During your clinical placements you may come across unusual conditions or surprising presentations that would be of interest to your colleagues. Many students choose to write these up as case reports. If your report is published, it may help your future job application to really stand out, as well as providing excellent evidence for your portfolio.
However, there are several necessary steps to take before your report can go ahead, and it's important to follow the guidance and advice. For a start, it's a good idea to familiarise yourself with the GMC's advice on good practice in research as well as the patient confidentiality and consent issues which need to be considered.
Choosing the right patient is critical to getting your case report published. Although extremely rare or unique cases can be interesting, also try to consider the educational value of your case report. Your colleagues may be more interested to read about a novel presentation or complication of a condition they see frequently than a condition that is so rare they will never encounter it.
If you have a case in mind, take a moment to search the literature for similar case reports and related evidence. This will help you to decide if you should pursue the case, but also your notes from this literature review will be helpful to you in writing the introduction and discussion sections of your report. The librarian in your Medical School library may be able to help you with this search.
When writing the report itself you will need access to the clinical records, as it's important to check the report you submit is factually accurate and doesn't leave out relevant information. Before you start writing, check the 'instructions for authors' for the journals you plan to submit the report to. Journals often state a word limit and a house style for academic references.
The three Cs – confidentiality, consent, capacity
If the case report is interesting because it's rare, there is a real possibility that a patient, or one of their relatives, would recognise the description of their condition. Even with major patient identifiers removed, it may not be possible to write the report in such a way that the patient could not be identified.
Because of this, it's always advisable to seek their written consent. During the consent process you might want to show the patient what you have written, as well as telling them which journals you intend to submit the case report to and if they'll be available online. Some journals require a specific consent form to be used; keep a record of your discussion.
If the patient is a young child you might be able to rely on the signed authority of someone with parental responsibility. Older children may be able to give consent if they're able to demonstrate they understand the implications, but you would usually encourage them to involve their parents in the decision-making process. As with any decision about a child, their needs must come first. Even if consent is forthcoming, you must consider if you are acting in the child's best interests.
Publication may be in the interests of patients with similar conditions, but not in the best interests of your patient.
You may also find that the patient lacks mental capacity to consent, in which case you should wait for the patient to recover from their illness and reassess their mental capacity. Sometimes the nature of a patient's illness will mean they'll always lack capacity. Publication may be in the interests of patients with similar conditions, but not in the best interests of your patient. You would then only be able to disclose identifiable information if it could be argued it was in the public interest. The threshold for doing so is very high and you should take advice from your medical defence organisation or Caldicott Guardian first.
If the patient has died you should seek the authority of the patient's Personal Representative, often the executor of the patient's will.
If you take photographs or other recordings of the patient to support your report, you must have written consent at the outset and respect any decision by the patient to withdraw their consent at any time. The recordings must be kept securely and not used for any other purpose. Certain radiology images and pathology slides can be used without consent as long as the patient's details are removed. Again, the GMC has some guidance to follow when dealing with recordings of patients.
It is possible to share writing the report with another student or doctor, which can reduce the work involved considerably without diminishing the learning opportunity. You may have senior colleagues with experience of publishing case reports who can guide you through the process. As ever, if you have any concerns about confidentiality or consent you can call the MDU for specific advice.
Dr Oliver Lord
Dr Oliver Lord
Before joining the MDU in 2013 Oliver was a consultant psychiatrist working for the Leicester, Leicestershire and Rutland crisis resolution and home treatment team. At the MDU Oliver is an adviser in a specialist advisory team with an interest in disciplinary matters and provides regular talks to members on medico-legal issues.
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