Everyone has a story to tell...

We all are a little bit excited about what we do.  It would be true to say that most people don’t understand how there is fascination in disease, more so when things are a bit gross to the casual observer.  What is even better is when you see something completely new, something not wanting to follow the established playbook, or something out of that playbook rip it up and take you on a rollercoaster.  So, what do good friends do when that happens?  They share.

The things we tend to remember are usually associated with a story – everyone has at least one good/bad/off-color joke ready to go.

While primary research and controlled studies dominate the literature, case reports are still a great way to tell people how things went.  Common things occur commonly, but we all hope to recognize the rare disease when we see it, or the routine when it tries to hide.  Kudos to the power of observation.  Parkinson’s Disease was first described in 1817 by James Parkinson in a report titled “An essay on the shaking palsy”1 that has been reprinted and reviewed many times since then.  More recently, in 1981, an unusually frequent occurrence of a rare skin tumor (Karposi’s sarcoma) generated a report that directly led to the uncovering of acquired immunodeficiency syndrome (AIDS).  Both above-mentioned diseases were first described in the literature in a case study format.  But for the keen observation of the authors, their commitment to the gathering of seemingly disparate information, and their commitment to putting pen to paper these diseases may have continued under the radar for longer with even more tragic outcomes.

What is fair game for a case report?  Is there a disease of unknown cause, an unexpected clinical course, a rare disease or one in a location it should not occur, or is a novel congenital defect at work?  Maybe the diagnosis was challenging, or you want others to avoid the pitfalls you came across on the way.  It is OK and brave to walk readers through your errors and how you overcame them.  If there were problems during treatment, or medications did not behave as expected, this may be difficult to replicate meaning the report may be the only evidence.  The story can illustrate several teachable moments to the benefit of all.

If you think you have a good idea, it is then time to read around and see if a report already exists.  No one really has time for a ‘me too’.  Your report should bring something new to the table or expand upon what is already known.  On the way you end up learning about the case and other things you never considered.

While case reports are less structured than scientific reports, you still need to be organized, and you need to be focused.  There are certain things they should always contain.  I will talk about these in the next post.

The hardest part is getting started.

 

1.    Parkinson J. An essay on the shaking palsy. Archives of Neurology 1969;20:441-445.


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