"Ethics" Quandry

[Lasclalo]

Hey, 1st post on SDN after haunting the forum a bit. Third year MS, applying to IM.

I have kind of a weird problem. Most of the advice on SDN has been pretty solid, so any words of wisdom would be appreciated. During my rotation through OB/GYN, I had a really crappy time and--without getting into specifics-- witnessed some pretty shady behavior by the attendings/residents. Our school has a bioethics class, and one of the paper topics was something like, "write about an unethical situation you have witnessed." Well, I wrote about my OB rotation and the professor liked it so much that she asked me if I would like to have it published, listing me as a first author. Normally, most medical students would jump at the idea of being a primary author on a paper, but I have some concerns.

Would publishing a paper that is essentially "snitching" on another department (although every word is true and their practices were pretty crappy) make it look like I am not a "team player" during the match process? Would this give a program director pause? I mean, I would like to get the paper published for altruistic reasons (e.g. getting the practice to stop), but I could probably delay publication until after the match or not list it on ERAS. Or am I being paranoid? Thanks, in advance

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[Geri_Gal]

I don't know why it would be a problem. This was unethical behavior -- not internal department politics -- in the OB/GYN program of your medical school. Unless your school's OB/GYN program director really has it out for you and has a lot of powerful connections in the IM world (which is unlikely), I don't see how this would affect you on the interview trail.

One important thing -- talk to your IM program director or advisor and ask about the ramifications of publication...they'll have more insight than most of us!

 

[carrigallen]

I'm not sure the answer to your question, but I suggest considering waiting a bit before having such a paper officially published.
You could work on preparing and submitting it now, since that process may take several months anyway. You could also let your co-author know about your situation. Also, I don't think it would be politic or prudent to include identifying information about the department you rotated in or the specific attendings. There is a true story from a couple years ago of a medical student being suspended for writing a story in the school newspaper which made an autopsy pathologist look bad.
It was the case of Sandeep Rao. He was expelled from Texas Tech Health Sciences as a medical student. Here is a link to Rao's original article. Here is a link to a newspaper article about his expulsion.

Events like this may make you think for a while about what you are going through with.

 

[xanthines]

Holy Jeebus!

Based on the links provided, I'd have to advise the OP to delay publishing and make sure to go over all the things you signed on your first day of orientation if you can (I already lost everything I ever signed!). You could also try and speak with a dean of students or someone in a position of power to get some advice. If that person does give you the OK, make sure to get it in writing (like email) for proof!

Medicine is full of giant delicate egos, so watch where you step...

-X

P.S. Whatever happened to that Rao guy?

I'm not sure the answer to your question, but I suggest considering waiting a bit before having such a paper officially published.
You could work on preparing and submitting it now, since that process may take several months anyway. You could also let your co-author know about your situation. Also, I don't think it would be politic or prudent to include identifying information about the department you rotated in or the specific attendings. There is a true story from a couple years ago of a medical student being suspended for writing a story in the school newspaper which made an autopsy pathologist look bad.
It was the case of Sandeep Rao. He was expelled from Texas Tech Health Sciences as a medical student. Here is a link to Rao's original article. Here is a link to a newspaper article about his expulsion.

Events like this may make you think for a while about what you are going through with.

 

[Gastrapathy]

I don't know why it would be a problem. This was unethical behavior -- not internal department politics -- in the OB/GYN program of your medical school. Unless your school's OB/GYN program director really has it out for you and has a lot of powerful connections in the IM world (which is unlikely), I don't see how this would affect you on the interview trail.

One important thing -- talk to your IM program director or advisor and ask about the ramifications of publication...they'll have more insight than most of us!

This strikes me as very naive. Medicine is a very small world. The ethics professor has nothing to lose, in fact, he NEEDS to publish this sort of thing. You, on the other hand, have the small amount to gain of submitting a "publication" (although it isn't really research) and tons to lose.

If you really think people behaved unethically in that department, the right way to handle it is to go to the med stud coordinator-type MD and discuss it with him. Have a doc you liked there? Talk to him. Have a mentor in IM you trust? Talk to him. If you publish a list of grievances before you've even let them know about your concerns, stand by. They will not appreciate that approach.

BTW, I googled Rao and it looks like he's a rads resident at Ohio State.

 

[post call]

im sure he went to med skool agin, but is taht 4 sure?
sandeep is a very common indian first name, rao is very common indian last name.

