Publication penalties
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Amanda D'Ambrosio, "Mayo Physician Fired Over COVID Book", MedPage Today 6/24/2021:
After publishing a book about his experience on the front lines during the COVID-19 pandemic, a physician was fired from his position at the Mayo Clinic this month, he confirmed to MedPage Today.
Steven Weiss, MD, an internist who practiced at the clinic's Eau Claire, Wisconsin location for 32 years, stated that he was terminated because he identified himself as an employee of the Mayo Clinic in his new book, called Carnage in America: COVID-19, Racial Injustice, and the Demise of Donald Trump.
According to a June 4 termination letter shared with MedPage Today, Mayo Clinic administrators told Weiss, 62, that his actions violated the health system's publishing policy, as he did not submit his manuscript to the institution for review before it was printed.
"I'm still in shock that I was terminated for this," Weiss said in an interview with MedPage Today. "I had no idea that they would claim a right to pre-vet a book before publication."
The outcome is the same as in the case of Timnit Gebru, though she apparently went ahead with publication over the objections of her management. My impression is that this general sort of thing happens fairly often, with outcomes ranging from withdrawal of the contested publication to termination of the author's employment.
Or, much less often, the author wins. Around 1980, as part of his work at Texas Instruments, George Doddington undertook a systematic comparison of the seven (hardware) speech recognizers then available on the market. He wrote up the results and submitted them to the company's internal publications review process, which denied permission on the grounds that valuable company information would thereby be made available to others.
George went ahead anyhow, and the paper was published as George R. Doddington and Thomas B. Schalk, "Speech recognition: Turning theory to practice", IEEE Spectrum Sept. 1981. This was certain to be noticed, since IEEE Spectrum is the flagship magazine of the Institue of Electrical and Electronics Engineers, "The world's largest technical professional organization for the advancement of technology", sent to all of the IEEE's hundreds of thousands of members. And George's article was the cover story.
When the responsible VP got his copy, he was understandably furious, and summoned George to his office. He waved the magazine in George's face and yelled "OK, Doddington, what's the meaning of this?" As I remember the story, as told to me a few years later by someone (not George) who was there, George sat in a visitor's chair, put his feet up on the desk, and responded "Obviously, it's blatant insubordination. The question is, what are you going to do about it?"
What they did, in fact, was to promote him.
They were probably influenced by the fact that his previous work for TI was to bring in knowledge of the LPC analysis/synthesis techniques, which he had learned about from Manfred Schroeder and Bishnu Atal as a student intern at Bell Labs. That knowledge had led directly to the the Speak & Spell toy. He also played a central role in developing a speaker verification system.
Philip Taylor said,
June 27, 2021 @ 1:15 pm
"Steven Weiss, MD, an internist who practiced at the clinic's Eau Claire, Wisconsin location for 32 years, […]"
Until a few years ago, I don't think the substantive "intern" was used in British English (with its American meaning), but we seem to have adopted it following the Clinton/Lewinsky débâcle, and my assumption has been that it means a very junior member of staff, analogous to an apprentice or an improver or whatever. But if Dr Weiss has held the position of "internist" for 32 years, then I am forced to assume that an internist and an intern are not one and the same. Could anyone who is familiar with both words possibly explain ?
Coby Lubliner said,
June 27, 2021 @ 1:28 pm
Collins English Dictionary (a British publication): "Internist (Medicine) a physician who specializes in internal medicine".
Kristian said,
June 27, 2021 @ 1:35 pm
Yes, and an intern in medicine (in the US) is a doctor in the first year of residency (first year after graduating from medical school).
Philip Taylor said,
June 27, 2021 @ 2:40 pm
Thank you both. I am now forced to wonder what an internist might be called in British English. Clearly (for example) a gastro-enterologist is an internist, but an internist presumably deals in far more than just gastro-enterology …
Alexander Browne said,
June 27, 2021 @ 2:52 pm
@Philip Taylor "Physicians", apparently:
Internal medicine or general internal medicine (in Commonwealth nations) is the medical specialty dealing with the prevention, diagnosis, and treatment of internal diseases. Physicians specializing in internal medicine are called internists, or physicians (without a modifier) in Commonwealth nations. (Wikipedia)
Jim Breen said,
June 27, 2021 @ 3:17 pm
Known as physicians in Australia. Internist is regarded as AmE.
