What is a clinical case report?
Clinical case reports have been the earliest form of medical communication. A clinical case report or case study is a means of disseminating new knowledge gained from clinical practice. Medical practitioners often come across patient cases that are different or unusual such as a previously unknown condition, a complication of a known disease, an unusual side effect or adverse response to a mode of treatment, or a new approach to a common medical condition. Thus, a clinical case report is expected to discuss the signs, symptoms, diagnosis, and treatment of a disease.
Clinical case reports are the first-line evidence in medical literature as they present original observations and can be an excellent way for medical students and practitioners to get started with academic writing. Additionally, a published case report is definitely a contribution to medical science and a great addition to a CV.
How to find a suitable case?
As a medical student or practitioner, you must keep an eye out for interesting or unusual cases. However, it might be difficult to identify which case would be worth writing about. According to Charles Young, Editor-in-chief of the journal Clinical Case Reports, a good case report is considered to be one that has a clear message, can be generalized, and is relevant to many other clinicians.
According to the University of Texas Health Science Center, most journals publish case reports that deal with one or more of the following:
1. Unusual observations
2. Adverse response to therapies
3. Unusual combination of conditions leading to confusion
4. Illustration of a new theory
5. Question regarding a current theory
6. Personal impact
Patient consent: an ethical requirement for case studies
Informed consent in an ethical requirement for most studies involving humans. It is important to take written consent from the patient before you start writing your case report as all journals will require you to provide patient consent at the time of manuscript submission. In case the patient is a minor, parental consent is required. For adults who are unable to consent to investigation or treatment, consent of closest family members is required.
Patient anonymity is also an important requirement. Remember not to disclose any information that might reveal the identity of the patient. You need to be particularly careful with pictures, and ensure that pictures of the affected area do not reveal the identity of the patient.
How is a clinical case report structured?
Different journals may have slightly different formats for case reports, and it is advisable to select a few target journals and read some of their case reports to get a general idea of the sequence and format.
However, in general, all case reports include the following components: an abstract, an introduction, a case, and a discussion. Some journals might also require you to include a literature review.
Abstract: The abstract should summarize the case, the problem it addresses, and the message it conveys. Abstracts of case studies are usually very short, preferably not more than 150 words.
Introduction: The introduction gives a brief overview of the problem that the case addresses, citing relevant literature where necessary. The introduction generally ends with a single sentence describing the patient and the basic condition that he or she is suffering from.
Case: This section provides the details of the case in the following order:
- Patient description
- Case history
- Physical examination results
- Results of pathological tests and other investigations
- Treatment plan
- Expected outcome of the treatment plan
- Actual outcome
The author should ensure that all the relevant details are included and unnecessary ones excluded.
Discussion: This is the most important part of the case report; the part that will convince the journal that the case is publication worthy. This section should start by expanding on what has been said in the introduction, focussing on why the case is noteworthy and the problem that it addresses.
This is followed by a summary of the existing literature on the topic. (If the journal specifies a separate section on literature review, it should be added before the Discussion). This part describes the existing theories and research findings on the key issue in the patient’s condition. The review should narrow down to the source of confusion or the main challenge in the case.
Finally, the case report should be connected to the existing literature, mentioning the message that the case conveys. The author should explain whether this corroborates with or detracts from current beliefs about the problem and how this evidence can add value to future clinical practice.
Conclusion: A case report ends with a conclusion or with summary points, depending on the journal’s specified format. This section should briefly give readers the key points covered in the case report. Here, the author can give suggestions and recommendations to clinicians, teachers, or researchers. Some journals do not want a separate section for the conclusion: it can then be the concluding paragraph of the Discussion section.
Where to publish a case study?
Publishing a case report is not easy, as some journals are reluctant to publish them. However, there are several new online journals that are dedicated to publishing case studies. BMJ Case Reports, Cases Journal, the Journal of Medical Case Reports, and Radiology Case Reports are some notable journals publishing case studies.
Case studies are a vehicle for doctors around the world to share their experiences with handling challenging patient cases. These can be valuable sources of information and guidance for clinical practitioners when faced with puzzling or challenging conditions in patients they attend to.
If you have any doubts or questions, you can post them in the comments section below. Alternatively, you can also post a question to Dr. Eddy if you are facing a problem and need expert publication advice.