Perceptions of disease. Values and attitudes of patients and medical students

Detta är en avhandling från Department of Community Medicine, Universitetssjukhuset MAS, 205 02 Malmö, ing 59

Sammanfattning: During the 20th century, the development of biomedical knowledge and the demographical changes have increased the needs and demands for health care in industrialised countries. Illness without evidence of disease and fear of disease are often the reasons for seeking medical care. Primary care is the official foundation of the Swedish health care system but priorities are vague and frequently changing. A considerable proportion of family physicians will retire within 10-15 years and the proportion of the medical students with preference for family medicine is insufficient to replace these doctors. The aim of this study was to explore the values and attitudes concerning disease expressed by patients and medical students and investigate their origin in culture, personal experience, education and training. The medical history of the family influenced the patients' interpretation of their present problem in several cases. The perceived seriousness of the condition in the family history was a prerequisite for this impact. The family history could influence the thoughts of patients through different mechanisms. Some fears may be linked to thoughts about genetic predisposition, while others may depend more directly on the emotional closeness to the affected relative. Also, some may be reflections of prevailing beliefs and values about health and disease. The fear of a disease seemed to be related to a more or less conscious estimation of its potential to stigmatise. The threat against autonomy could have a general importance. Different aspects of identity and control were important themes. The results of this study indicate that some medical students choose their career in order to achieve control over disease and suffering. Authority, power and control were the common denominators. The perceptions of medical students concerning certain diseases seemed to be determined by prevailing values and beliefs on one hand and by private and professional experiences on the other. The diseases mentioned as most fear provoking all had characteristics that put the patient as well as the doctor out of control; no preventive measures, extremely contagious, no remedies, an unpredictable course, a potential to alter bodily appearance and behaviour. Final year medical students were more interested in conditions for which effective treatment is available and less frightened by conditions, which they have low probability to be afflicted by. Moreover, the results indicated that not only theoretical and practical knowledge, but also values and attitudes were transmitted to the students during the process of professionalisation.

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