|Research has become an integral part of medical careers. A case report
is a way of communicating information to the medical world about a rare
or unreported feature, condition, complication, or
intervention by publishing it in a medical journal.
When to start
Be on the look out for a case report from the start of your basic surgical
or medical training. This will introduce you to the research world, and
if your report is published it will be an asset to your CV.
Any kind of research entails a lot of hard work and persistence. Your
thought processes should be geared towards research in your postgraduate
career, and you should use every opportunity you get
for writing a report. So if you come across something unusual, discuss
it with a consultant, particularly one who is keen on research. Many consultants
have huge amounts of material in the top drawers
of their desks, waiting to be published. All they want is an enthusiastic
medic who will help share their load in writing and getting it published.
They are usually helpful if you ask them about this.
How to start
A senior doctor’s help is a must from the beginning. He or she may
know from their experience what cases are suitable for publication. Do
an extensive literature search—PubMed, Medline, Ovid, Embase, and even
search engines like Google will give you a vast amount of information related
to the condition or feature you are after. Narrow down the search to your
actual topic. If this comes up with very few search results, it means (assuming
your search method is correct) that the case is rare and the report is
therefore more likely to be published.Your hospital library staff can help
(especially in the beginning) by
doing your searches for you and then getting relevant literature from
other sources, if necessary. So don’t be afraid to ask them. It is always
useful to read in a standard textbook or appropriate journal everything
about the topic that your case report relates to. Note down or photocopy
important references at the end of the chapter or article and follow them
up. Obtaining consent from the patient is not only good medical practice
but also mandatory for some journals, such as the Eye Journal (which has
its own consent form). If there is no standard form, make up your own.
It is useful to have the patient’s contact details on the form just in
case you want to trace him or her later. It is also polite to
ask permission from the doctor in charge of the patient’s management.
How to collect information related to the case
After you have done the groundwork, collect all the material for the
case report. Use the patient’s notes to record the details of all the events
in the patient’s care—that is, history, examination findings, results of
investigations with dates, and operative findings, if any, together with
the details of the actual intervention and follow ups. Get copies—do not
take the originals (they are the patient’s only records for future reference).
You are allowed to have copies only of radiographs, slides, photographs,
and so on, but in this electronic age it is better to use a digital camera
for your personal copies of radiographs and clinical photographs. This
avoids many potential problems and saves a lot of time. Make sure you return
the notes and radiographs to their original source. You should also visit
the patient again and make sure you have got the facts right.
Which journal to choose
(Note: It is important to choose a journal which will be indexed
on the midline.)
Again, the advice of your supervising consultant is useful. Select
a journal that you think would be the most appropriate for your case report.
For example, unusual injury presentations are more likely to
be accepted in the journals such as Trauma rather than more mainstream,
general interest journal. The BMJ does not publish case reports, only Lesson
of the Week. In other words, be sensible in
choosing the journal. Download or copy the information for authors
for that particular journal and keep the hard copy safely in a folder with
all the other information about the case. It is also useful to have a copy
of any case report from a previous issue of the journal to get an idea
of the presentation. It is extremely important to understand the basic
format required by the journal. Your case report may be rejected because
it does not conform to the standard format, no matter how good the content
is. Margins, spacing, figure numbering, and style of references (Vancouver,
Harvard, and so on), all are important aspects.
How many colleagues should be included?
The honest answer is not many: the supervising consultant and maybe
one or two other colleagues, depending on how sincere and helpful they
have been in collecting information or literature. You
or your consultant (discuss with him or her) must be the first author.
Do not ever give photographs or any other material related to your case
report to anyone who you think might misplace them.
How do I write it? It is best to write everything in one stretch. Piecemeal
time because you have to go over everything repeatedly. The following
format is the most common way of writing a case report.
Describe your case report in one sentence. Also mention how rare it
You have to summarise the information that you have gathered: a brief
history and important and relevant positive and negative findings with
details of investigations, treatment, and the condition of the patient
after treatment. Don’t include unnecessary details. Remember, this part
should read like an interesting story, which your reader should enjoy.
One common form of presentation is to divide it into separate paragraphs
with history, examination, investigation, treatment, and outcome in separate
paragraphs—a textbook style of presentation without the headings.
Remember that the probability of getting any research work published
in a reputable journal is determined primarily by how well your arguments
are presented scientifically —that is, how your
report is supported or discussed. The first paragraph may explain the
objective of reporting the case.
You must subsequently describe whatothers have written before about
the condition or any related feature. Be generous in quoting the literature
but don’t go into unnecessary details.
The third and most important stage in the discussion is to substantiate
the message you are trying to convey. Your reviewers want proof of the
rarity of the condition and the scientific explanations for it. If you
don’t do this, they are likely to reject your report immediately. So you
must be able to describe the cause of the condition or why a particular
procedure or feature was chosen. How did it influence the outcome?
How does it differ from usual and what are your recommendations? Are
there any lessons to be learnt? All (or at least most) of these questions
need to be answered in the discussion.
This is not always necessary in a case report but if it is, summarise
your message in a few sentences.
The reference section is boring and time consuming but extremely important.
Keep to the style (Vancouver, Harvard, etc) that your journal requires.
The references should be in the form of numbers
as you go along (usually 1, 2, 3, etc, as superscripts or in brackets
in the order of appearance, as required by your journal). It is useful
to put the same number on your hard copy of the reference.
Expect to have to edit and revise the report about three times. Make
sure you use the spell and grammar check on your computer. Every section
of the case report—discussion, reference, etc—should start on a new page.
Get the senior author (usually supervising consultant)
to review the finished report and then write a covering letter. All
the other documents, including photographs, copyright, and so on, as required
by the journal, should be attached to the final
copy of the report before sending it to the journal.You are allowed
to have a party once you have put your completed case report in the mailbox.
Not for celebration but for preparation. Your search for the next case
report should start the next day.