Radiology Case Reports Volume 8, Issue 3, 2013
From the editor’s desk: Whose case is it, anyway? Matthew T. Heller, MD, and Puneet Bhargava, MD The radiology case report continues to serve an invaluable role in the medical literature. Case reports contribute to scientific advancement by reporting unique findings and acting as catalysts for further investigation. They also have educational value and can enhance daily clinical practice (1, 2). The case report can foster one’s career by acting as a segue into more advanced scientific writing, and it can provide an avenue for mentorship. However, before a case report can be added to the literature, its authors and contributors must be decided. While organizations such as the International Committee of Medical Journal Editors have determined authorship rules for manuscripts, there is a relative paucity of information in the literature regarding the proprietary rules and protocol for case reports. Therefore, we ask, "Whose case is it, anyway?" In this editorial, we describe the complex milieu in which case reports often originate and propose some ground rules for determining their authorship.
be the specific, single diagnosis. Since this favored diagnosis is a rather rare entity, the resident seeks a second opinion before submitting the preliminary report and informally phones an attending radiologist (#1) who happens to be working a shift at another hospital. Radiologist #1 views the case and tells the resident that the proposed diagnosis is a possibility. The next morning, another attending radiologist (#2) reviews the case, agrees with the resident’s interpretation, and creates the final and official report for this patient’s imaging examination. A few days later, the resident follows up on the case and receives confirmation that his or her favored diagnosis was indeed correct. Excited by this news, the resident begins to gather the radiologic images, pathology slides, and clinical information, in the hopes of creating a case report. However, radiologist #1 states that he or she has already asked another resident to write the case report for this patient. Radiologist #1 justifies this stance by his or her more senior position and the use of his or her more seasoned opinion in corroborating the diagnosis. The resident is upset by this interaction and asks his or her training program for mediation. This scenario highlights the complex environment in which case reports are often spawned and leads us to ask, "Whose case is it, anyway?" Certainly, the resident is justified in having proprietary feelings for the case, since he or she was the first to suggest the actual, rare diagnosis. However, being a trainee, does he or she need the backing of an attending radiologist? Radiologist #1 can justify some proprietary feelings by stating that his or her corroboration
Figure 1. Matthew T. Heller, MD.
Let us start with a scenario. A patient is admitted for nonspecific symptoms and undergoes an imaging examination at the time of admission. A radiology resident is asked to provide a preliminary interpretation for the primary medical service. The resident lists a few differential possibilities for the patient’s diagnosis but summarizes by stating what he or she believes to
Citation: Heller MT, Bhargava P. From the editor's desk: Whose case is it anyway? Radiology Case Reports. (Online) 2013;8:869 Copyright: © 2013 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License, which permits reproduction and distribution, provided the original work is properly cited. Commercial use and derivative works are not permitted. Dr. Heller is an Assistant Professor at the University of Pittsburgh Medical Center, Pittsburgh PA. Dr. Bhargava is an Assistant Professor in the Department of Radiology, VA Puget Sound Health Care System and University of Washington, Seattle WA, and editor-in-chief of Radiology Case Reports. Contact Dr. Heller at [email protected]. Competing Interests: The authors have declared that no competing interests exist. DOI: 10.2484/rcr.v8i3.869
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2013 | Volume 8 | Issue 3
From the editor’s desk: Whose case is it anyway? allowed the resident’s preliminary report to go forth; therefore, radiologist #1 feels that he or she actually facilitated this rare diagnosis, and that proprietary rights of the case are compensation for the time and experience that were donated to the resident. What about radiologist #2, who dictated the official report for this case in the morning? He or she feels justified in claiming proprietary rights for this case, since his or her name is now part of the official medical legal document in the patient’s records. Additionally, the primary medical team is also excited to care for a patient with such a rare diagnosis and contacts the radiology department to see if the patient’s images can be processed for the case report that they are planning to submit. Finally, the pathologist would also like to incorporate some imaging correlation in his or her case report to supplement the fantastic histopathology that has resulted from this patient’s diagnosis. So—whose case is it, anyway? The only thing clear about this scenario so far is that there is no clear answer. Anecdotally, it seems that difficult scenarios similar to this one are not uncommon in academic centers. With increasing pressures on young faculty to be academically productive, it is not surprising that there is competition for all types of publications. This competition, coupled with the uncertainty about the proprietary rights of a case report, have been led to difficult interactions with colleagues (3). In these situations, one may consider several solutions. 