Dr Sameera Gunawardena is a senior lecturer and head of the Department of Forensic Medicine and Toxicology of the Faculty of Medicine, University of Colombo.
“Always note and record the unusual…Publish it. Place it on permanent record as a short and concise note. Such communications are always of value” - William Osler (1849-1919)
Many scholars in the field of medicine begin their academic journey through the scientific publication of rare and important cases that they encounter in clinical practice. Indeed, the earliest origins of many significant clinical conditions that we hold common today such as AIDS, Paget’s disease, physical child abuse can be traced to single cases being reported in medical literature. Unfortunately, in recent years, with the emphasis gradually shifting to large scale epidemiological studies, clinical trials and laboratory experiments, attention to case reports has dwindled. Many of the leading scientific journals themselves have placed greater restrictions on the acceptance of case reports for publication in comparison to ‘original’ articles. Even in scientific forums and conferences, case reports generally tend to be considered for poster presentations which rarely receive the same hearing as oral presentations. There is a misconception, especially among younger clinicians, that a case should be reported only if it’s rare and previously unreported. One must not forget that a case report can be a holistic learning tool on its own. Its impact goes beyond the mere reporting of a disease or clinical condition. There are several ways how a case report can be academically valuable and some of them are tabled below under four broad categories.
When selecting cases for case reports, the author must first identify how this case is academically important and then must structure the article accordingly. All too often case reports tend to get rejected when the author fails to highlight the message that the case provides and when there is no new information that can enhance medical knowledge.
It is encouraging to note that several new journals have emerged which exclusively publish case reports such as the BMJ case reports, the Journal of Medical Case Reports and Clinical Case Reports. Many of them however are open access journals and therefore may constitute a publication charge from the author. There are websites such as the Scientific Writing in Health and Medicine which provide assistance to authors interested in knowing how to structure and develop case reports. The most commonly practiced template is the CARE template and authors are advised to visit www.care-statement.org for more information on the CARE guidelines.
Medicine is too vast a field to rely purely on research and experimentation for its advancement. Since time immemorial, undergraduate and postgraduate medical education has largely relied on students and trainees enhancing their knowledge, skills and attitudes through observing, managing and reflecting on patients. Just as each individual is unique and different from the other, each case will have its own uniqueness and rare occurrence which we as doctors must always strive to recognize.
This blog post was originally an excerpt from the RPFC Newsletter Volume 1, Issue 3 November 2019.