The Vital Assignments of the Sick Role in Society

The Essential Features of the Sick Role and the Physician's Role

The Sick Role, developed by sociologist Talcott Parsons, is based on the idea that illness is "disruptive for society" since sick people cannot fulfill their normal roles (1951). As a result, society "instituted a special role for sick people that functions to control the amount of illness in society and to return sick people back to a state of health as quickly as possible" (1951). The sick role has two vital role assignments: the patient's role and the physician's role. The patient has two rights (exemption from normal social roles, exemption from responsibility for their own state) and two responsibilities (to get better as soon as possible, to cooperate and consult with medical experts when warranted) (Parsons 1951). The physician's role consists of diagnosing and labeling the patient, therefore legitimatizing their illness and establishing their place in the "sick role." Pros of the sick role include the promotion of both individual health and the health of society so long as the patient-physician role-set is functional; cons of the sick role include its normative nature, the prevalence of non-functional physician-patient relationships, and the evolving landscape of illness in society. Ultimately, the sick role served as an important stepping- stone to establishing patient rights in society but is no longer a functional model of medical sociology.

So long as the patient-physician role-set is functional, the sick role has some important pros. These include promoting individual health - by allowing sick people to focus on getting better - and promoting the health of society - by both controlling the number of people opting into the sick role (by having physicians act as the gatekeepers of the sick role) and by returning sick people to health through the two patient responsibilities. Additionally, the sick role legitimizes illness by giving the patient exemption from responsibility from his or her state. A functional patient-physician role-set is one that establishes mutualism, the "meeting of two experts:" the physician brings clinical skills and knowledge while the patient brings their personal experience. In a mutualistic physician-patient relationship, both the physician and the patient are highly invested, decreasing the power imbalance between the patient and physician and instead orienting the two as "partners" in the patient's care.

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While the sick role does have some pros, it is ultimately outdated because it is overly normative in its definition of illness and does not account for non-functional physician-patient relationships. The sick role accounts for neither medically-unexplained symptoms (MUS) - such as "chronic pain, stress, milder forms of depression and contested illnesses, including fibromyalgia, chemical intolerance, irritable bowel syndrome and chronic fatigue syndrome" (Mik-Meyer and Obling 2012) - nor chronic illnesses. The physician's role, which includes the need for a diagnosis, is difficult in situations of MUS. As a result, "doctors tend to either classify the symptoms as psychological in nature or ignore the patients' physical symptoms altogether" (Mik-Meyer and Obling 2012). Thus, in situations of MUS the assignment of the sick role is unreliable, and "the negotiation of the sick role is a social process" that the physician may or may not be prepared to undertake (Mik-Meyer and Obling 2012). Chronic illnesses are also unaccounted for in the sick role, since by definition they cannot include a return to "normal society." Many people with chronic illnesses are encouraged to work toward independence, to "return to normal role performances in spite of persisting illness (Varul 2010). This is inconsistent with the sick role, which requires patients to dedicate all of their time to returning to "normality." Chronic illnesses are especially relevant in current times, as they have been more prevalent than acute illnesses since the 1970s (Varul 2010).

Another drawback of the sick role is the precariousness of the physician-patient relationship, which is subject to bias on both sides. Patients may not trust their providers for a variety of reasons, such as stigma or resistance to authority. This can be seen even in non- contested illnesses and conditions: "For example, if an illness such as epilepsy or HIV/AIDS has a powerful stigma, it can make people less likely to seek treatment for fear of being mistreated by healthcare providers and publicly associated with a tainted condition" (Conrad and Barker 2010). Additionally, obese women report "avoiding routine gynecological exams, despite having higher rates of gynecological cancer than non-obese women, because of the stigma of obesity and the corresponding negative attitudes of healthcare professionals toward overweight people" (Conrad and Barker 2010). It can be difficult to establish trust between patients and physicians, and research shows that many patients do not trust their doctors with "discussion of emotional aspects of their problems" and as a result "chose not to present them" (Peters 2009). On the other side of the relationship, many physicians "fail to respond to hints of the patients' desire for emotional support" (Salmon 2008). The result is a physician-patient relationship that may not be strong enough to act as the gatekeeper of something so important as the sick role.

Despite its numerous flaws, the sick role does deserve a nod for its importance in establishing that illness has an effect on one's role in society. From the 1950s to 1980s the sick role was considered to be "one of the major concepts of [medical sociology]" (Burnham 2014). However, it is ultimately defunct. Even Parsons himself reworked the concept with his piece "The Sick Role and the Role of the Physician Reconsidered" (1975). In the 1990s, essentially no research papers focused on the sick role; moving forward, medical sociology should seek more flexible approaches to the social roles of sick people.

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