A Model to Explain Visits to the Doctor: With Specific Reference to the Case of Israel

W HEN do people see a doctor? At one extreme, blatant pathology and extreme pain will, with few exceptions, bring one to a doctor in those societies where doctors are available (with the possible exception of mental illness). At the other extreme, a small portion of the visits are accounted for by a preventive health orientation, where no symptoms have been perceived. But, as Zola points out (1966, 1968), we find that the vast bulk [of a physician's load] is concerned with quite minor disorders. There is, on the other hand, he notes, a great body of data which show that there is much illness, defined as such both clinically and subjectively, which is not brought to the attention of the physician. What Zola is saying, then, is that the potential for entry into patienthood is extraordinarily widespread and continuous. One can be ill, clinically speaking, without going to the doctor; or one can go to the doctor, either without any particular change in one's clinical condition or even without any particular justification from the point of view of the physician. If variations among individuals, social subgroups, or societies in visiting rates cannot be explained, within limits, by variations in clinically-determinable morbidity, what are the factors that can predict such variations? It is the purpose of this paper to present a model which. though derived from the case of Israel, should be applicable to other societies as well.