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Do diseases have a prestige hierarchy? A survey among physicians and medical students

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By D Album and S Westin • • September 15, 2007

Surveys have shown that the prestige of medical specialties is ordered hierarchically. We investigate whether similar tacit agreement in the medical community also applies to diseases, since such rankings can affect priority settings in medical practice.

A cross-sectional survey was performed in three samples of physicians and medical students in Norway in 2002. A questionnaire was sent to 305 senior doctors (response rate, 79%), 500 general practitioners (response rate, 65%) and 490 final-year medical students (response rate, 64%).

Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most health personnel would accord to a sample set of 38 different diseases as well as 23 medical specialties.

Both diseases and specialities were clearly and consistently ranked according to prestige. Myocardial infarction, leukemia and brain tumor were among the highest ranked, and Fbromyalgia and anxiety neurosis were among the lowest. Among specialties, neurosurgery and thoracic surgery were accorded the highest rank, and geriatrics and dermatovenerology the lowest.

Our interpretation of the data is that diseases and specialties associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged.

At the other end, low prestige scores are given to diseases and specialties associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.

Source: Social Science & Medicine. 2007 Sep 10; [E-publication ahead of print]. PMID: 17850944, by Album D, Westin S. University of Oslo, Oslo, Norway.

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