
ing in the balance, participants may fervently wish to
sionals. The focus is more on identifying physical ab-
behave correctly.
normalities and fixing them. When providers take on
A role is a set of expectations that applies to
a mechanic role, they are typically more concerned
people performing various functions in the culture.
with what they can observe and change than what a
For example, people may play the roles of patient,
patient might be feeling.
doctor, sister, friend, employee, and parent. Each role
Some people feel that scientific medicine is rela-
is guided by a set of culturally approved rules. Typi-
tively mechanistic. That is, when health profession-
cally, one role exists in relation to another: patient-
als take on the role of scientists, they are much like
caregiver, student-teacher, parent-child, and so on.
mechanics-concerned with the orderly physical fune-
A role may lose meaning without its counterpart (e.g.,
tioning of the human body. As mechanics or scientists,
a teacher is not a teacher without students). Therefore,
care providers are expected to be objective, value neu-
role-playing is a collaborative endeavor, and people
tral, and capable of collecting information, diagnosing
usually adjust their performances to form meaningful
a problem, and fixing it. It may seem inappropriate
combinations. This can be so compelling that people
for them to display emotions or to call into play such
sometimes feel forced into roles they would rather not
intangible notions as faith and spirituality. Eric
assume. For example, if your conversational partner
Cassell (1991) puts it this way: "Adjectives like warm,
adopts a parental role, you may feel like a child, and
tall, swollen, or painful exist only for persons but, ide-
you may act that way even if you would rather not. To
ally, science deals only with measurable quantities like
do otherwise might seem uncooperative and rude.
temperature, vertical dimensions, diameters" (p. 18).
As you will see in this section, patients and care-
One advantage of the mechanic-scientist role is
givers often play complementary roles-as mechan-
that it reduces the emotional drain on health profes-
ics and machines, providers and consumers, parents
sionals. If patients are like machines who simply need
and children, and so on. Keep in mind that these
fixing, emotions need not become part of the process CHAPTER 7
(Bonsteel, 1997). At the same time, the confidence that
people can be fixed may seem comforting and neat.
with or question an authority figure such as a health
of course, patients may not appreciate being
professional. In these cultures, patients have tradi
treated like machines. Some argue that ignoring pa
tionally declined to take part in treatment decisions,
tients’ descriptions and considering them passive in
preferring that professionals make decisions on their
their own care casts them as little more than a set
behalf (‘Reducing Health Disparities," 2005). It is
of parts. In Richard Swiderski’s (1976) analysis of
risky to assume that this is always the case, though.
medicine through the age
e ages, he concludes that doc-
When Dana Lathan Alden and colleagues (2010) in-
tors have often considered patients less relevant than
terviewed urban Vietnamese women, most of them
their pulse rates, blood, and urine. This is an image
indicated that they would like a say in choices regard-
the public has embraced as well, as evidenced by pa-
ing their contraception use, even though it is common
tients’ disappointment when their physicians do not
in their culture to honor the judgment of physicians
run tests or prescribe medications. One reason for
without question (Alden, Merz, & Thi, 2010).
overuse of antibiotics is patients’ insistence that treat-
One challenge of the paternalistic model is that
ment be embodied in some physical form, even when
professionals may misunderstand how much pa-
pharmacology suggests it will have no effect (Fisher,
tients understand and agree with them. For example,
1994). Moreover, the unrealistic belief that doctors
Japanese individuals may use the word "yes" to signal
can fix anything may lead to disappointment and even
politely that they understand the speaker, not as a sign
that they agree. If they have questions, they may not
ask them, for this might be seen as criticism.
Another challenge is that health profession-
als may be expected to know what is best for their
patients. Some theorists believe this is a dubious
"Your patient has no more right to all the
assumption because patients may have many feel-
truth you know than he has to all the medi-
ings and desires unknown to their care providers
cine in your saddlebags. . . . He should only
(Bealieu-Volk, 2014). Expecting providers to antici-
get so much as is good for him."
pate and act on patients’ wishes may place an un-
That was the message from revered physician
realistic burden on them and unfairly rob patients
Oliver Wendell Holmes at the 1871 commence-
of opportunities to make their own decisions. (See
ment address at Bellevue Hospital College.
