ABSTRACT
In this chapter, I explore a theme that often emerges in the context of patient problem presentation, but that also surfaces elsewhere in the medical visit. This is the theme of legitimacy: Specifi cally, the idea that the patient’s visit to seek medical care should be properly motivated by an appropriate medical problem. From the physician’s perspective, this theme is summed up in a rather hard-nosed fashion by the New Zealand primary care physician who observed that “In order to have the privilege of talking to your doctor, you must fulfi l the essential precondition of being sick. Then you may go to him and ask him if he will perform his professional services upon you” (Byrne & Long, 1976, p. 20). At the societal level, this theme is enshrined in everyday language that contains numerous terms for patients who inappropriately seek medical care: hypochondriac, malingerer, crock, and so on, and the pathological disposition to do so (as manifested in Munchausen’s Syndrome) is itself treated as a medical condition. And it is also present in contemporary popular culture. A recent cartoon in the New Yorker magazine depicts a nurse entering a crowded waiting room and saying, “We’re running a little behind, so I’d like each of you to ask yourself ‘Am I really that sick, or would I just be wasting the doctor’s valuable time.’” (New Yorker, May 14, 2001). And this concern helps to explain the peculiar confl ict we sometimes experience when we go to the doctor: we want to be told that we are well, but we also would like to have had ‘good reasons’ for wrongly believing that we were not. As another New Yorker cartoon, depicting the delivery of a diagnosis, caricatures the concern: “You’re not ill yet, Mr. Blendell, but you’ve got potential” (New Yorker, September 11, 1998).