1: One extreme solution would be to quickly piece together the case and submit it before anyone else has the chance. While it may seem that this approach would easily guarantee authorship and ownership of the case, it is too shortsighted to be plausible. In this approach, the submitting author is at risk for damaging his or her reputation, straining relationships with colleagues, and being subjected to potential ethics investigations by his or her institution. In addition to the grossly unprofessional conduct required by this approach, the potential fallout from loss of collegiality and future collaborations would make it unpalatable to most potential authors. 2: At the other extreme, it may be tempting to be overly inclusive; authorship would be open to anyone tangentially involved with the case. However, despite the seemingly good intentions of nonexclusivity, this approach is also suboptimal, as it often violates the ethics of authorship. Inflated co-authorship has been described as a dishonest practice that allows contributors to receive the designation of author when it was not deserved (4). However, the notion of polyauthorship has trended upward for years (5). Because of this, several journals have decided to place a limit on the number of authors or provide specific criteria for the fulfillment of authorship (6, 7). Therefore, the correct answer to "Whose case is it, anyway?" likely falls somewhere between these two extremes. Although authorship issues may more commonly arise when trainees and junior faculty are involved, they are not limited to them or to case reports; senior faculty and larger projects can also be plagued by even more complex authorship dilemmas. In the setting of a radiology case report, it
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seems most appropriate that the radiologist who is the first to suggest the correct diagnosis should be given the informal proprietary rights to write the manuscript, irrespective of seniority. If the radiologist received a helpful consultation from a colleague, then that consultant should be given the opportunity to participate as an author or contributor (as a professional courtesy). Since case reports are good avenues for mentoring, the radiologist who made the initial diagnosis may wish to invite a junior staff member or trainee to participate in the process, keeping in mind that the number of potential authors is often limited by the journal to which the manuscript is submitted. If, however, the proprietary radiologist declines the opportunity to write up the case report, then it seems appropriate for someone more peripherally involved in the case to assume leadership in doing so. Once the appropriate participating parties are determined, it is critical that the criteria for authorship are fulfilled by each participant who is designated as an author. Authorship criteria may vary by journal and should be thoroughly reviewed for each submission; several journals require an attestation statement wherein authors disclose their specific contributions (8). Persons who do not meet criteria for authorship should be clearly acknowledged as contributors only (4). Most importantly, we feel that much of the confusion and frustration regarding proprietary rights and authorship designation can be offset if a publication plan is established before anyone begins to construct the case report. All persons involved in the creation of a case report must understand and agree to their role (9). Since collaboration is requisite for a successful career in academic radiology, it is important for trainees and young faculty to be mentored by collaborative leaders (9). Therefore, we feel that a communicative team approach is the most effective way to initiate a case report and may even render obsolete the question, "Whose case is it, anyway?" References 1. Vandenbroucke JP. In defense of case reports and case series. Ann Int Med. 2001;134(4):330-4. Epub 2001/02/ 22. [PubMed] 2. Kontzialis M, Heller MT, Bhargava P. From the editor’s desk: why still write a case report? Radiology Case Reports. 2012;7(3):757. DOI: 10.2484/rcr.v7i3.757 3. Nixon MC. Case report of a case report--who owns the data? Anaesthesia. 1997;52(1):94. Epub 1997/01/ 01. [PubMed] 4. Fotion N, Conrad CC. Authorship and other credits. Ann Int Med. 1984;100(4):592-4. Epub 1984/04/01. [PubMed] 5. Levsky ME, Rosin A, Coon TP, Enslow WL, Miller MA. A descriptive analysis of authorship within medical journals, 1995-2005. South Med J. 2007;100(4):371-5. Epub 2007/04/27. [PubMed] 6. Gupta P, Sharma B, Choudhury P. Limiting authorship in Indian Pediatrics: an initiative to curb gift authorship. Indian Pediatrics. 2007;44(1):37-9. Epub 2007/02/ 06. [PubMed] 2!
2013 | Volume 8 | Issue 3
From the editor’s desk: Whose case is it anyway? 7. Huth EJ. Guidelines on authorship of medical papers. Ann Int Med. 1986;104(2):269-74. Epub 1986/02/01. [PubMed] 8. Bates T, Anic A, Marusic M, Marusic A. Authorship criteria and disclosure of contributions: comparison of 3 general medical journals with different author contribution forms. JAMA 2004;292(1):86-8. Epub 2004/ 07/09. [PubMed] 9. Bhargava P, Shin D, Moshiri M, Iyer RS. The art of collaboration in radiology. ARRS InPractice. Winter 2013;7(1):8-11.
RCR Radiology Case Reports | radiology.casereports.net!
3!
