In an article entitled Culture, Illness, and Care, medical anthropologist Arthur Kleinman writes about the important distinction between illness and disease. He defines diseases as “abnormalities in the structure and function of body organs and systems.” In other words, disease is what is actually physically wrong with the body. In contrast, illness is what patients experience when they are sick. This is profoundly influenced by multiple factors such as a person’s culture, social situation, and the meaning attributed to symptoms.
Kleinman writes that the focus of modern medicine tends to be disease. Doctors are trained to find a distinct abnormality in the structure and function of the body and provide an effective remedy. This approach works for straightforward problems such as appendicitis and pneumonia that have a clear biological cause. It is much less useful for conditions that do not have a discernible physical etiology. This is a significant limitation since about 50% of visits to the doctor are for complaints without an ascertainable biologic basis.
In some cultures, physical symptoms are the most acceptable way of expressing psychological problems such as anxiety and depression. When I volunteer at a local clinic that provides care for immigrants and refugees, I try to always ask about the stories of the people I see. In learning about their life journeys and hardships, the causes of otherwise inexplicable physical symptoms, such as headaches, chest pain, and shortness of breath, often reveal themselves.
I have asked patients suffering from illnesses without a straightforward diagnosis and treatment how physicians can be most helpful. They tell me that sometimes doctors become frustrated when they cannot find a diagnosis and cure for what is wrong. I must admit that I have at times felt nervous seeing somebody whose symptoms I cannot understand and effectively treat. But many of these patients tell me they understand that doctors cannot always figure out what is wrong. They don’t expect us to be miracle-workers. What these patients tell me they most appreciate is a physician who will not stop caring and trying to be helpful.
James Marroquin is an internal medicine physician who blogs at his self-titled site, James Marroquin.
