Models and management: the case of ‘cystitis’ in women

Both patients and doctors use explanatory models to manage episodes of sickness. The symptoms of lower urinary tract infections (cystitis) are used (i) to explore lay aetiological theories and the way they are modified through interaction with health professionals; (ii) to consider the range of professional explanatory models. Typically the explanatory models used by doctors have received less attention than those of patients since they are assumed to be derived from homogeneous, internally consistent and rationally scientific bodies of knowledge. Cystitis is used as an illustration of the way theoretical/scientific models which have been developed in a research context are applied in everyday practice. It is argued that the biomedical approach to diagnosis leads to the creation of a puesdo‐disease, the urethral syndrome, and that apparent rationalisation of the diagnostic process by the use of clinical tests can lead to problems in the long‐term management of these patients. Such problems occur, not because patients have different explanatory models from doctors but because both doctors and patients become committed to the same explanatory model of underlying organic pathology and thus unable to consider other potential causes or address the wider question of coping with the patients ‘illness’.