The sick role and the role of the physician reconsidered.

The main substance of this paper was presented orally at a meeting of the Sick Role, organized and chaired by Andrew Twaddle. It was a commentary on four papers and the oral discussion of them. In response to these the paper first discusses the relation of the sick role to deviant behavior and the motivation to become and remain ill. The position was taken that the author never had meant to confine the category of illness to deviant behavior, though its negative valuation should not be forgotten. Nor had he confined it to cases of acute illness, omitting consideration of chronic and other types. The most important issue, however, concerned the structure of the relation between physician and patient. Though insisting that interaction between them is two-way, not one-way, the author insisted that the relation is basically asymmetrical because of the physician's expertise in health matters, gained through training and experience, and his special fiduciary responsibility for the care of the sick. In this respect the relationship is different from others such as the competitive market or the democratic association, but is comparable to the relation of teacher and student in higher education.