Intended for healthcare professionals

Letters Disease severity

Categorising severity of disease is inevitable and essential in routine medical practice

BMJ 2018; 361 doi: (Published 14 June 2018) Cite this as: BMJ 2018;361:k2556
  1. Santhanam Sundar, consultant oncologist
  1. Nottingham University Hospital NHS Trust, Nottingham, UK
  1. sundar.oncology{at}

I wholeheartedly agree with McHugh that apparently mild symptoms can have a devastating effect on the quality of life.1 Acknowledging and dealing with this fact is critical in any doctor-patient relationship.

Equally, I am uncomfortable with the notion that the severity of a disease should not be classified and that treatments should be discussed without reference to a so called severity scale.1

Legally, not discussing the severity of disease would severely compromise informed consent.

Medically, daily clinical practice in all specialties entails objective categorisation of diseases and pre-diseases into various groups such as mild/moderate/severe or low/intermediate/high risk. For example, risk needs to be categorised in discussing anticoagulation for atrial fibrillation, statins for primary prevention, and adjuvant chemotherapy for breast cancer.234

Comparing a patient with the general population is not only inevitable but also essential as it can have a positive effect too. Patients with low risk, grade 1 prostate cancer feel immensely reassured that their life expectancy is likely to match that of their peers, thus avoiding unnecessary overtreatment of their cancer.5


  • Competing interests: None declared.


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