Another factor emerges as the word illness is stripped down to its barest essentials.

Another factor emerges as the word illness is stripped down to its barest essentials.

Many of the characteristics attributed to health occur in illness, too. You may receive a rude awakening when you realize that a person perceived as healthy by clinical assessment may then—by a given set of symptoms— define him- or herself as ill (or vice versa). For example, in summertime, one may see a person with a red face and assume that she has a sunburn. The person may, in fact, have a fever. A person recently discharged from the hospital, pale and barely able to walk, may be judged ill. That individual may consider himself well, however, because he is much better than when he entered the hospital—now he is able to walk! Thus, perceptions are relative and, in this instance, the eyes of the beholder have been clouded by inadequate informa- tion. Unfortunately, at the provider’s level of practice, we do not always ask the patient, “How do you view your state of health?” Rather, we determine the patient’s state of health by objective and observational data.

As is the case with the concept of health, we learn in nursing or medical school how to determine what illness is and how people are expected to behave when they are ill. Once these terms are separated and examined, the models that health care providers have created tend to carry little weight. There is little agreement as to what, specifically, illness is, but we nonetheless have a high level of expectation as to what behavior should be demonstrated by both the patient and the provider when illness occurs. We discover that we have a vast amount of knowledge with respect to the acute illnesses and the services that ideally must be provided for the acutely ill person. When contradictions surface, however, it becomes apparent that our knowledge of the vast gray area is minimal—for example, whether someone is ill or becoming ill with what may later be an acute episode. Because of the ease with which we often identify cardinal symptoms, we find we are able to react to acute illness and may have negative attitudes toward those who do not seek help when the first symptom of an acute illness appears. The questions that then arise are “What is an acute illness, and how do we dif- ferentiate between it and some everyday indisposition that most people treat by themselves?” and “When do we draw the line and admit that the disorder is out of the realm of adequate self-treatment?”

These are certainly difficult questions to answer, especially when careful analysis shows that even the symptoms of an acute illness tend to vary from one person to another. In many acute illnesses, the symptoms are so severe that the person experiencing them has little choice but to seek immediate medi- cal care. Such is the case with a severe myocardial infarction, but what about the person who experiences mild discomfort in the epigastric region? Such a

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symptom could lead the person to conclude he or she has indigestion and to self-medicate with baking soda, an antacid, milk, or Alka-Seltzer. A person who experiences mild pain in the left arm may delay seeking care, believing the pain will disappear. Obviously, this person may be as ill as the person who seeks help during the onset of symptoms but will, like most people, minimize these small aches because of not wanting to assume the sick role.

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