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    I’ve got 2 doctors in the family. Generally the lower socio-economic classes just want ‘The Doc’ to ‘fix ’em’. They don’t want to know, don’t care, and won’t listen to much advice or communication from their doctor. I hear story after story of my Aunt patiently explaining to patients (she volunteers for clinics in poor areas) why certain things are dangerous, have potential side effects, etc but they come back 2 weeks later with the same problem. She runs through the spiel again and eventually gives up, and just writes the script that will solve the short term issue. There’s only so much talking to a brick wall you can do before you realise it’s pointless. Generally these people arrive because they have some sort of crisis they need resolved.

    Those who are more ‘well off’ generally have a worldview of Prevention: eg, avoiding falling off the cliff in the first place. They are future-minded people who think of consequences and plan. The lower socio-economic bloc tend to have a worldview that falling off the cliff happens to someone else – then when it does, they want an Ambulance at the bottom with a magical resurrection device that fixes everything (the Doctor).

    Fundamentally, it’s a difference in patient world views. Therefore, it is no surprise Doctors find common ground and communicate much better with those who share the same world view.

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    Volumes have been written on ‘health communication’, including recent suggestions which highlight effective ways of communicating with men. However, after some years studying health literacy and modifiable risk factors for disease, I have to say that…JSW is absolutely right: there are the worried well, and then there are those who ‘don’t want to know, don’t care, won’t listen,’ and the latter may out-number the former by a fair margin. The reasons are many and varied, and include not only lack of knowledge and sense that ‘it won’t happen to me’, but also: skepticism about causes and effects for disease; confusion about seemingly contradictory information and advice; not wanting to bow to moralistic ‘healthism’ or the ‘agendas’ being run by governments and health groups; and a belief that ‘prevention’ means giving up just about everything that makes life enjoyable. There is some evidence to support the claim that your ‘world view’ (or at least your ‘life view’) affects how you run your health-life: research has shown that ‘masculinity beliefs’ are far more important than socio-economic class, education, occupation, etc. when it comes to men adopting and providing a context for preventive behaviours. This should not be taken as an endorsement of the ‘individual responsibility’ view of health, however: we need to look for ‘the causes of the causes’ to consider what encourages people to have the attitudes that they do and whether these are amenable to change or whether it will be more productive to focus on making the healthy choices easier and requiring less conscious and deliberate individual action.


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