Box 7.4 for more on this issue.)
Holmes also advised the graduates to adopt the
habit of "shrewd old doctors" who keep a few
stock phrases to quiet "patients who insist on
Caregivers may be cast as spiritualists who use their
knowing the pathology of their complaints with-
powers on behalf of faithful patients. The image of
out the slightest capacity of understanding their
caregivers as spiritual figures (and even as gods) was es-
scientific explanation" (Holmes, 1891, p. 389).
tablished thousands of years ago. Jesus has been called
"the great physician" and is revered for legendary acts
of curing the sick (Moore, Van Arsdale, Glittenberg, &
Aldrich, 1987). Throughout history, physicians have
been described as "little gods," a celestial metaphor that
The popular expression "doctor’s orders" suggests a
extends to nurses, often portrayed as "angels of mercy"
relationship in which physicians issue directions that
(Moore et al., 1987, p. 232).
patients are expected to obey. This approach is consis-
Anthropologists have compared the physician’s
tent with paternalism, the idea that patients are like
role to that of a priest, a powerful and somewhat mys-
children and caregivers are like parents.
terious authority figure. This awe-inspiring image
The dynamic that "health providers know best"
may be strengthened by patients’ reverence and phy-
may be enacted in cultures common in Japan, India,
sicians’ displays of power. Pendleton and colleagues
and Venezuela that honor a high power distance-
(1984) point to doctors’ laboratory coats, specialized
that is, the degree to which they defer to people of
vocabulary, and honorific titles as supporting props
in this image. They also suggest that the image is
greater power or status (Hofstede, 2001). Members
bolstered by an information imbalance that makes
of these cultures may consider it rude to disagree 172
Physician as Parent or Partner?
Medical ethicist Robert Veatch (1983) reflects that
care. These factors make it unlikely that doctors
physicians are often criticized as being "aloof and
will understand the unique needs and preferences
unconcerned" rather than concerned and attentive,
of each patient. The paternalistic model is also cray
as people would like them to be. In short, physicians
cized as inconsistent with patient empowerment
often act like strangers when patients wish they
which presumes that patients are knowledgeable
would act like friends or family members.
and active agents in their own health care (Emanuel
Paternalism (the idea that doctors are like par-
& Emanuel, 1995).
ents) is a long-standing tradition. The ppocratic
Do You Think?
oath, written approximately 2,500 years ago, be-
seeches physicians to use their best "ability and judge
1, Do you feel it is realistic or preferable for health
ment" on each patient’s behalf. This presumes that
caregivers to know their patients’ feelings and
physicians are well acquainted with medicine and
values? If so, how might they accomplish this? If
not, what alternatives would you suggest?
with the particular needs and preferences of each pa-
2. Can you think of circumstances in which you
tient, Paternalism is also based on the belief that phy-
would want your physician to know your feelings
sicians are more capable of making medical decisions
and life circumstances?
than patients are.
3. Can you think of circumstances in which you
Some people feel that paternalism is outdated.
would rather your physician did not know
Veatch (1983) points out that it is difficult to know
you well?
patients well in the current age of large patient
4. Do you feel patients are capable of making deci-
loads, specialization, and emergency and outpatient
sions about their own care?
physicians’ knowledge seem all the more marvelous:
Folk medicine’s focus on sense-making and social
"Powerful rituals, such as examining and prescribing,
support addresses the distinction between healing
are the more charismatic in the absence of adequate
and curing. McWhinney (1989, p. 29) calls healing a
explanations" (p. 9).