David Marjanović said,
June 27, 2021 @ 3:30 pm
That made me wonder if Mayo Clinic was a private for-profit corporation. It's private, but it's a non-profit public charity. Odd.
Internist (m.), -in (f.) is used in German for practitioners of internal medicine.
Michael Watts said,
June 27, 2021 @ 6:42 pm
Speaking as the son of an American gynecologist, I'm aware of the field "internal medicine", but have never heard the term "internist".
Stephen Hart said,
June 27, 2021 @ 7:18 pm
"I'm aware of the field "internal medicine", but have never heard the term "internist"."
Compare to "hospitalists"
https://en.wikipedia.org/wiki/Hospital_medicine
Josh R said,
June 27, 2021 @ 7:28 pm
Phillip Taylor said
"…my assumption has been that [intern] means a very junior member of staff, analogous to an apprentice or an improver or whatever."
In the US, an internship (non-medical) is a short-term (typically one year or less), unpaid or low-paid position in an organization, which is filled by college students or new graduates in order for them to gain experience and/or connections in a particular field.
maidhc said,
June 27, 2021 @ 7:37 pm
Usually in the US, an internship (in a non-medical sense) is a part-time temporary job taken as part of an educational program at the university level. The intention is to give the student some practical experience in their field. The employer coordinates with a faculty member to assess the student's accomplishments, which may receive academic credit. I'm not sure about government interns, but I think it's basically the same idea, maybe with a little political patronage added.
A medical intern is slightly different in that the intern has already received a degree.
An internist is a specialist in internal medicine.
Rick Rubenstein said,
June 27, 2021 @ 9:10 pm
People often misuse "internist" when they really mean "worldwidewebist".
Michael Watts said,
June 27, 2021 @ 11:22 pm
US internships are often quite highly paid. What makes them "internships" is the fact that they are occupied by college students, not the pay scale.
maidhc said,
June 28, 2021 @ 2:42 am
Michael Watts US internships are often quite highly paid.
That can be true. In engineering, for example, a student intern would probably be paid comparably to what a new hire would get. I think the same is true in some other fields.
However, in some fields, such as journalism, internships are very poorly paid, or not paid at all. Since internships are often a key step to obtaining permanent employment, this means that access to employment can depend on the young person's having a family affluent enough to finance them living in an expensive region like Manhattan for a couple of years before they actually get a paid position.
Obviously a controversial topic.
Ralph J Hickok said,
June 28, 2021 @ 7:29 am
My impression is that many (perhaps most, maybe even all) interrnists are what were called general practitioners once upon a time. At least, I have had three primary care physicians who were called internists and their main function was to refer me to specialists when necessary
.
Philip Taylor said,
June 28, 2021 @ 8:24 am
Certainly the term "general practitioner" is still widely used in the UK, and almost invariable abbreviated to "GP" (or "gp"). "I have to see my GP on Friday" would be a typical usage. But I am now led to wonder what the American "opposite" of "internist" is — is there such a thing (or person) as an "externist" ?
Kristian said,
June 28, 2021 @ 8:31 am
Your primary care physician may be an internist, but a general practitioner is generally either a doctor without a specialty (more historically) who works as a primary care physician or (generally nowadays) a doctor with a specialization in what is called family medicine or general medicine. Internal medicine has always been a specialty, but it's a very broad one, so more and more physicians have more specific subspecialties.
Kristian said,
June 28, 2021 @ 8:40 am
Semantically, the "opposite" of an internist is a surgeon. (or the complimentary category, it might be more accurate to say)
Or in the UK, I guess, the "opposite" of a physician (who treats people with "physic" i.e. medicine) is a surgeon. So, for example, British surgeons aren't called "Dr." but "Mr/Mrs/Ms".
