Glenton Claire
Department of Health Services Research, Norwegian Directorate for Health and Social Welfare, PO Box 8054, N-0031 Oslo, Norway.
Soc Sci Med. 2003 Dec;57(11):2243-52. doi: 10.1016/s0277-9536(03)00130-8.
The paper draws on data from a Norwegian online discussion list for back pain sufferers and from open, in-depth interviews with Norwegian back pain sufferers. In both sources, back pain sufferers express a fear that the reality of their pain is being questioned. The paper discusses how these experiences of delegitimation can be understood as a result of the back pain sufferers' inability to achieve the sick role. Many of these individuals strive and frequently fail to achieve clinical and social characteristics that make up appropriate sickness behaviour. A lack of proof that they are sick, including a lack of medical diagnosis, appropriate health care treatment, and visible disabilities, can lead to accusations, both felt and enacted, of malingering, hypochondria and/or mental illness. This in turn can lead to problems in the achievement and/or legitimisation of sick role benefits such as sick leave and medication. The sick role concept has been criticised as being inappropriate for describing the experiences of the chronically ill. The paper argues that the sick role concept still appears to reflect the expectations of health professionals, the public and the patient himself. The study does not support the view that chronic illness is related to a decreased dependency on the medical profession. Instead, doctors' inability to offer chronic back pain sufferers a clear diagnosis, explanation, and/or a course of treatment or cure appears not to liberate the patient but rather prolongs his or her dependence on the doctor.
本文借鉴了挪威一个针对背痛患者的在线讨论列表中的数据，以及对挪威背痛患者进行的公开、深入访谈的数据。在这两种来源中，背痛患者都表达了一种担忧，即他们疼痛的真实性受到质疑。本文讨论了这些被剥夺合法性的经历如何被理解为背痛患者无法进入病人角色的结果。这些人中的许多人努力并经常未能表现出构成适当疾病行为的临床和社会特征。缺乏他们患病的证据，包括缺乏医学诊断、适当的医疗护理以及明显的残疾，可能会导致人们认为并实际指控他们诈病、疑病症和/或精神疾病。这反过来又可能导致在获得病假和药物治疗等病人角色福利以及/或使其合法化方面出现问题。病人角色概念被批评不适用于描述慢性病患者的经历。本文认为，病人角色概念似乎仍然反映了医疗专业人员、公众和患者本人的期望。该研究不支持慢性病与对医疗行业的依赖减少有关的观点。相反，医生无法为慢性背痛患者提供明确的诊断、解释和/或治疗或治愈方案，这似乎并没有使患者解脱，反而延长了他们对医生的依赖。
