Although doctors are sometimes framed as great and heroic figures, they are also humans who are connected with the world and influenced by the social, cultural and professional cues. They have emotions and judgements that will affect their work and productivity too, like any other professions.

The way doctors conceptualise their work is addressed as “disease prestige”, in which some diseases are considered as more prestigious than others in a hierarchy. The leading researcher on disease prestige, Dag Album, a Norwegian sociologist, has been conducting research on how Norwegian doctors rank different diseases in terms of prestige.

One of his more recent studies compared three previous survey studies on disease prestige on a scale from one to nine. The results showed a remarkable stable pattern of the prestige rank order over 25 years. The top three diseases in all surveys were leukaemia, brain tumours and myocardial infarctions even though the order has switched around. As for the lowest ranked diseases, fibromyalgia, depression, anxiety and cirrhosis of the liver took the place.

The fascinating theories behind the hierarchy

In addition to diseases, the ranking for specialities was also taken into accounts. The highest ranked were neurosurgery and thoracic surgery whereas geriatrics and dermatovenerology were the lowest. Moreover, the most noticeable change in the hierarchy was apoplexy (brain stroke), hence providing an insight for the research along with the stability observed.

These trends indicated that the prestige ranking of a disease is highly relevant with three sets of criteria, namely the localisation of the affected organ or body part, the effect and style of its typical treatment and the social attributes of the typical patient. It was concluded that the acute and lethal diseases with clear diagnostic signs treated with active, risky and high technological medicine on organs in the upper part of the bodies of young or middle-aged patients were awarded high prestige.

From the doctors’ point of view, the prestigious diseases or medical conditions may be favoured because they help them to be viewed more positively. Lars E.F. Johannessen, the study’s co-author, conducted a research and found that disease prestige “shows how physicians value narratives in which they are portrayed as ‘masculine and extraordinary lifesavers’, reflecting deep-rooted heroic tales of Western culture.”

Physicians are thus said to “value disease categories associated with acuteness and drama over those considered chronic and mundane.” For a doctor, these conditions are claimed to be more interesting and exciting to handle compared with chronic diseases that take long time and do not involve high technological medical interventions.

Ramifications for the practice of medicine

Based on Album’s research, the findings do go beyond just the evaluation of disease categories as it influences the doctors’ medical decision-making. For instance, prestige criteria such as acuteness, lethality and curability may influence the judgement of physicians on how to plan their treatment.

Also, the distinctive similarity between the ranking of diseases and specialities further supports the claim that the disease hierarchy elaborates fundamental evaluative tendencies in medical culture. An example includes students taking prestige as a factor for choosing their medical specialty and informal priority setting in intensive care units.

Furthermore, the presence of disease prestige is said to exert a significant emotional force on physicians like symbols do, as a shown by renowned French sociologist Émile Durkheim. It is hypothesised that the varied importance of disease category could leave impacts in the clinics, boardrooms and budget meetings.

However, as further research is needed to find out more about the connections between disease prestige and decision-making, Album and the colleagues encouraged more studies aimed at understanding how and why doctors may make decisions based on their social and cultural perception in medicine. MIMS

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