Kristian said,
June 28, 2021 @ 8:57 am
In Chinese I believe surgery and internal medicine are actually called wàikē (outside discipline) and nèikē (inside discipline), but I don't know Chinese, and I don't know the history of these terms.
Joe said,
June 28, 2021 @ 9:01 am
When I got to the "read the rest of this entry" link, I was convinced the commentary would be about the redundancy in "pre-vet a book before publication."
Philip Taylor said,
June 28, 2021 @ 9:19 am
So if (for example) I needed an emergency appendicectomy, even tho' my appendix is very definitely inside my body, such a procedure would not be classed as "internal medicine" and an internist would therefore not attend but would instead refer me to a surgeon. Is that correct ? If so, I begin to think that "internal medicine" is not quite what I envisaged when the phrase was first introduced into this thread by Coby Lubliner.
Kristian said,
June 28, 2021 @ 9:28 am
Exactly, internists don't perform surgical procedures.
Philip Taylor said,
June 28, 2021 @ 10:16 am
OK, all is now clear (I think) — an <Am.E> internist is a <Br.E> physician, and a <Am.E> surgeon is a <Br.E>surgeon.
Michael said,
June 28, 2021 @ 11:49 am
@David Marjanović: Not sure what you find odd. In the USA a 501(c)3 corporation is a private not-for-profit. This is how most charities exist. Anything public would have to be a government agency, and charity is not a popular political platform, so public charities do not exist. There are religious-sponsored charities, of course, which are also considered to be 501(c)3, either by default because of belonging to a recognized church, or because of having applied for the status. In either case, they remain private organizations.
Jerry Friedman said,
June 28, 2021 @ 1:05 pm
Michael: My guess was that David Marjanović found it odd that a private charitable corporation would be as harsh as a for-profit corporation to employees who allegedly violate its policies—but as an American, I don't find that odd at all.
VVOV said,
June 28, 2021 @ 1:12 pm
As an American internist (and linguistics fan), two comments:
1. "Internist", a practitioner of internal medicine, is not equivalent to "GP." A "GP", or "primary care doctor"/"PCP" in more contemporary U.S. usage, may be either trained in internal medicine or family medicine. Additionally, an internist may either practice outpatient medicine (as a PCP) or inpatient medicine (as a hospitalist). Finally, people who practice subspecialties of internal medicine, such as cardiology or oncology, usually are not described as "internists" (even though they have been trained as one).
2. The description that the "physician was fired from his position at the Mayo Clinic" is slightly misleading. It appears that the doctor in question worked at "the clinic's Eau Claire, Wisconsin location". This hospital is part of the "Mayo Clinic Health System", a network of community hospitals in Minnesota/Wisconsin/Iowa that have become acquired / partially owned and operated by Mayo Clinic in recent years, but NOT part of the Mayo Clinic *per se*, the academic medical center located in Rochester, MN. I don't have insider information about the internal workings of Mayo Clinic, but even though the author technically is a "Mayo employee", I suspect that the Clinic leadership may have been particularly offended by this backwater (in their perception) doctor implying that he works for *the* Mayo clinic.
David Marjanović said,
June 28, 2021 @ 5:05 pm
What I find odd is that a non-profit, which doesn't have business secrets to hide, has a publication policy like that at all.
"Internists know everything and do nothing. Surgeons do everything and know nothing. Pathologists know everything and do everything, but too late."
"Quick! A dermatologist!!!"
Norman Smith said,
June 28, 2021 @ 9:17 pm
I'm with Joe; I was sure the discussion would be on "pre-vet". This strikes me as being like "pre-prepare" which I have heard on occasion.
Jason M said,
June 28, 2021 @ 10:45 pm
As a pathologist (and linguistics fan), I second everything @VVOV said including that the sin to Mayo Central here was likely as much that a physician/internist (non-surgeon, non-pathologist) at a distant, recently acquired affiliate hospital would represent himself as “at the Mayo” (with all implied prestige) for marketing purposes without clearing his affiliation with Mayo HQ, let alone the content of the book.
Which reminds me of “Airplane!”: Give me Ham on 5, hold the Mayo….
