One of the exceptions to the case of the individual making his own defi-
nition of illness occurs when a disability renders him incapable of as-
sessing his own condition or of initiating treatment. A serious accident is
an example, where bystanders or companions diagnose the injured person
as badly hurt, consider him a patient, and rush him off to a doctor or a
hospital. A similar circumstance occurs when a person suddenly becomes
too weak or too sick to make his own decisions or to call for a physician.
The worried family, office staff, landlady, or someone else makes the de-
cisions and undertakes treatment measures.

Children also constitute an exception to the rule of initial self-diagnosis.
They may or may not complain of symptoms or show signs of malfunc-
tion. It is the parents who observe them and decide whether or not the
symptoms constitute an illness. Should they decide the child is ill, they
will begin to act differently toward the child by considering him a pa-
tient. The child must conform to the new role, "stay in bed," "don't play
outside," "take the medicine."

Another exception to the initial self-diagnosis situation is the person
who is unaware of any pathologic condition but is advised by someone
else that he is ill, as in the case of an individual who submits to an annual
physical examination and is informed by the physician that he suffers
from heart disease or a low grade anemia, or some other pathologic con-
dition. Although it is usual for the patient to accept the diagnosis of the
doctor, most physicians have had experience with patients who did not.
Rejection of the diagnosis implies refusal to undergo medical care, and
the patient may suffer serious consequences. This set of circumstances
clearly demonstrates the importance of individual definitions of illness as
a determinant for the subsequent events of health care.

The observations stressed so far are (1) The initial diagnosis of the
individual depends upon his awareness of bodily sensations, his notions
of what illness is, and the extent to which the bodily state he observes in
himself corresponds with his notions of illness. If his sensations fit his
idea of illness, then he will decide he is sick and undertake curative ef-
forts. (2) People do not have the same notions about illness; one man may
think himself ill and another, with the same symptoms, will not consider
himself ill.

Three determinants (origins, causes, and antecedent events) contribute
to the varying definitions people have for illness. These are culture,
socioeconomic class, and individual personality. In order to manage
the doctor-patient relationship well, the physician should be informed
about the contributions of these determinants to the attitudes and actions
of his patients.

-2-