CHAPTER 3
Seeking and Receiving Health Care
Lecture Outline
I. Seeking Medical Attention
How people determine their health status when they don’t feel well depends on their
social and cultural background, their interpretation of symptoms, and their concept of what
constitutes illness. Illness behavior consists of those activities taken by people who feel sick
and are directed toward determining health status before an official diagnosis. Sick role
behavior consists of those activities exhibited by people after they have been diagnosed and
are aimed at trying to get well.
A. Illness Behavior
Many people experience symptoms that may signal illness; some seek help for these
symptoms and others do not. Six possibilities explain how people respond to symptoms.
1. Personal factors include people’s way of viewing their own body, their level of
stress, and their personality traits. Stress affects people’s readiness to seek care—that
is, people who experience a great deal of stress are more likely to seek health care
than those under less stress, even with equal symptoms.
2. Gender also plays a role in seeking health care, with women more likely than
men to seek treatment. Women tend to be more sensitive to their bodies than men and
3. Age is another factor in seeking treatment, with young and middle-age people
being most reluctant to check out symptoms. Older adults must decide if their
4. Socioeconomic, ethnic, and cultural factors also relate to seeking medical care.
People in high socioeconomic levels are less likely than other to have symptoms, but
5. Symptom characteristics often influence how people respond to illness. People
are most likely to seek medical care when: (1) their symptoms are quite visible to
6. Conceptualization of disease is a sixth factor that may help explain why some
people seek health care, whereas others with the same symptoms do not. Howard
Seeking and Receiving Health Care
B. The Sick Role
After people become convinced that they are ill, they adopt the sick role, which
allows them both privileges and responsibilities. Their privileges include: (1) the right to
II. Seeking Medical Information from Nonmedical Sources
Once an individual notes symptoms they must decide if and how they are going to seek
help. Individuals often turn to family and friends (e.g., lay referral network) and the internet
before seeking health information from a doctor.
A. Lay Referral Network
Many people seek help from their lay referral network, a network of friends and
family who offer information and advice. This is often a person’s first source of
information, and while it may be beneficial, it can also provide people with false or
faulty healthy information.
B. The Internet
The Internet has become a popular source of health information. The majority of
Internet users in the US have used the Internet to seek health information. Women
and those with higher education are more likely to seek health information on the
Internet. However, like the lay referral network, the Internet can be a source of health
misinformation.
III. Receiving Health Care
By the time most people in the United States have reached their 21st birthday, they
have had multiple experiences of receiving health care. Those experiences vary according to
economic factors, which may limit access to health care.
A. Limited Access to Health Care
Hospitalization and other complex medical treatments are so expensive that most
B. Choosing a Practitioner
Sick people have a wide choice of health care providers, including midwives, nurses,
physical therapists, psychologists, osteopaths, chiropractors, dentists, nutritionists, and
herbal healers. The recent growth of alternative medicine has come mainly from well-
educated people who are dissatisfied with traditional medical care. For many poor people,
their most common experience of receiving health care is going to a hospital emergency
room, giving them very little choice of practitioner.
1. Practitioner-Patient Interaction
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2. Verbal Communication
Verbal communication is important in practitioner-patient interactions. Reasons
3. The Practitioner’s Personal Characteristics
Patients are more likely to follow the advice of physicians they see as worm,
caring, friendly, and interested in the welfare of patients, and these may be more
likely to be female doctors. Female doctors spend 10% more time with patients,
are more positive in their communications, and were evaluates more highly by
their patients than male doctors.
C. Being in the Hospital
1. The Hospital Patient Role
The experience of being in the hospital has changed during the past 25 years.