Jerry Friedman said,
June 29, 2021 @ 4:23 pm
David Marjanović: I'd guess the Mayo Clinic doesn't want employees saying anything critical (true or false) about it or anything offensive that people will associate with the corporation, or claiming to speak for it except as authorized by the top executives or the PR department.
B.Ma said,
June 30, 2021 @ 1:12 am
In the UK, an "intern" is a Junior Doctor and an "internist" is a General Medical Doctor who works in a hospital and is not a surgeon, colloquially known as "medics" (for example when someone is assessed in A&E, the outcome may be "admit to hospital under the medics" versus "admit under surgeons").
A General Practitioner doesn't work in a hospital at all (except when parts of hospitals are designated as "GP clinics", which happens on evenings and weekends in some areas to relieve pressure on A&E by seeing patients who should have gone to a GP) and under the NHS their role is to manage patients who are not in hospital or whose long-term condition is stable enough that they don't need to be seen by a specialist doctor in hospital. They are also gatekeepers to specialist doctors.
An "internist" who is a consultant (AmE "attending") would have passed the exams of the Royal College of Physicians. They would also have a specialty (a list can be found at https://www.rcplondon.ac.uk/about-us/who-we-are/rcp-specialties) however at least in NHS hospitals, the "internists" who cover ward patients have to look after patients not under their own specialty outside 'normal' working hours. For example on Sunday if a cardiologist is on call they manage all the medical patients until they are transferred to their 'proper' medical specialty such as gastroenterology or respiratory medicine on Monday morning.
Basically internists treat patients with medications and (less) invasive procedures like bronchoscopy and endoscopy rather than cutting them open.
Junior Doctors range from those just out of medical school to those who are about to become consultants. In the profession the first two years are called Foundation Doctor and then Core Trainee/Specialist Trainee followed by a number but you will also hear terms like "Senior House Officer" (= CT1, CT2) and "Registrar" (= ST3 to ST7, but some specialities start with ST1). All of these are technically covered by the AmE term "intern" even though an ST7 is basically trusted to work independently and a newly-passed consultants from outside the UK might be advised to start at ST6 to demonstrate that they meet the UK requirements.
Richard Hershberger said,
June 30, 2021 @ 9:16 am
@VVOV & Jason M: I think it at least as likely that this guy never claimed to work at the Mayo Clinic, but that journalists didn't understand the distinction between the Mayo Clinic and the Mayo Clinic Health System. This is just the sort of detail I would expect a journalist to get wrong unless there is a very detailed and explicit explanation confined to small words, and possibly even then. Nothing I can find on the bits available at Amazon suggest otherwise. The author bio blurb on the back cover identifies his employment as "Mayo-Eau Clare." My guess is that this was enough to get him fired.
Jerry Packard said,
June 30, 2021 @ 10:34 am
To provide an additional detail, we now have the hospitalist: an internist who works specifically in a hospital. So we have:
intern – just graduated med school, in a hospital, not yet a resident
resident – finished internship, responsible for interns
attending – finished residency, responsible for interns and residents
internist – physician who is a general practitioner (内科医生)
hospitalist – internist who works specifically in a hospital
surgeon – cuts people open (外科医生)
When I first heard the term 外科医生 (outside-subject-doctor) for ‘surgeon’, I found it confusing, because surgeons deal with the inside of patients, not the outside!
Brendan said,
July 1, 2021 @ 6:57 pm
Would people quit listening to Philip Taylor please
I'm breaking my own rule but as long as folks are into medical designations: what is the proper, formal term of address toward a Physician Assistant? (In the USA this is an official category between 'nurse' and 'doctor' (sort of, let's skip the technicalities)). I have asked this of both PAs and MDs, the PAs generally say Just call me XYZ (John etc), the MDs say I have no idea, I call them XYZ.
Jerry Friedman said,
July 2, 2021 @ 4:46 pm
Brendan: I think the MDs and PAs have answered your question. There's no special honorific like "Doctor" or "Nurse" for PAs. You address them by first name or, in the unlikely event that more formality is appropriate, by "Mr." or "Ms." or "Mx." with their last name.