HUI: Beautiful scars.

This article is the written account of a discussion between a group of indigenous women (trained both in Western and Indigenous knowledge systems), on the relevance of diagnosis in their conceptualisations of health and illness.

Between the Spaces: graphic diagnosis.

This illustrated essay describes the graphic diagnosis memoir as a form of illness narrative that uses a different way of telling stories than standard prose. A cartoon is broken into sequenced segments that ask the reader to jump across the gaps between the panels at the same time as they bridge the images and text assembled in each panel. To be successful in presenting a graphic story, the artist must be able to express an idea, but also must be able to project, or imagine, how readers will be able link ideas, images, and words. The cartoon diagnosis story makes the diagnosis relevant and visible. It does so by recognizing what reader and artist share, then adding, between the spaces, what separates them.

Fighting Words in the Antipodes.

In this commentary, written in two bursts-the first completed in April 2020, and the second at the end of July-we explore how media metaphors of COVID-19 constitute the pandemic in Australia and New Zealand. We argue that the media's rhetorical strategies play an important role not only in describing the illness, but in influencing and shaping individual and collective responses to the pandemic, with significant consequences for mental health and well-being in the context of crisis. We align this commentary with the tenets of the sociology of diagnosis, which argue that even though there are material realities of disease, their social form and consequence cannot be separated from the tangible nature of illness and its management. We also lean on Derrida's approach to metaphor, which underlines how even observable viral entities such as COVID-19 are simultaneously material, abstract, and in flux. We describe the metaphors used by local media to describe the pandemic-including combat, bush fires, earthquakes, and other natural disasters-and we explore how and why these metaphors construct the pandemic locally and farther afield.

Animals, veterinarians and the sociology of diagnosis.

While sociologists of medicine have focused their efforts on understanding human health, illness, and medicine, veterinary medical practice has not yet caught their attention in any sustained way. In this critical review article, we use insights from the sociology of diagnosis literature to explore veterinary practice, and aim to demonstrate the importance of animals to sociological understandings of health, illness and disease. As in human medicine, our analysis shows the importance of diagnosis in creating and maintaining the power and authority of the veterinary professional. However, we then explore how diagnosis operates as a kind of dance, where professional authority can be challenged, particularly in light of the complex ethical responsibilities and clinical interactions that result from the triad of professional/owner/animal patient. Finally, we consider diagnosis via the precept of entanglement, and raise the intriguing possibility of interspecies health relations, whereby decision-making in human health care may be influenced by experiences in animal health care and vice-versa. In our conclusion, we argue that this analysis provides opportunities to scholars researching diagnosis in human health care, particularly around the impact of commercial drivers; has implications for veterinary and public health practitioners; and should help animate the emerging sociology of veterinary medicine.

More than a "touch of the flu": a response to Mayrhuber et al's ""with fever it's the real flu I would say": laypersons' perception of common cold and influenza and their differences - a qualitative study in Austria, Belgium and Croatia".

This short reply contests two assumptions made by the authors of Mayrhuber et al's. "With fever it's the real flu I would say." The first is that there is influenza can be reliably defined by a medical case definition. The second is that this small qualitative study can be generalisable. However, it does underline the important point that technical diagnostic terms may be used on different registers by a variety of actors in the medical setting.

Patient-Identified Needs Related to Seeking a Diagnosis in the Emergency Department.

STUDY OBJECTIVE: Although diagnosis is a valuable tool for health care providers, and often the reason patients say they are seeking care, it may not serve the same needs for patients as for providers. The objective of this study is to explore what patients specifically want addressed when seeking a diagnosis at their emergency department (ED) visit. We propose that understanding these needs will facilitate a more patient-centered approach to acute care delivery. METHODS: This qualitative study uses semistructured telephone interviews with participants recently discharged from the ED of a large urban academic teaching hospital to explore their expectations of their ED visit and postdischarge experiences. RESULTS: Thirty interviews were analyzed. Many participants reported wanting a diagnosis as a primary reason for seeking emergency care. When further asked to identify the functions of a diagnosis, they described wanting an explanation for their symptoms, treatment and guidance for symptoms, and clear communication about testing, treatment, and diagnosis. For many, a diagnosis was viewed as a necessary step toward achieving these goals. CONCLUSION: Although diagnosis may not be a feasible outcome of every acute care visit, addressing the needs associated with seeking a diagnosis may be achievable. Reframing acute care encounters to focus on addressing specific patient needs, and not just identifying a diagnosis, may lead to more effective transitions home and improved patient outcomes.

'Deal with It. Name It': the diagnostic moment in film.

