Illness

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Introduction

There is an important distinction, recognized within health care, research, and narrative literature, between disease and illness.

Disease represents a collection of observations, including physical signs, and tissue and cellular abnormalities evidenced by lab tests, imaging, or pathological assessments. These may be classified according to established criteria to result in a diagnosis, useful for guiding treatment choices and making prognoses.

"Illness, in contrast to this, us the patient's personal and subjective experience of sickness; the feelings, thoughts, and altered behavour of someone who feels sick" (Brown, Weston, and Stewart, p 35, in Sewart et al, 2003).

Disease and illness are far from the same, and may not even co-exist. Many people feel ill, though do not have a disease; likewise, many people with not-yet-diagnosed disease may feel perfectly healthy. Knowing this will reduce the need for patients and clinicians to prematurely search for a diagnosis - especially important when tests are in short supply, expensive, and carry risk such as pain, radiation, or toxic effects.

The Case of...

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Why Patients Seek Care

Certainly there are frequently times when a patient will seek care for a clear reason - obstetrical events, trauma, and acute, signficiant infections being major causes. Other visits are routine, and are frequently precipitated by the clinician or health care system - for example, for immunizations or other preventive care.

However, a large number of visits are for poorly characterized symptoms, or changes in the patient's experience, that are less clear cut than the above examples. In these visits, a fuller exploration of the illness experience becomes very important.

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