Bibliographic record
Abstract
No: Gifts debase the true value of careIt is a rare privilege to save a patient's life, and I have only done so once in my years of practice.Shortly after the event, my secretary received a sheepish call from the patient's wife, who was asking what might make an appropriate gift to express their gratitude.Without reflection, I suggested a bottle of single malt scotch.It never materialized.Had I asked for too much?Had I intimidated them?Did they no longer think my service special and worthy of reward?Whatever the reason, my dealings with them were colored from that moment forward.Gift giving from patients to physicians is common.In 1980, a survey of British physicians found that 20% had received a gift from a patient in the preceding 3 months.1 Most often, physicians received alcohol, chocolate, or cash.Despite the prevalence of the practice, ethical codes offer little guidance on the appropriateness of accepting such gifts.The issue is not broached at all in the American Medical Association Principles of Medical Ethics.The Code of Ethics of the Canadian Medical Association touches on the subject only indirectly in its admonition to "not exploit them [patients] for personal advantage." 2 The ethics of accepting gifts from patients has received little sustained discussion in the literature.Lyckholm argues that while inordinately expensive or otherwise inappropriate gifts should be rejected, small gifts ought to be accepted by physicians: "Declining a gift actually may cause more damage than any harm done by accepting it.If a physician rejects a gift, it may be interpreted by the patient as a lack of regard for the patient's wishes, and may hurt the patient's feelings, irrevocably fracturing the patient-physician relationship."3 This analysis is flawed.There are 4 reasons why physicians should never accept gifts from patients.First, the physician-patient relationship is a fiduciary one; that is, the physician owes an obligation of fidelity to the patient.Profiting from the treatment of a patient, other than through established reimbursement schemes, violates the physician's fidelity to the patient.Accepting gifts erodes the special moral character of the physicianpatient relationship.Second, gifts are given with differing motivations, and it may be difficult for the physician to divine the reason for a particular act of giving.I strongly suspect the
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.065 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.006 | 0.031 |
| Scholarly communication | 0.010 | 0.020 |
| Open science | 0.001 | 0.007 |
| Research integrity | 0.012 | 0.019 |
| Insufficient payload (model declined to judge) | 0.017 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".