The moment a serious diagnosis is announced creates an important crisis for a patient, as it shifts their sense of self and of their future potential. This essay discusses the creative representation and use of this diagnostic moment in film narratives. Using Still Alice, A Late Quartet, Wit and Cléo from 5 to 7 as examples, we describe how each of these uses the diagnostic moment in relation to narrative construction and characterisation in recognisable ways. We associate the diagnostic moment with certain narrative and visual devices that are frequently implemented in films as means for character development, and for managing the audience's empathy. This is the case whether or not the diagnosis is contested or accepted, and whether the diagnostic moment is the frame for the narrative, or a closing device. By analysing its representation in film, we emphasise the cultural significance of diagnosis as a life-transforming event.

"The News is Not Altogether Comforting": Fiction and the Diagnostic Moment.

The moment at which a person receives a life-threatening diagnosis is replete with drama. The life-altering impact of putting a name to disease preoccupies clinicians and social scientists, but also infuses creative work. This paper describes the use of the diagnostic moment in fiction. Using Ian McEwan's Saturday, Anna Funder's All That I Am, Arthur Hailey's The Final Diagnosis, Téa Obreht's The Tiger's Wife, and myriad others, I show how diagnosis is variably the subject, the trigger, and the frame for narratives. It is a characterization device as well as a tool for defining right and wrong, morality and truth. But it is also a means by which we can "imagine" diagnosis, ahead of any experience of illness, and give meaning to what a serious diagnosis may mean in the life of an individual.

When pigs could fly: influenza and the elusive nature of diagnosis.

Diagnosis plays an important role in how we understand disease, and how medicine confirms its status in contemporary society. However, diagnoses are far less concrete than their taxonomies suggest. This essay presents influenza as a case study in the elusive nature of the diagnosis, and in its complicated realities. Using the metaphor of boundary transgression, it reveals the fluidity of diagnosis and the paradoxes presented by the naturalization of diseases. In order to contain influenza, medicine commits other paradoxical transgressions of boundaries. Lay self-diagnosis, use of the lay expression "flu," and wide reliance upon the belief in the influenza-like syndrome are used to attempt to cement a concrete notion of influenza.

Past, present and imaginary: Pathography in all its forms.

Diagnosis is a profoundly social phenomenon which, while putatively identifying disease entities, also provides insights into how societies understand and explain health, illness and deviance. In this paper, we explore how diagnosis becomes part of popular culture through its use in many non-clinical settings. From historical diagnosis of long-deceased public personalities to media diagnoses of prominent politicians and even diagnostic analysis of fictitious characters, the diagnosis does meaningful social work, explaining diversity and legitimising deviance in the popular imagination. We discuss a range of diagnostic approaches from paleopathography to fictopathography, which all take place outside of the clinic. Through pathography, diagnosis creeps into widespread and everyday domains it has not occupied previously, performing medicalisation through popularisation. We describe how these pathographies capture, not the disorders of historical or fictitious figures, rather, the anxieties of a contemporary society, eager to explain deviance in ways that helps to make sense of the world, past, present and imaginary.

Classification, disease, and diagnosis.

Classification shapes medicine and guides its practice. Understanding classification must be part of the quest to better understand the social context and implications of diagnosis. Classifications are part of the human work that provides a foundation for the recognition and study of illness: deciding how the vast expanse of nature can be partitioned into meaningful chunks, stabilizing and structuring what is otherwise disordered. This article explores the aims of classification, their embodiment in medical diagnosis, and the historical traditions of medical classification. It provides a brief overview of the aims and principles of classification and their relevance to contemporary medicine. It also demonstrates how classifications operate as social framing devices that enable and disable communication, assert and refute authority, and are important items for sociological study.

Uncertainty and the inconvenient facts of diagnosis.

One common contemporary usage of the term "diagnostic uncertainty" is to refer to cases for which a diagnosis is not, or cannot, be applied to the presenting case. This is a paradoxical usage, as the absence of diagnosis is often as close to a certainty as can be a human judgement. What makes this sociologically interesting is that it represents an "epistemic defence," or a means of accounting for a failure of medicine's explanatory system. This system is based on diagnosis, or the classification of individual complaints into recognizable diagnostic categories. Diagnosis is pivotal to medicine's epistemic setting, for it purports to explain illness via diagnosis, and yet is not always able to do so. This essay reviews this paradoxical use, and juxtaposes it to historical explanations for non-diagnosable illnesses. It demonstrates how representing non-diagnosis as uncertainty protects the epistemic setting by positioning the failure to locate a diagnosis in the individual, rather than in the medical paradigm.

"But doctors do it...": nurses' views of gifts and information from the pharmaceutical industry.