"restoration of wholeness," which includes spiritual
By contrast, folk healing is typically oriented
and moral consideration, as opposed to purely physi-
toward lifeworld concerns (Chapter 4). Usually, a folk
cal curing, which he says may still leave a patient in
healer’s role is to integrate social support with spiri-
"anguish of spirit" about the causes, effects, and fears
tual faith and physical treatment. Among the most
associated with the illness.
well-known healers and spiritualists are the shamans
Another spiritualist group is the Christian Sci-
and hand-tremblers of Native American cultures
ence Church. Some members of this religion believe
and the curanderos (coo-ran-DARE-ohs) of Mexican
that conventional medicine is anti-Christian and that
American cultures. These folk healers are usually
illness is an illusion and can be cured only through
well-known members of their communities. As such,
prayer (Christian Science, n.d.). Thus, they may refus
they are familiar and accessible, without institutional
biomedical therapies, including surgery. This ha
boundaries or technical jargon.
raised controversy across the nation, especially when
A shaman is believed to coax a patient’s disease
children’s lives are involved. Currently, the church
into his or her own body and then expel it through
website presents examples of people who were cure
strength of will (Hutch, 2013). The assumption is
by prayer and mind control but says health-related d
that illness is an invasion of magical or supernatural
cisions are up to individual members.
forces. The faithful believe shamans can communi-
cate with beings beyond the physical world, an ability
A belief in the supernatural also characterizes t
health beliefs of some southern Appalachians. In t
that gives them magical abilities and healing powers.
culture, spiritual ceremonies involving faith healing CHAPTER 7 CULTURAL CONCEPTIONS OF HEALTH AND ILLNESS
glossolalia (speaking in tongues) are believed to restore
health. Faith healers are expected to channel the cura-
clients who pay caregivers primarily to provide infor-
the power of the Holy Spirit, which they pass to believ-
mation and carry out the patients’ wishes. Consumer-
ers through ceremonies known as the laying on of hands.
ism is fueled in part by Internet resources. People can
Glossolalia involves a trancelike state during which a
now look up extensive health information for them-
worshipper seems to speak in a foreign language. It is
selves. Websites such as
believed that the language is known only to God, or that, and now offer
it is a foreign tongue known to some but unknown to the
reviews of hospitals, treatments, products, and
worshipper, except through divine inspiration.
professionals-including consumer reviews of doc-
The success of a spiritual ceremony is often said to
tors’ bedside manner, perceived quality of care, price,
rely on the patient’s faith in the healer and the greater
the cleanliness of their offices, the courteousness of
spiritual force that has accepted the healer as a medium.
their staff members, and more.
One result of this assumption is that failure to recover
Competitiveness has made many care providers
may be construed as an indication of the patient’s insuf-
especially mindful of patient satisfaction. However,
ficient faith (Kearney, 1978). For this reason, patients
some who see themselves as serving a higher purpose
may be particularly trusting and may benefit from the
than profit margins find the marketplace metaphors
power of positive thinking. However, if their conditions
disturbing. Analysts warn that consumer websites can
do not improve, they may be loath to admit it.
have a backlash. For one, anyone can file comments
Even scientists acknowledge the power of faith,
online but most people don’t. As a result, the com-
although they are not likely to regard it as the central
ments that appear may not represent most patients’
opinions. For another, physicians who are worried
focus of their work. Evidence supports that people
about their stats may be dissuaded from taking high-
who expect to be cured sometimes are, even when the
risk cases, which are more likely than others to result
"treatment" is an inactive placebo such as flavored
in lawsuits and disappointing outcomes. Thus, con-
water or sugar. Placebo effects are so common that
sumer reviews can inadvertently punish doctors for
medical researchers routinely give some research par-
going out on a limb for patients with critical or rare
ticipants an actual treatment and give other people a
placebo. If the treatment group does not experience
Years ago, Howard Friedman and M. Robin
greater effects than the placebo group, the researchers
DiMatteo (1979) cautioned that consumerism may be
cannot be sure they are measuring anything more than
a risky conceptualization for all involved. If the cus-
the power of suggestion. The reverse is sometimes true
tomer is always right, they wondered, will medical
as well. People who have no confidence in a treatment
centers that respect patients’ treatment decisions later
may be unaffected by it. These examples do not prove
be held liable if adverse outcomes result? Friedman
that all disease can be reduced to the effects of faith
and DiMatteo also worried that pleasing patients may
and emotions. However, they demonstrate that there
sometimes be at odds with ing them. Considering
is more to disease than meets the (microscopic) eye.
