Relinquishing the Sick Role Following Open-Heart Surgery

Abstract

depression, preoperative tendency to reject the sick role, duration of illness prior to surgery, age, and sex-emerged as significant predictors of tendency to relinquish the sick role following surgery. OFall the chronic diseases prevalent today, heart disease probably poses the greatest threat to the health and wellbeing of the nation. Its costs are enormous, whether measured by its high mortality rate, by economic losses, human suffering and anxiety, or by the eroded quality of the lives of those victims who survive. Such individuals find their physical activity restricted, social lives curtailed, occupational pursuits interrupted, hopes and plans drastically altered. Until recently, treatment was focused mainly on containing the illness, slowing its progress, lessening pain, and rehabilitating patients to the highest level of functioning feasible within the limits of the existing pathology. However, within the past decade, advances in open-heart surgery have made it possible to restore effective physical functioning of the heart to large numbers of persons with congenital or valvular heart disease. Many patients submitting to such surgery have in fact returned to a way of life roughly comparable to that enjoyed by persons without heart problems. However, for reasons as yet not fully understood, many others do not resume normal activities following surgery. Even while manifesting improvement by the surgeons' standards, some patients judge their condition unchanged or even worsened. They may complain of pain, fatigue and irritability, report sexual maladjustments, and continue to depend on others to meet their needs, and to carry out their everyday responsibilities. Clearly the patient's view of his condition is not identical with his clinically evaluated health. And just as clearly recovery must proceed along behavioral and psychological dimensions, as well as physical. A sizeable literature (for reviews, see Rosen and Bibring, 1966; Croog et al., 1968) has accumulated which purports to explain differential recovery outcomes of cardiac patients (not specifically openheart surgery patients) in terms of numerous medical, personality, demographic, and social variables. Inasmuch as existing empirical studies have usually limited their analyses to one or two independent variables, the relative significance of these factors remains obscure. In partial remedy of this situation, Garrity recently (1973a; 1973b) has utilized the technique of multiple regression to assess the relative effects of a number of these variables on the recovery of males following first myocardial infarction. He found that the patient's own perception of his health was a better predictor of rehabilitation outcome-whether measured by gainful employment, by involvement in community organizations, or by morale-than any of the other physical, psychological, or social predictors identified in the literature. Moreover, this relation held even when the effects of the other variables were controlled statistically. Garrity theorized that health perception is an intervening variable between assorted predictors cited in the literature, and the several aspects of rehabilitation outcome. On that reasoning, he concluded that a knowledge of patient health perceptions and their determinants was