Untrained, unpaid, and unacknowledged: the patient as worker

This article considers the patient as the central worker in his or her own care. It traces the history of a concept called "illness trajectory," explaining how this concept has been questioned, reformulated, and expanded through research among people with chronic illness. The trajectory concept illuminates the manner in which living with a chronic illness imposes on-the-job training on the unskilled patient as worker, who must learn to integrate biographical work, illness-related work, and everyday life work. That this patient work is unpaid renders it invisible to a society accustomed to valuing work only as it is connected to monetary exchange. Finally, by virtue of this invisible dimension, the work patients do remains unacknowledged and unappreciated by the larger society.