Hospitalization has become less common for many types of surgery and diagnostic tests,
2. Children and Hospitalization
Children are especially vulnerable to persistent fears as a result of receiving medical
treatment. Reassuring children that they have nothing to fear is not effective, but allowing
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Exploring Health on the Web
The Internet is now a vast resource for information about various conditions and treatment
options. Several websites offer good, objective information and links related to the health
care system and choosing a practitioner.
to a listing of physicians and hospitals, one of the features presents guidelines to choosing a
doctor or health care services. The site contains no advertising (as many sites about choosing
a practitioner do) and no endorsements. MedlinePlus screens the information carefully and
updates it frequently.
Suggested Activities
Personal Health Profile — Assessing Personal Preferences in Health Care
Some people prefer to be involved, active participants in their own health care
whereas others prefer to rely on the opinions of professionals. The 16-item Krantz Health
Opinion Survey (Krantz, Baum, & Wideman, 1980) measures preferences for different
treatment approaches. The questionnaire asks respondents to agree or disagree with
statements about their preferences in health care situations. Krantz and his colleagues divided
the survey into two scales; one measures the desire for information and the other measures
the extent of behavioral involvement in health care. Your students can complete this survey
Culture and Medical Care
Direct your students to explore the impact of culture on giving and receiving medical
care. They can gather this information from Internet sources, research articles, and even by
interviewing people. They should look for information concerning the cultural differences in
types of acceptable and desirable medical care, the impact of culture and ethnicity on
receiving health care, and the impact of those factors on providers.
Instruct your students to find examples of instances in which health care has been
culturally aware and sensitive and examples in which patients have received less than
optimal care because their culture is not compatible with the health care they sought.
A further point of discussion could be to ask students how the US healthcare system
could change to decrease confusion that may arise. Also, the textbook mentions studies that
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show that perceived discrimination decreases the likelihood of utilizing the healthcare
system. What could practitioners or hospitals change about their current practices that may
help increase minority ethnic groups seeking of health care?
What Makes a Practitioner Good?
Conduct a class discussion concerning the important decision of choosing a
practitioner. Although most people would say that competence is the main criterion in this
decision, research indicates that people tend to choose a medical practitioner on the basis of
many other factors. What other factors have your students used to decide what physician,
dentist, chiropractor, or other practitioner to visit?
Do your students believe that their practitioners are competent? On what do they base
their opinions? Do some students believe that their practitioner is competent because she or
he is friendly and appears to be caring? How can people without medical training know the
competence level of health care professionals?
Of course, physicians’ personal beliefs influence their interactions with patients as
well. For example, a recent study from Johns Hopkins University suggests that physicians’
beliefs about the causes of obesity influence the advice they give to their patients. In what
other ways might the beliefs of a physician influence the type and quality of care they
provide?
This article can be found in:
Bleich, S. N., Gudzune, K. A., Bennett, W. L., & Cooper, L. A. (2013). Do physician
beliefs about causes of obesity translate into actionable issues on which physicians
counsel their patients?” Preventive Medicine.
How Children Are Prepared for Hospitalization
Many hospitals in the United States offer programs that prepare children for
hospitalization and stressful medical procedures. If you are able to locate a hospital that
offers such a program, you can invite the person who administers it (often called a child life
specialist) to speak with your class. Request that information be included about the size of
the program, types of children served, costs and benefits, and the types of activities included
in the program. If the hospital has no analogous program for adults, ask the guest to consider
why these preparations are considered worthwhile services for children but not for adults.
If you cannot get a person from your community to speak to your class, the Internet
offers a wide variety of options to learn about programs from various hospitals. A search
engine such as Google will allow you to access dozens of hospitals’ child preparation
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Have students think about the last time they sought (and did not seek) medical care
for a condition, by asking the following questions- “What was the symptom? How did you
interpret the symptom? Think about the last time you decided not to get care for a
condition… what was the symptom? How did you interpret the symptom? Did you seek help
from any other sources besides a doctor or nurse?”
Video Recommendations
From Films for the Humanities & Sciences:
The Hospital Experience (2003) explores why hospitalization is such a distressing experience
by following a patient through the process.
Killed by Care: Making Medicine Safe (2004) presents the problem of medical errors,
including commentary by two of the most prominent proponents of patient safety, Donald
Berwick and Lucien Leape.