 

[tibor75]

Geez, get it published. Nobody can fire you or do anything to you. Once it's published, you have something on paper to show everybody if somebody does try to blackball you.

I love these comments (in this thread and others) about medicine being a "small world." Uh, no it's not. It's big. And most people have bigger fish to fry than a medical student.

If anything, the senior author on the paper is the one who could get in hot water.

And the Rao case has NO bearing on your situation. He went to the lay press. You are trying to get htis published in the medical literature. BIG difference. For example, as a cardiologist, if one of my patients had an unusual complication and I wrote it up as a case report, nobody would say anything. If instead I told my local newspaper about it, I'm sure I'd get fired.

 

[Lasclalo]

Hey everyone,

Thanks for advice. I am not really sure what I am going to do. Just to clear things up, the administration is aware of the situation (e.g. dean of students, etc), so I am not just publishing the paper out of the blue. I will try to get some stuff in writing, but I do not necessarily think that the Rao case directly bears upon what I am trying to do, but it is scary, nonetheless.

I have a meeting with our PD concerning general residency issues later this week, and I will broach the subject with him. Hopefully, they will have some good advice. The only fortunate thing is that the publication schedule is so slow that it may not be ready before ERAS submission.

As far as medicine being a small world, I don't know enough to know, yet. It does seem like phone calls have a fairly prominent status in medical student mythology (e.g. "he/she made a phone call to get a person into a particular residency"), so I don't think its too paranoid to worry about getting a bad "rep."

thanks again!

 

[Dejavu]

Please be very careful about your interpretation of the events.

Someone is bound to recognize the details of the case and call their friend, the staff involved. Life could get complicated for you after that. The other staff will no doubt be non-committal or support their colleague that they have know for years, not you the FNG.

Always be careful while flying in someone's radar screen.

 

[dodoc07]

talk about hypocrisy... probably one of the few things in medicine that's less personal and more detached from direct patient care than forensic pathology would be radiology. looks like sandeep rao has come full circle.

 

[tibor75]

Please be very careful about your interpretation of the events.

Someone is bound to recognize the details of the case and call their friend, the staff involved. Life could get complicated for you after that. The other staff will no doubt be non-committal or support their colleague that they have know for years, not you the FNG.

Always be careful while flying in someone's radar screen.

uh, yeah, because EVERYBODY reads the student doctorb network.

Delusions of gradeur...

 

[elwademd]

i think you're in a tough position. it'd be different if it were a happy case- where all of the ethical principles were weighed, discussed, and a happy ending... but that wouldn't be great material for an ethics article (or maybe it would, lol).

alas, the case sounds negative. thus, people involved, the department, the school, and ultimately the people that run the school, may have a different feeling about it than you and your professor.

Please be very careful about your interpretation of the events.

Someone is bound to recognize the details of the case and call their friend, the staff involved. Life could get complicated for you after that. The other staff will no doubt be non-committal or support their colleague that they have know for years, not you the FNG.

Always be careful while flying in someone's radar screen.

uh, yeah, because EVERYBODY reads the student doctorb network.

Delusions of gradeur...

perhaps he meant, be careful about your interpretation in the article you would publish... hence, when it gets to print, someone who reads it may recognize it...

And the Rao case has NO bearing on your situation. He went to the lay press. You are trying to get htis published in the medical literature. BIG difference. For example, as a cardiologist, if one of my patients had an unusual complication and I wrote it up as a case report, nobody would say anything. If instead I told my local newspaper about it, I'm sure I'd get fired.

the difference is only that of perception. journals aren't some sort of private thing that only doctors can read. they're public-ations. someone can purchase a subscription to new england journal just like they can purchase a subscription to the local paper.

there's no true protection for a writer/researcher/opinion writer who puts an article in a respected medical journal. it's not as if there's an exception for medical journals. you could try to publish a case report in the local paper... but the paper may reject it based on the demographics of the paper's readership. but it makes it no more nor less "legal" to put a case report in a medical journal.

when a case report is published in a medical journal... neither you nor the editors of the journal know who's going to read it... it's intended target (physicians) are some of the people who will read it, but there will be others (nurses, medical students, researches, pharmacists, pharmaceutical companies to name a few). you're giving info out to the public.

again, the perception is different (newspaper versus medical journal), but the act itself (publication) is not.