BACKGROUND: Most nurses, like their physician counterparts, lack education regarding pharmaceutical marketing strategies, and little is known of their beliefs and practices regarding this industry. Nurses are increasingly targeted by pharmaceutical companies as they become more involved in prescription and as policies restrict pharmaceutical companies' contact with physicians. OBJECTIVE: To assess nurses' beliefs and reported practices concerning pharmaceutical marketing and sponsorship strategies. METHODS: We conducted parallel Web- and paper-based surveys of a sample of senior registered nurses employed by government-funded health boards in 2 regions of New Zealand to explore their contact with the pharmaceutical industry as well as their beliefs and practices regarding information, gifts, and sponsorship provided by pharmaceutical companies. Returns were tested using Fisher's exact test to determine consistency in response between regions. Results for key outcome variables, including attitude toward the value of industry-derived information, were analyzed by region and in aggregate. RESULTS: Most nurses had contact with pharmaceutical sales representatives (69/106), accepted gifts from representatives (79/105), and believed information from the pharmaceutical industry probably improved their practice (71/106). Half believed that they would be able to detect misleading information if it were present, and 35% believed that accepting gifts and sponsorship was ethically acceptable. We found positive associations between the belief that information from the industry improved practice and reported acceptance of conference funding (OR 3.63; 95% CI 1.41 to 11.55), free food (OR 3.24; 95% CI 2.03 to 7.55), or gifts (OR 3.52; 95% CI 1.38 to 8.95). Nurses generally acknowledge the presence of pharmaceutical marketing in the hospital and the ethical challenges it presents; nonetheless, they also generally accept marketing gifts and may underestimate both the ethical challenges and their own susceptibility to persuasion. CONCLUSIONS: Given the increasing role that nurses may play in pharmaceutical marketing strategy, the profession should consider its position vis-à-vis the industry.

Shrinking social space in the doctor-modern patient relationship: a review of forces for, and implications of, homologisation.

OBJECTIVE: Forces for modernisation appear to have led to role convergence and reduced social distances between doctors and modern patients. This review aims to document and understand this process in theory and practice, and to consider the implications for modern patients in particular but also non-modern patients and doctors. METHOD: Narrative review of published and grey literature identified from sources including electronic databases, the Internet and reference lists of retrieved works. RESULTS: Forces for role convergence between doctors and modern patients include consumerism and increased patient literacy; socio-technological changes; values convergence; increased licence for doctors to use their emotions in patient care; and structural changes in the social organisation of health care. As a result, modern patients appear to have gained more in health care than they have lost and more than have the non-modern (or less modern) patients. Doctors have lost authority and autonomy in patient care. CONCLUSION: The net impulse toward role convergence is, on balance, a positive development. The differential uptake of modernisation by patients has increased health inequalities between modern and non-modern patients. The need of doctors to accommodate these changes has contributed to a form of reprofessonalisation. PRACTICE IMPLICATIONS: A key challenge is to make available the benefits of modernisation, for example through patient education, to as many patients as possible while minimising the risk of harm. It is important therefore to elucidate and be responsive to patient preferences for modernisation, for example by enlisting the support of the modern patients in overcoming barriers to the modernisation of non-modern patients. There is also a need to support doctors as they redefine their own professional role identity.

Sociology of diagnosis: a preliminary review.

Diagnoses are the classification tools of medicine, and are pivotal in the ways medicine exerts its role in society. Their sociological study is commonly subsumed under the rubrics of medicalisation, history of medicine and theory of disease. Diagnosis is, however, a powerful social tool, with unique features and impacts which deserve their own specific analysis. The process of diagnosis provides the framework within which medicine operates, punctuates the values which medicine espouses, and underlines the authoritative role of both medicine and the doctor. Diagnosis takes place at a salient juncture between illness and disease, patient and doctor, complaint and explanation. Despite calls for its establishment, almost two decades ago (Brown 1990), there is not yet a clear sociology of diagnosis. This paper argues that there should be, and, as a first step, draws together a number of threads of medical sociology that potentially contribute to this proposed sociology of diagnosis, including the place of diagnosis in the institution of medicine, the social framing of disease definitions, the means by which diagnosis confers authority to medicine, and how that authority is challenged. Through this preliminary review, I encourage sociology to consider the specific role of diagnosis in view of establishing a specific sub-disciplinary field.

Diagnosis: a critical social reflection in the genomic era.

Diagnosis is a pivotal tool for the work of medicine as they categorise and classify individual ailments via a generalised schema. However diagnosis is also a profoundly social act, which reflects society, its values and how it makes sense of illness and disease. Considering diagnosis critically, as well as practically, is an important job of the sociologist. This paper reviews how a social model can provide a critical tool for viewing diagnosis in the genomic era. It explores how the formulation of diagnosis, be it via genetic explanations or microbiological ones, are the product of social discovery, negotiation, and consensus.