title: Calling the doctor: a qualitative study of patient-initiated physician consultation among rural older adults.
abstract: OBJECTIVE
  Guided by Leventhal's self-regulatory model and Cockerham's theory of health lifestyles, we explore two questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants' accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time?
  
  
  METHODS
  We analyze data from semistructured in-depth interviews with 62 older rural adults.
  
  
  RESULTS
  Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment.
  
  
  CONCLUSIONS
  We characterize participants' responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham's emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal's conceptualization of illness behavior, including patient-initiated physician consultation.
authors.affiliation: Department of Sociology, Wake Forest University, Winston-Salem, NC 27109, USA. stolleep@wfu.edu
authors.forename: Eleanor Palo
authors.initials: EP
authors.lastname: Stoller
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Grzywacz
authors.forename: Sara A
authors.initials: SA
authors.lastname: Quandt
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
authors.forename: Christine
authors.initials: C
authors.lastname: Chapman
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Altizer
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Arcury
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D002908:Chronic Disease; D019468:Disease Management; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008962:Models, Theoretical; D009657:North Carolina; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*