2013 | Volume 8 | Issue 3
From the editor’s desk: Whose case is it, anyway? Matthew T. Heller, MD, and Puneet Bhargava, MD The radiology case report continues to serve an invaluable role in the medical literature. Case reports contribute to scientific advancement by reporting unique findings and acting as catalysts for further investigation. They also have educational value and can enhance daily clinical practice (1, 2). The case report can foster one’s career by acting as a segue into more advanced scientific writing, and it can provide an avenue for mentorship. However, before a case report can be added to the literature, its authors and contributors must be decided. While organizations such as the International Committee of Medical Journal Editors have determined authorship rules for manuscripts, there is a relative paucity of information in the literature regarding the proprietary rules and protocol for case reports. Therefore, we ask, "Whose case is it, anyway?" In this editorial, we describe the complex milieu in which case reports often originate and propose some ground rules for determining their authorship.
be the specific, single diagnosis. Since this favored diagnosis is a rather rare entity, the resident seeks a second opinion before submitting the preliminary report and informally phones an attending radiologist (#1) who happens to be working a shift at another hospital. Radiologist #1 views the case and tells the resident that the proposed diagnosis is a possibility. The next morning, another attending radiologist (#2) reviews the case, agrees with the resident’s interpretation, and creates the final and official report for this patient’s imaging examination. A few days later, the resident follows up on the case and receives confirmation that his or her favored diagnosis was indeed correct. Excited by this news, the resident begins to gather the radiologic images, pathology slides, and clinical information, in the hopes of creating a case report. However, radiologist #1 states that he or she has already asked another resident to write the case report for this patient. Radiologist #1 justifies this stance by his or her more senior position and the use of his or her more seasoned opinion in corroborating the diagnosis. The resident is upset by this interaction and asks his or her training program for mediation. This scenario highlights the complex environment in which case reports are often spawned and leads us to ask, "Whose case is it, anyway?" Certainly, the resident is justified in having proprietary feelings for the case, since he or she was the first to suggest the actual, rare diagnosis. However, being a trainee, does he or she need the backing of an attending radiologist? Radiologist #1 can justify some proprietary feelings by stating that his or her corroboration
Figure 1. Matthew T. Heller, MD.
Let us start with a scenario. A patient is admitted for nonspecific symptoms and undergoes an imaging examination at the time of admission. A radiology resident is asked to provide a preliminary interpretation for the primary medical service. The resident lists a few differential possibilities for the patient’s diagnosis but summarizes by stating what he or she believes to
Citation: Heller MT, Bhargava P. From the editor's desk: Whose case is it anyway? Radiology Case Reports. (Online) 2013;8:869 Copyright: © 2013 The Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License, which permits reproduction and distribution, provided the original work is properly cited. Commercial use and derivative works are not permitted. Dr. Heller is an Assistant Professor at the University of Pittsburgh Medical Center, Pittsburgh PA. Dr. Bhargava is an Assistant Professor in the Department of Radiology, VA Puget Sound Health Care System and University of Washington, Seattle WA, and editor-in-chief of Radiology Case Reports. Contact Dr. Heller at [email protected]. Competing Interests: The authors have declared that no competing interests exist. DOI: 10.2484/rcr.v8i3.869
RCR Radiology Case Reports | radiology.casereports.net!
1!
2013 | Volume 8 | Issue 3
From the editor’s desk: Whose case is it anyway? allowed the resident’s preliminary report to go forth; therefore, radiologist #1 feels that he or she actually facilitated this rare diagnosis, and that proprietary rights of the case are compensation for the time and experience that were donated to the resident. What about radiologist #2, who dictated the official report for this case in the morning? He or she feels justified in claiming proprietary rights for this case, since his or her name is now part of the official medical legal document in the patient’s records. Additionally, the primary medical team is also excited to care for a patient with such a rare diagnosis and contacts the radiology department to see if the patient’s images can be processed for the case report that they are planning to submit. Finally, the pathologist would also like to incorporate some imaging correlation in his or her case report to supplement the fantastic histopathology that has resulted from this patient’s diagnosis. So—whose case is it, anyway? The only thing clear about this scenario so far is that there is no clear answer. Anecdotally, it seems that difficult scenarios similar to this one are not uncommon in academic centers. With increasing pressures on young faculty to be academically productive, it is not surprising that there is competition for all types of publications. This competition, coupled with the uncertainty about the proprietary rights of a case report, have been led to difficult interactions with colleagues (3). In these situations, one may consider several solutions. 1: One extreme solution would be to quickly piece together the case and submit it before anyone else has the chance. While it may seem that this approach would easily guarantee authorship and ownership of the case, it is too shortsighted to be plausible. In this approach, the submitting author is at risk for damaging his or her reputation, straining relationships with colleagues, and being subjected to potential ethics investigations by his or her institution. In addition to the grossly unprofessional conduct required by this approach, the potential fallout from loss of collegiality and future collaborations would make it unpalatable to most potential authors. 2: At the other extreme, it may be tempting to be overly inclusive; authorship would be open to anyone tangentially involved with the case. However, despite the seemingly good intentions of nonexclusivity, this approach is also suboptimal, as it often violates the ethics of authorship. Inflated co-authorship has been described as a dishonest practice that allows contributors to receive the designation of author when it was not deserved (4). However, the notion of polyauthorship has trended upward for years (5). Because of this, several journals have decided to place a limit on the number of authors or provide specific criteria for the fulfillment of authorship (6, 7). Therefore, the correct answer to "Whose case is it, anyway?" likely falls somewhere between these two extremes. Although authorship issues may more commonly arise when trainees and junior faculty are involved, they are not limited to them or to case reports; senior faculty and larger projects can also be plagued by even more complex authorship dilemmas. In the setting of a radiology case report, it
RCR Radiology Case Reports | radiology.casereports.net!