The Chronically Ill: Pain, Profit, and Managed Care (2000) focuses on the problems of
providing medical care to people with chronic illness in a system oriented toward acute care.
The video also highlights the issues of cost and the profit-oriented health care system in the
United States.
From Fanlight Productions:
To highlight the role of culture in receiving medical care, Worlds Apart: A Four-Part Series
on Cross-Cultural Healthcare (2003) follows four patients with serious medical problems as
they negotiate the health care system and make important medical decisions.
Multiple Choice Questions
1. Which of these statements expresses a healthy attitude toward seeking medical care?
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a. “I believe that if I feel well, I’m healthy.”
b. “Only severe symptoms of a disease are worth worrying about.”
c. “When I don’t understand my doctor’s explanations or instructions, I’ll ask
questions until I do understand.”
d. “When facing a stressful medical procedure, I try not to think about it.”
2. Although the terms “disease” and “illness” are often used interchangeably, they have
somewhat different meanings. Technically, disease refers to
a. psychological disorders.
b. the experience of being sick.
c. the process of physical damage.
d. an existing, official diagnosis.
3. In the United States, people are considered to be ill
a. after they have been officially diagnosed by a health care provider.
b. if they have an elevated temperature for at least 24 hours.
c. when a disease process first begins.
d. whenever they feel sick.
4. Maud has not been feeling well due to a sore throat. She has taken aspirin and spent
most of the day in bed. Her actions would be defined as
a. sick role behavior.
b. illness behavior.
c. both a and b.
d. neither a nor b.
5. Edna waited almost 2 weeks after her sinuses started bothering her before she made
the appointment to see her doctor. Making the appointment would be considered
a. sick role behavior.
b. illness behavior.
c. psychotic behavior.
d. health-seeking behavior.
6. Joshua has been told by friends that he does not look well. He feels flushed and
decides to take his temperature to determine if he has a fever. His actions would be
defined as
a. self-defeating behavior.
b. disease behavior.
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c. illness behavior.
d. socialized behavior.
7. The function of illness behavior is to
a. determine health status.
b. alleviate symptoms.
c. seek a cure.
d. increase compliance.
8. People experiencing high levels of stress are _____ likely to report symptoms and
______ likely to have their symptoms acknowledged as indicating a disease.
a. more . . .more
b. more . . .less
c. less . . .less
d. less . . .more
9. Women are more likely than men to seek health care, possibly because
a. they feel less stress than men.
b. they tend to be more introverted.
c. they have more diseases than men.
d. they may be more sensitive to their internal body status.
10. Who is most likely to seek health care?
a. a 55-year-old women with a rapid heart beat
b. a 26-year-old man with a sprained ankle
c. a 70-year-old women who attributes her symptoms to age
d. an unemployed 30-year-old mother with four children
11. Jane and Betty are both experiencing fever and nausea. Jane’s friend Myrna asks her
if she is sick and tells her that she looks terrible, but when she sees Betty, Myrna says
nothing about Betty’s appearance. Research suggests that Jane
a. is likely to seek health care but to advise Betty not to.
b. is more likely than Betty to seek health care.
c. will seek alternative health care rather than go to a physician.
d. and Betty will both make appointments with a physician.
12. Which of these people is most likely to seek health care?
a. A 19-year-old college man with a knot on his leg
b. A 19-year old college woman who misinterprets HIV symptoms for the flu
c. A 9-year-old boy knocked unconscious from a fall off his bicycle
d. A 40-year-old women worried about a lump in her breast
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13. Which of these people is most likely to seek health care?
a. Mildred is 72 years old and simply does not feel well. She refers to her
symptoms as “the crud.”
b. Melvin is a 63-year-old owner of his own profitable business. He began to feel
chest pains yesterday and is concerned.
c. Elmer is 68 years old, never married, and lives alone. For the past 2 years,
Elmer has experienced “shortness of breath.”
d. Ida is 92 years old and feels fine. However, she is lonely and would “like to
talk to someone about her health.”
