Anthropology – What is an Explanatory Model
An Explanatory Model is what a patient or client would use to help to explain how they perceive their problems or to describe their symptoms to a Doctor or a health professional. These are what a Doctor or a health professional should use to enable them to diagnose and treat a patient or client.
Who holds them?
The patient or client holds the Explanatory Models, as it is only that person who can give a detailed description of how they are feeling.
What is their relevance for health professional-patient interactions?
A Doctor would use an Explanatory Model to elicit facts from a patient about his or her illness or problems. Medical anthropology has some relevance in this instance because as a Doctor they should have some form of understanding about how a patient lives, their life style, culture and customs, religion, surrounding area but also the family environment and the way they live.
In a study conducted by Durkheim (1893) he stated that different or more intellectual societies had a complex system of division of labour while in simpler societies most men performed the same type of task. This can be seen in a Doctor/Patient relationship with the Doctor coming from the intellectual society and the patient from the simpler society.
A Doctor who has a practice in a deprived inner city area should try and have some understanding in what is making people ill in that area. Discover why they drink smoke abuse drugs and why they are eating an unhealthy diet. All of the above are the obvious triggers to ill health but there are other factors that can and should be taking into account such as pollution, high unemployment, living on the breadline, Poverty trap, High crime rates and stress which can be caused by all of the above.
When a Doctor is treating a patient for stress does he just hand out a prescription for anti-depressants or does he try to address the problem, which is causing the stress. Doctors don’t have cures for poverty or crime but maybe he could refer that patient for counselling to help them talk through their fears and problems brought on by these things.
The way in which the Doctor tends to treat the illness and not the person can be seen with the treatment of drug addicts. They will write out a prescription for methadone without trying to establish why they are using drugs in the first instance. Many drug addicts use them as a way to escape poverty, crime, health problems, employability and they way in that their family functions. It is also true that some drug abusers do not wish to be treated. But the ones that do should be treated holistically.
The way in which a Doctor treats a patient is also very important and this could be very much influenced by the Doctors upbringing, Social class and the way in which he or she received their training, very much like Durkhiems (1893) study shows. Parsons (1951) was one of the first people to examine the relationship between a Doctor and a patient. He believed that it was similar to that of a father/son relationship and thought it important for a Doctor and patient to have some sort of social understanding.”Their success or otherwise depends not only on the Doctors clinical knowledge and technical skills, but also on that of the relationship that exists between a Doctor and patient”(Parson, 1951).
In another study conducted by Stewart and Roter (1989) they indentified four different types of a Doctor/patient relationship. The first being the paternalistic one in which the Doctor is in control and very much a parental figure and believes what they are doing is in the patient’s best interest. This is a very out of date way for a Doctor to treat a patient but most patient s wont speak out against it as they feel inferior to the Doctor and he knows best.
Secondly there is the Doctor/patient relationship based on mutuality that is where the Doctor uses his clinical knowledge and skills, and the patient uses their own experiences, theories and feelings. This is a very democratic type of Doctor/patient relationship as in both parties gets an equal say and they are both gaining knowledge from each other.
Thirdly there is the consumerist type of relationship in which the roles are reversed and the patient is taking control of the consultation and the Doctor is being passive. In this form of relationship the Doctor agrees to the patient’s demands and will refer then to hospital or in writing them a sick note. This type of relationship is mainly used among the paying private patient.
Lastly there is that of the default relationship in which the patient is passive even, though the Doctor has lowered his control over the consultation. This sort of relationship can eventually lead to a patient being miss diagnosed by the Doctor, as they are very unwilling to share their problems with the Doctor.
Out of all of those types of relationships the one that should be used more by Doctors is that of the one based on mutuality as the Doctor and patient have an understanding of each other and this is what anthropology is about the understanding of people and their culture and customs.
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