seems most appropriate that the radiologist who is the first to suggest the correct diagnosis should be given the informal proprietary rights to write the manuscript, irrespective of seniority. If the radiologist received a helpful consultation from a colleague, then that consultant should be given the opportunity to participate as an author or contributor (as a professional courtesy). Since case reports are good avenues for mentoring, the radiologist who made the initial diagnosis may wish to invite a junior staff member or trainee to participate in the process, keeping in mind that the number of potential authors is often limited by the journal to which the manuscript is submitted. If, however, the proprietary radiologist declines the opportunity to write up the case report, then it seems appropriate for someone more peripherally involved in the case to assume leadership in doing so. Once the appropriate participating parties are determined, it is critical that the criteria for authorship are fulfilled by each participant who is designated as an author. Authorship criteria may vary by journal and should be thoroughly reviewed for each submission; several journals require an attestation statement wherein authors disclose their specific contributions (8). Persons who do not meet criteria for authorship should be clearly acknowledged as contributors only (4). Most importantly, we feel that much of the confusion and frustration regarding proprietary rights and authorship designation can be offset if a publication plan is established before anyone begins to construct the case report. All persons involved in the creation of a case report must understand and agree to their role (9). Since collaboration is requisite for a successful career in academic radiology, it is important for trainees and young faculty to be mentored by collaborative leaders (9). Therefore, we feel that a communicative team approach is the most effective way to initiate a case report and may even render obsolete the question, "Whose case is it, anyway?" References 1. Vandenbroucke JP. In defense of case reports and case series. Ann Int Med. 2001;134(4):330-4. Epub 2001/02/ 22. [PubMed] 2. Kontzialis M, Heller MT, Bhargava P. From the editor’s desk: why still write a case report? Radiology Case Reports. 2012;7(3):757. DOI: 10.2484/rcr.v7i3.757 3. Nixon MC. Case report of a case report--who owns the data? Anaesthesia. 1997;52(1):94. Epub 1997/01/ 01. [PubMed] 4. Fotion N, Conrad CC. Authorship and other credits. Ann Int Med. 1984;100(4):592-4. Epub 1984/04/01. [PubMed] 5. Levsky ME, Rosin A, Coon TP, Enslow WL, Miller MA. A descriptive analysis of authorship within medical journals, 1995-2005. South Med J. 2007;100(4):371-5. Epub 2007/04/27. [PubMed] 6. Gupta P, Sharma B, Choudhury P. Limiting authorship in Indian Pediatrics: an initiative to curb gift authorship. Indian Pediatrics. 2007;44(1):37-9. Epub 2007/02/ 06. [PubMed] 2!
2013 | Volume 8 | Issue 3
From the editor’s desk: Whose case is it anyway? 7. Huth EJ. Guidelines on authorship of medical papers. Ann Int Med. 1986;104(2):269-74. Epub 1986/02/01. [PubMed] 8. Bates T, Anic A, Marusic M, Marusic A. Authorship criteria and disclosure of contributions: comparison of 3 general medical journals with different author contribution forms. JAMA 2004;292(1):86-8. Epub 2004/ 07/09. [PubMed] 9. Bhargava P, Shin D, Moshiri M, Iyer RS. The art of collaboration in radiology. ARRS InPractice. Winter 2013;7(1):8-11.
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2013 | Volume 8 | Issue 3