14. With equal symptoms, who is most likely to seek health care?
a. A 45-year-old man who runs his own business
b. A 45-year-old unemployed man
c. A 55-year-old woman with a very low level of stress
d. A 55-year-old woman with a very high level of stress
15. According to David Mechanic, which of these symptom characteristics is LEAST
likely to determine people’s response to illness?
a. cost of treatment and hospitalization
b. perceived severity of the illness
c. visibility of the symptoms
d. the extent to which the symptoms interfere with normal daily functioning
16. Several symptom characteristics predict a person’s readiness to seek health care.
Which of these is NOT one of these characteristics listed by David Mechanic?
a. severity of the symptom as seen by medical authorities
b. visibility of the symptom
c. frequency and persistence of the symptom
d. extent to which symptoms interfere with daily life
17. Finding a label for symptoms
a. tends to catastrophize the problem.
b. tends to make women believe that the problem is more serious but tends to
make men believe that the problem is less serious.
c. is an important component of personal understanding of illness.
d. is less important than receiving support from family and professionals.
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18. Gail has not been feeling well lately. According to the model of illness
conceptualization described by Howard Leventhal and his colleagues, Gail is likely to
a. deny her symptoms.
b. try to label her symptoms in a non-threatening way.
c. repress her symptoms and get to the point where she believes she does not
experience them.
d. exaggerate her symptoms and attempt to get all the sympathy she can.
19. Which of these factors was NOT among the factors identified by Howard Leventhal
as a component in the conceptualization of illness?
a. identification of the disease
b. monetary cost of the illness and treatment
c. cause of the disease
d. consequences of the disease
20. Alexander Segall proposed that the sick role includes three rights and privileges and
three responsibilities. Which of these factors is a responsibility of people who have
adopted the sick role?
a. making decisions about one’s health-related issues
b. making an attempt to get better
c. the duty to perform everyday chores
d. the duty to depend on other people for assistance
21. A _______ is the event that separates illness behavior from sick role behavior.
a. heart attack
b. diagnosis
c. hospitalization
d. death
22. Poor people, in comparison to wealthy people, utilize health care _______, and when
they do their illnesses are _________.
a. less often; severe
b. less often; not severe
c. more often; severe
d. more often; not severe
23. Of all ethnic groups, _____ are the most likely to report a visit to a physician.
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a. Asian Americans
b. European American
c. African Americans
d. Mexican Americans
24. When diabetes patients viewed their illness as acute, rather than chronic, their illness
management was
a. better.
b. worse.
c. unchanged.
d. better for a few months, then worse.
25. Margaret finds a lump in her breast but delays seeking medical attention because she
is worried it might be breast cancer. According to Leventhal, Margaret is worried
about the
a. consequences of her disease
b. timeline of her disease
c. determination of her disease
d. identity of her disease
26. Women and those with higher education are more likely to seek health information
from
a. their friends and family.
b. the Internet.
c. newspapers and magazines.
d. television.
27. Alex found some information about a new treatment for asthma on the Internet and
shares this information with her doctor. Since Alex’s information is accurate and
relevant, her relationship with her doctor will most likely
a. deteriorate, as her doctor feels challenged.
b. benefit, as Alex and her doctor can discuss this new information.
c. end, as Alex no longer trusts her doctor to provide her with new information.
d. Both a and c.
28. Patients’ _________ with their practitioner can lead to patients following medical
advice and continual use of medical services, like obtaining checkups.
a. payment plan
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b. satisfaction
c. differences
d. all of the above
29. To help people 65 years old and older, the United States Congress established
a. the Health Maintenance Act.
b. Medicaid.
c. Medicare.
d. the Dole/Clinton Act of 2001.