that the most effective medical options are sometimes
A religious-like faith in caregivers serves multiple
the most unpleasant, how far will caregivers go to
goals. It inspires confidence on the part of patient and
avoid upsetting their patients?
caregiver, which may be an important part of heal-
Similarly, consumerism seems to place cost as a
ing. It also honors the extraordinary role health pro-
top priority. Richard Glass (1996) is concerned that
fessionals play in managing life and health. There is
physicians may choose less aggressive treatment op-
a downside, though, in dashed hopes and exorbitant
tions if they are forced to be more mindful of cost than
malpractice claims. With the expectation that medi-
care. A physician himself, Glass maintains that pa-
cine can work miracles if done correctly, people may
tients "rightly expect something different from their
feel particularly angry when things do not go well, and
doctors than from consumer goods salespersons"
they may rightly or wrongly charge that their caregiv-
(p. 148). He argues that a marketplace mentality may
have "perverse effects" on medical care, and he be-
ers are incompetent (Kreps, 1990).
seeches health care managers not to interfere unduly
in medical decision making.
There is some evidence that people who are well
It has become popular to describe health care in terms
informed about health information do not view
their doctors in quite the same way as before, Unlike
of consumerism. Patients are regarded as shoppers or 174
Partners in Care
Tina, a middle-aged mother of two, has been referred
rather than a parent, when it comes to patients.
to a hemodialysis center for treatment. When she ar-
They reflect that a paternalistic model probably
rives for her first visit, an advanced nurse practitioner
would not have ed Tina understand the need for
notices that she is upset and takes the time to speak
dialysis or coordinate her care in light of her other
with her. Tina says she has long had diabetes, but she
does not understand why her doctor wants her to un-
"Tina is forever grateful for the support she re-
dergo dialysis. She feels fine and her family relies on
ceived at a time she desperately needed it," the au-
her to work full time.
thors write, reflecting that, when the nurse practitio
Recognizing that Tina needs to be an active agent
ner asked Tina what had made her start dialysis, she
in making decisions about her own care, the nurse
replied warmly, "It’s the way you spoke to me" (Hain
practitioner listens attentively to her concerns and
& Sandy, 2013. p. 156).
s her better understand her medical condition,
which involves kidney disease that might kill her
Do You Think?
without treatment. Together, they devise a regimen in
1. In what circumstances, if any, might you follow a
which Tina is able to undergo dialysis for about a year
doctor’s advice without question?
until she receives a donor kidney
2. In what circumstances, if any, would you rather
Debra Hain and Dainne Sandy (2013) write about
be treated as a partner in making decisions about
Tina in an article on the value of being a partner,
your care?
generations past, people are unlikely to believe that
emphasis underscores the importance of trusting
doctors have all the answers (Lowrey & Anderson,
communication between patients and caregivers.
2006). This may diminish physicians’ professional
Some people find the partnership model ap-
status. Or it may simply fuel a different kind of rela-
pealing because it allows both patients and health
tionship, such as the one we will discuss next.
professionals to have influence over medical deci-
sions, as opposed to being strictly patient centered
or caregiver centered. Hufford (1997) attests that
patients have important and relevant statements to
Only as partners do patients and caregivers assume
make about their own health: "Sick people, it turns
roles of roughly equal power. Of course, they each bring
out, often do know exactly what has been happen
something different to the encounter in terms of ex-
ing to them, what it feels like, and when it happens
periences and expertise. But as partners, they orient
and there is nothing fictional about it" (p. 118). (Se
themselves to identifying mutually satisfying solutions,
Box 7.5 for an example.)
acting as peers in the process. The partner role is con-
One way to encourage patients’ active particip
sistent with collaborative medical talk (Chapter 5).
tion is to follow the lead of Myra Skluth (2007) an
The success of health care managed in this way
hinges largely on the quality of patient-caregiver
create patient to-do lists. She and patients negotia
relationships. In 1996, the Journal of the American
the terms of the to-do lists, and then each keeps a co
Medical Association introduced a column called "The
"This approach works very well," she says (p. 16).
cause the to-do lists are in patients’ charts, "if they

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