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2. THEORETICAL ORIENTATIONMedical sociology studies the provision and utilisation of health care services,as well as the behaviour of individuals in health care settings, within theoverall context of medical systems in societies. In this study the traditionalapproaches of medical sociology were reviewed and found to be inappropriatefor the investigation. It was considered necessary, therefore, to construct amore humanistic 2 theoretical perspective to view the elderly patients’perceptions of their medical encounters at an outpatient centre.Free download from www.hsrcpress.ac.za2.1 Traditional approaches in medical sociologyThe traditional approaches in medical sociology have been largely positivisticand quantitative, dealing more at a functional or structural level than on aninteractional level. Among these are the structural-functional approach ofParsons (1951) and the structural approach of Freidson (1961, 1970, 1973). 3Themes that have commonly been investigated in earlier studies are culturaland social class factors in the treatment of illness (Koos 1954; Kosa, Zola1957); utilisation rates of medical services (Koos 1954; Blum I960); differinglay and professional perspectives (Baumann 1961; Davis 1963); the doctorpatientrelationship (Parsons 1951; Freidson 1961, 1970, 1972);communication between patient and doctor (Apple I960; Duff, Hollingshead1968), and the concept of an illness career (Suchman 1965).Most of the traditional approaches have derived from the model of illnessbehaviour implied by the Parsonian concept of the sick role (Parsons 1951) —a classic description of a set of expectations most commonly accepted by sickpeople. These expectations are that (i) the sick person understands that he isexempted from performance of his normal roles; (ii) he is not held responsiblefor his condition and it is accepted that he cannot cure himself; (iii) it is hisresponsibility to get better as soon as possible, and (iv) he must therefore seekcompetent technical help and co-operate with medical agents.Parsons’ formulation of the sick role concept has been severely criticised.Basic inadequacies of the postulates appear to be the assumption that all sickindividuals will behave in a similar manner (Twaddle 1969), and that thepostulates represent only the physician’s point of view (Freidson 1961,1971,1972; Bloom 1963). The formulation has also been criticised for itslimited applicability to chronic illnesses (Kassebaum, Baumann 1965; Callahanet al. 1966). For the chronically ill, the issue of getting well is irrelevant andthe patient is often expected to take a more active, independent role in dealingwith the illness than Parsons describes.In addition Ding wall (1976) criticizes the traditional approaches for failing toview illness and illness behavior as social action. He suggests that it is in theirconcern with precise measurement and quantification that these studies200