30. Which of these industrialized nations has the greatest restrictions on access to health
care?
a. France
b. China
c. Germany
d. the United States
31. In the United States,
a. most people with health insurance are either employed or have a family
member who is employed.
b. all citizens must possess health insurance.
c. every person 65 or older receives free prescription drugs.
d. private health insurance is not available to people with Medicare.
32. When people without health insurance are in serious need of medical attention, they
are most likely to go to
a. an emergency room.
b. an alternative health provider.
c. a pharmacist.
d. another country.
33. Which of these factors reflects a significant trend in the health care system during the
past 30 years?
a. Hospital stays are much longer.
b. Medical schools are graduating fewer physicians.
c. The percentage of general practitioners has increased dramatically.
d. Hospitalized patients are more severely ill than they were 30 years ago.
34. The “nonperson” treatment that hospital patients experience arises from
a. the requirement that patients follow hospital routine.
b. intentional efforts by hospitals to transfer control from patients to staff.
c. physicians who do not care about their patients’ well-being.
d. all of these.
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35. Malone has been in the hospital for two weeks due to injuries from an automobile
crash. Because he is hospitalized, he does not have to work; he receives three healthy
meals a day; and most of his normal, everyday decisions are made for him. In such
circumstances, Malone will probably
a. enjoy his hospital stay.
b. become addicted to pain medication.
c. experience less stress than usual.
d. experience more stress than usual.
36. Medical errors cause some deaths in the United States. Research suggests that the
number of such deaths per year is at least
a. 2,000.
b. 6,000.
c. 21,000.
d. 44,000.
37. Parents who reassure children who are about to undergo stressful medical procedures,
telling them that “There’s nothing to be afraid of,”
a. provide effective models.
b. decrease the anxiety level in their children, but raise it in themselves.
c. are more effective than filmed models in helping a child cope with the
stressful medical procedure.
d. tend to increase rather than decrease their children’s fears.
38. Using modeling to help children in the hospital prepare for stressful medical
procedures
a. is not successful in helping children prepare for surgery but can help with less
serious procedures.
b. is successful with children but not with adolescents or adults.
c. can be as successful as drugs when modeling is combined with a cognitive
behavioral intervention.
d. can be effective if the parents of the young patient are not allowed to
participate.
39. Most adults would profit from the techniques that hospitals use to prepare children for
hospitalization. The main barrier to preparing all patients who undergo stressful
medical procedures is that
a. adults do not have the time for these procedures.
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b. these procedures add to medical costs.
c. patients find the preparation as stressful as the procedures, so preparation adds
to the overall stress of hospitalization.
d. these procedures are not effective.
1. People with a disease are also ill.
2. Those actions people undertake to learn whether or not they are ill are called illness
behaviors.
3. Sick role behaviors occur before a person has seen a health care provider and prior to
receiving a diagnosis from that health care provider.
4. Women are more likely than men to seek health care, even when pregnancy and
childbirth are not considered.
5. African Americans are more likely than European Americans to visit a physician.
6. In the United States, medical errors are the second leading cause of death.
7. Men tend to report only life-threatening situations, such as heart disease, whereas
women tend to report more body symptoms and distress.
8. Young adults show the greatest reluctance to seek health care.
9. People often seek medical information from their family and friends, also known as
their lay referral network.
10. Emily is trying to decide between two doctors: one is female and one is male.
Research on how doctors interact with their patients, suggest that Emily may want to
consider choosing the female doctor, as this doctor is more likely to spend more time
with her and be more positive when communicating with her.
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Essay Questions
1. Differentiate illness behavior from sick role behavior and give examples of each.
2. What personal and social factors influence seeking health care?
3. How people understand disease is critical for their behavior when they believe they are
ill. Discuss each of the five components that Leventhal and his associates have identified
as components of illness conceptualizations in terms of the implications for illness
behavior.
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4. What circumstances restrict people’s access to adequate health care?
5. In addition to being ill, what makes hospitalization stressful? Why don’t hospitals make
changes to alleviate these circumstances?
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