PMID: 9004366Feb 1, 1997Paper

The ellipsis of prognosis in modern medical thought

Social Science & Medicine
Nicholas Christakis

Abstract

Contemporary textbooks of internal medicine give scant attention to the prognosis of diseases. Has this always been the case? If not, when and why did prognosis come to be de-emphasized? Using a highly regarded, standard medical textbook initially authored by William Osler, The Principles and Practice of Medicine, I performed qualitative and quantitative content analysis of entries regarding lobar pneumonia in selected editions published between 1892 and 1988, with special attention to the period between 1892 and 1947. I chose lobar pneumonia because it was a leading cause of death throughout this period and because it is recognizable across time, thus making it possible to follow the evolution in clinical thinking about prognosis while holding constant the diagnosis. I argue that two powerful forces converged to lead to the ellipsis of prognosis: (1) the emergence of effective therapy, and (2) a fundamental change in the cognitive basis of medicine. With respect to the former, I show that there is a complementary, inverse relationship between the clinical acts of prognostication and therapy; as one increases in salience in the management of a disease, the other decreases. With respect to the latter, I argue that the particular...Continue Reading

References

Feb 1, 1963·American Journal of Public Health and the Nation's Health

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Aug 19, 2003·Seminars in Surgical Oncology·Mary Gospodarowicz, Brian O'Sullivan
Jul 5, 2005·Journal of Palliative Medicine·Barbara HeadTonya M Smoot
Feb 28, 2006·Journal of Palliative Medicine·Elizabeth B Lamont
May 25, 2010·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Jonathan Gillis, Bernadette Tobin
Jul 10, 2002·The Milbank Quarterly·Charles E Rosenberg
Jul 26, 2003·BMJ : British Medical Journal·Paul GlareNicholas Christakis
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