Each generation has its peculiar array of fads and fashions. Remember the hirsute styles of the Beatles era, and the cropped crew cuts that followed the popularity of the Beach Boys? In the 60s and 70s, hemlines rose inexorably as miniskirts became the norm, and bell-bottom trousers gave way to stovepipe pants, only to be replaced when our love affair with denim jeans began.
Medicine, too, has not escaped passing faddishness. The start of the 20th century witnessed “chlorosis” — a greenish discolouration of the skin, attributed to constrictive corsets and accompanied by dysphagia and iron deficiency — a syndrome rarely seen today.
The early 21st century has seen a different array of fashionable diseases. Norwegian researchers recently asked senior doctors, general practitioners and medical students to rank 38 diseases and 23 specialties according to their perceived prestige. The results for all three groups were remarkably consistent: myocardial infarction and leukaemia topped the disease prestige stakes. Brain and testicular cancers also ranked highly, whereas fibromyalgia, anxiety neurosis, hepatic cirrhosis, depressive neurosis, schizophrenia and anorexia ranked lowly. Interestingly, neurosurgery topped the specialties.
The investigators noted that
* Dobson R. Doctors rank myocardial infarction as most “prestigious” disease and fibromyalgia as least. BMJ 2007; 335: 632.
. . . 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.*
Such findings would have only marginal relevance, were it not for the authors’ contention that disease rankings may well influence the interests and focus of doctors, and could even impact on management.
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