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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 29; 335(7621): 632.
PMCID: PMC1995502

Doctors rank myocardial infarction as most “prestigious” disease and fibromyalgia as least

Fibromyalgia and anxiety neurosis are the illnesses with the lowest prestige among doctors, according to a survey of Norwegian doctors.

The survey found that heart attacks top the prestige league, closely followed by leukaemia, and that neurosurgery is regarded as the most prestigious specialty (Social Science & Medicine doi: 10.1016/j.socscimed.2007.07.003).

“Results show that there exists a prestige rank order of diseases as well as of specialties in the medical community,” write the authors. “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.”

They say that any such ranking among doctors could have effects on practice.

In the study, the authors, from the University of Oslo and the University of Science and Technology, Oslo, sent questionnaires to 305 senior doctors, 500 general practitioners, and 490 final year medical students.

Respondents were asked to rank 38 diseases as well as 23 specialties on a scale of one to nine. The item concerning the prestige of diseases said, “Please give each disease a number based on the prestige you imagine it has among health personnel.”

The authors say that the prestige scores for diseases and for specialties were remarkably consistent across the three samples.

Myocardial infarction, leukaemia, spleen rupture, brain tumour, and testicular cancer were given the highest scores by all three groups. Prestige scores for fibromyalgia, anxiety neurosis, hepatic cirrhosis, depressive neurosis, schizophrenia, and anorexia were at the other end of the range.

“The existence of a prestige rank order of medical specialties has been known for a long time,” write the authors.

“Our results show that two different samples of physicians scored diseases according to prestige with only minor differences, and a sample of medical students in their final year scored them in much the same way. This is remarkable, as the prestige order of diseases is not openly debated, but must arise as a result of the numerous talks and actions going on in connection with the daily practice of medicine.”

They add that disease is a “nexus around which many medical activities are organised, such as categorising patients, planning and allocating work, setting priorities at all levels, pricing services, and teaching and developing medical knowledge.

“A widespread, and at the same time tacit, prestige ordering of diseases may influence many understandings and decisions in the medical community and beyond, possibly without the awareness of the decision makers.”

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