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The hospital developed in response to the needs, values, attitudes and aspirations of the societies they serve. Historically, hospitals have passed through four distinct phases or stages of development. Corker ham (1982) has highlighted these stages as:

  1. Centers of religious practice
  2. Poor house
  3. Death houses, and
  4. Centers of medical technology.

The genesis of the hospital as a health care organization is usually associated with the rise of Christianity. It was part of Christian theology that spiritual salvation could be obtained by providing care to the sick and needy. When religious institutions were relieved of their control of hospital in Europe, the hospitals were left loose under many separate administrations. This led to gross abuse, lowering of standard and misappropriation of funds. The poor became major victims.

After the renaissance and the reformations, there was still much to be desired in public hospitals with respect to their potentials to provide welfare services for the poor. Towards the 14th century however in Europe, physicians started to associate themselves with hospitals as they now saw themselves as major stakeholders in the administration of health care services. Even up to the 18th century, hospitals were regarded as death houses because typically, hospitals were dirty, poorly ventilated and congested.

Hospitals as centers for medical technology became a new phenomenon since the end of the 19th century. This new image of hospitals has been attributed to the improvement in the quality of medical care.

One major factor in this change was the fact that medicine had become a science in terms of employing scientific method for the acquisition of accurate knowledge. Also, the discovery and use of antiseptic measures in the hospitals to curtail infection has been a good development. There has also been a significant development in the qualities of hospitals personnel in modern times, not only in Euro-American societies, but also in many developing economies of the world like Nigeria.


Hospitals can be categorized into tertiary, secondary, primary and comprehensive. A tertiary health institution, among others performs the functions that include research and teaching. The secondary is next and is superior in hierarchy to a primary health care (PHC) scheme. Comprehensive health institutions are mainly for ambulatory care. They are cottage, or district health centers.


Hospitals perform the following functions:

  1. Providing services (care) for the sick.
  2. Teaching and research.
  3. Support the health system.
  4. Performing societal duties which may be related to state legitimacy or political authority,
  5. Serving as a base for medical power
  6. Providing employment opportunities.


The occupational growth in the hospitals setting and those who perform most health care tasks in the hospital wards are the nurses and auxiliary nursing workers. Nurses are responsible to the physicians for carrying out the physician’s orders. Nurses however, are also responsible to the nursing supervisors and other superiors in the hospital administration. It is common place to note that hospital services are mainly towards supporting patient welfare.

It is known also that hospital rules and regulations are generally designed for the benefit of hospital personnel in order that patients can be more efficiently taken care of. Usually, the sick and the injured are categorized into various diseases such as obstetrics, neurology, psychiatric, orthopedics etc. It has been observed that an improved patient care can result in increased organizational efficiency and that this ultimately serves the interest of the patient.


One major expectation about the sick is that they are unable to take care of themselves. The sick have some unique behavioural characteristics in most societies. According to Talcott Parsons (1951), being sick is an undesirable state and the sick wants to get well. Getting well involves the process in which the sick is a major stakeholder.

The concept of sick role: The sick role represents the most consistent approach to explaining the behavioural pattern of the sick people. Talcott Parsons opined that being sick is not a deliberate choice of the person even though illness may occur due to exposure to infection or injury. The sick person usually is unable to take care of himself, and this is why it is necessary for him to seek medical advice and cooperate with medical experts.


  1. The sick person is exempt from ‘normal’ social roles. The person has an exemption from normal role performance and social responsibilities because of the state of his health. Usually, in many societies the more severe the illness, the greater the exemption.
  2. The sick person is not responsible for his or her condition. The sick person’s illness is assumed to be beyond his/her own control.
  3. The sick person should try to get well. The sick individual must have the desire to regain normal health.
  4. The person should seek medical advice and cooperate with medical experts in order to get well.


The patient-physician role involves mutual relationship between the two parties. The patient is on one side of the party and the physician on the other. Each participant in the social situation is expected to be familiar with his expectations as well as the expectations of the others in the same social situation. The patient usually has a conception of what a physician is in terms of the social role.

Also, the patient is expected to recognize the fact that being sick is undesirable and that he has an obligation to get well by seeking the physician’s help. The physician in turn has an obligation to turn the sick person to his or her normal state of functioning. To sum up, the patient-physician relationship is intended to serve some therapeutic functions in most societies and promote some significant change in the health of the patient.


Reasons for seeking medical help and advice by the sick include that:

  1. Illness is undesirable.
  2. Illness and disease obstruct normal social functioning
  3. Illness reduces human potentials, and capabilities.
  4. Illness is a kind of grievance
  5. In most societies, illness brings stigmatization on its victims.

The process of seeking medical care in Nigeria has been examined by Erinosho (2005). Erinosho observed that there is an admixture of the use of both orthodox and traditional medicine in seeking health services. He maintained that, there is a hierarchy in the pathways of health care in Nigeria. Many patients utilize the services of assorted traditional healers before seeking care from western-style health workers and facilities. Other general and specialist practitioners come next as care agents.

These are followed by patent medicine sellers and pharmacists. In most traditional societies like Nigeria, patients tend to have greater confidence in the therapeutic skills of traditional healers than those of the western-style medical doctors and other health workers because the later are more accessible to the ordinary man as well as the wide spread belief in witchcraft or sorcery which these healers are believed to possess to handle all kinds of problems.

Medical sociologists have also identified some social factors which tend to encourage a person from seeking medical care. These factors include socio-demographic variables such as age, sex, ethnicity, economic status and level of education.


The most commonly cited definitions of the above concepts are those provided by WHO (1980) in The International Classification of Impairments, Disabilities and Handicaps.

  1. Impairments: Any loss or abnormality of psychological, physiological or anatomical structure or function.
  2. Disability: Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
  3. Handicap: A disadvantage for a given individual that limits or prevents the fulfillment of a role that is normal.

 As traditionally used, impairment refers to a problem with a structure or organ of the body; disability is a functional limitation with regard to a particular activity; and handicap refers to the disadvantage in filling a role in life relative to a peer group.

Disabling environment: This is an environment which does not have the adoptions and facilities to ensure that individuals with impairment are able to take part in full social life. Example, a person in the wheelchair is only disabled if the place he or she wants to go does not have wheel chair access.


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