Bibliographic record
Abstract
The article to which Drs. Cruess, Cruess, and Hafferty respond was prepared by Dr. Harris; however, both of us contributed to its message. We welcome their invitation to develop a larger dialogue on medicine’s relationship with society. Drs. Cruess, Cruess, and Hafferty want to ensure “meaningful negotiations” over the nature of the relationship between medicine and society. In stating this goal they reassert a model in which (1) medicine is separate and distinct from the rest of society, and (2) any relationship between the parties is best described as a bilateral contract. The point of Dr. Harris’s article is that we reject both of these assertions on theoretical and historical grounds. Their statements that “the majority of observers” use the term “social contract” and that the medical profession was well respected until after World War II do not address the substance of these arguments. Moreover, there is ample evidence that the medical profession in the United States had a very fractious relationship with society before 1900 and after 1930. Nor are we alone in questioning whether the traditional contract model is inevitable or desirable for what they grant are multiple relationships with different parties at different levels. For example, the medical profession in the United Kingdom has explicitly rejected the concept of “contract” in favor of “partnership.”1 As Dr. Harris argued, our concern is that the “social contract” metaphor limits the understanding and teaching of professionalism by misrepresenting the moral underpinnings of the physician’s responsibilities as a bilateral bargain. Many physicians practice ethically in specialties where rewards and privileges are comparatively low. Few if any physicians find the privilege of self-regulation more morally grounding than the humanity and vulnerability of their patients. Fostering a sense of these complex responsibilities is our mutual goal. We do agree with the correspondents that medical professionalism goes beyond the individual physician–patient relationship. Part of the challenge of teaching and learning professionalism is to broaden students’ (and the profession’s) understanding of social processes and the nature of society. We believe that it is possible to do this without reasserting the traditional (U.S./Canadian) claim of professional exceptionalism. We are pleased that Academic Medicine encourages this kind of discussion and welcome the chance to continue it here and in other settings. John M. Harris Jr, MDFormer executive director of continuing medical education, University of Arizona College of Medicine, Tucson, Arizona; [email protected]m. Lynette Reid, PhDAssociate professor, Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.010 | 0.086 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.006 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.006 | 0.005 |
| Research integrity | 0.063 | 0.079 |
| Insufficient payload (model declined to judge) | 0.011 | 0.008 |
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".