In her accompanying editorial, Dr. Laine suggests that physicians may have no choice in the matter but they might be prudent to warn patients that playing the sick role may prevent them from obtaining optimal health. I suggest that the nature of the physician-patient relationship is at the heart of this issue. When ill, patients tend to regress emotionally. Part of the physician's role is to assess the amount of regression and demoralization and to instil hope and improve morale by providing information and explanations. It may be bordering on insult to suggest the sick role as a chosen role for the majority of patients.
Some patients play a different sick role.
They often mistrust physicians and when they do seek help are unable to take advice because of their rigid ideas. In such cases the patient often wants to take charge of decisions involving treatment. Most physicians will be uncomfortable if they have to treat someone inappropriately, at the patient's insistence. It takes a lot of effort and understanding to work with these patients and to establish a therapeutic alliance whereby the patient has enough trust to follow the physician's advice. By requiring patients to collaborate and make their own decisions we might sometimes be failing to take responsibility for our own role within the physician-patient relationship.