Do nurses rate diseases according to prestige? A survey study.

AIMS: To see whether nurses rate diseases according to prestige and, if so, how their ratings compare to the disease prestige hierarchy previously uncovered among physicians. DESIGN: Cross-sectional survey. METHODS: In 2014, 122 nurses in a continuing education programme for healthcare personnel in Norway rated a sample of 38 diseases according to how prestigious they see these as being among healthcare workers in general. RESULTS: The nurses were found to rank myocardial infarction, leukaemia, and brain stroke at the top of the prestige hierarchy and depressive neurosis, anxiety neurosis, and fibromyalgia at the bottom. Their rankings overlap significantly with those previously documented for physicians and suggest that nurses assess the diseases through a 'cure' rather than a 'care' perspective on health care. CONCLUSION: The nurses ordered diseases in a prestige hierarchy and their rankings are strikingly like those of physicians. The findings are of significant relevance to nursing practice and set a new course for future research into prestige and nursing culture. IMPACT: The findings should encourage nurses - individually and collectively - to reflect on whether and how notions of disease prestige influence their decision-making. By showing that nurses as well as physicians are able to rate diseases according to prestige, the study suggests new avenues for future disease prestige research.

Stability and change in disease prestige: A comparative analysis of three surveys spanning a quarter of a century.

In this paper, we present a comparative analysis of three survey studies of disease prestige in medical culture. The studies were conducted in 1990, 2002 and 2014 using the same research design. In each of the three rounds, a sample of Norwegian physicians was asked to rate a set of 38 diseases on a scale from 1 to 9 according to the prestige they believed health personnel in general would award them. The results show a remarkable stability in the prestige rank order over 25 years. The top three diseases in all three surveys were leukaemia, brain tumour and myocardial infarction. The four lowest ranked were fibromyalgia, depressive neurosis, anxiety neurosis and hepatocirrhosis. The most notable change concerns apoplexy (brain stroke), which moved from a rank of 33 to 29 and then to 23 over the three rounds. We argue that the stable pattern, as well as this change, substantiate the interpretation of previous research, i.e. that the prestige of a disease is affected by the localization of the affected organ or body part, the effect and style of its typical treatment, and the social attributes of the typical patient. Analysing physicians' shared evaluations of different diseases, the paper contributes to the cultural understanding of disease conceptions in medicine. Understanding these conceptions is important because disease prestige may influence decision-making in the healthcare sector.

Legitimating the illegitimate: How doctors manage their knowledge of the prestige of diseases.

Although the sociology of medicine has developed a rich body of research on patients' experiences and how they handle their illnesses, few analyses have examined doctors' concepts of disease. Building on previous research findings that doctors consider some diseases to be more worthy than others, this article focuses on how these differences in disease prestige are articulated and made logical. We presented a focus group panel of doctors a table of 38 diseases rank-ordered by prestige according to the results of a previous quantitative study of doctors. We prompted a lively discussion among the doctors by asking them whether they were familiar with this rank order. In analysing how they managed the prestige knowledge presented to them, we focused on how they handled the value conflict between this informal rank order and the formal value of equality of treatment. Using positioning theory as a theoretical premise and a methodological tool, we found that the focus group participants created positions in their conversations that allowed them to present and discuss views on disease prestige that would be considered illegitimate if they were declared directly. However, they were able to do so without being forced to take a personal stand. Thus, we demonstrate how informal disease rankings can be produced and reproduced.

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

Surveys have shown that the prestige of medical specialities 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 specialities. Both diseases and specialities were clearly and consistently ranked according to prestige. Myocardial infarction, leukaemia and brain tumour were among the highest ranked, and fibromyalgia and anxiety neurosis were among the lowest. Among specialities, neurosurgery and thoracic surgery were accorded the highest rank, and geriatrics and dermatovenerology the lowest. Our interpretation of the data is that diseases and specialities 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 specialities 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.

Prestige and its significance for medical specialties and diseases.

AIMS: The aim of this paper is to review the literature concerning the existence of prestige hierarchies for medical specialities and diseases. Moreover, the implications of prestige for priority setting in healthcare systems are discussed. METHODS: The study is based on a review of the literature. Papers were obtained through the National Library of Medicine, PubMed. The search was conducted on 14 July 2005, and included articles from 1950 until that date. The medical subject headings "disease", "illness", and "medical specialities" were combined with the search word "prestige". A total of 183 papers were found. Only studies focusing on prestige hierarchies for medical specialities and diseases were included. The final search identified 20 articles, six of which specifically established hierarchies for medical specialities and diseases. RESULTS: The review documented prestige hierarchies for medical specialities and diseases. Explanatory characteristics behind the distribution of prestige were identified. It was demonstrated that active, specialized, biomedical, and high-technological types of medicine practised on organs in the upper part of the bodies of young or middle-aged people were accorded high levels of prestige. Medicine with the opposite characteristics had low levels of prestige. CONCLUSIONS: Medical specialities and diseases differ with regard to prestige. Characteristics related to specialties and diseases determine their prestige. The authors suggest that differences in prestige bear consequences for actual priority setting in healthcare systems, and contend that this should be further investigated.