Case reports are one of the most important staples of evidence-based medicine. They represent the cornerstone of qualitative medical research, as opposed to quantitative research such as clinical trials, and focus on shedding light on all practicalities of a given case. They help medicine students as well as fellow researchers understand a disease, treatment course or disease from a pragmatic point of view, by putting that clinical experience into context through real-life examples. Often viewed as less reliable and scientifically sound than other research methods, case reports do still possess the unique strength of capturing the actual day-to-day life issues of doctors and patients that cannot be grasped by simply reading a medical textbook. However, moving from clinical practice to a great case report is all but an easy feat that requires diligence and rigor.
Knowing what to ask: the questions behind a Case Report
In order to build and record all the relevant details of a clinical experience, the researcher must synthesize the whole patient’s history in a compelling chronicle through a reliable analysis protocol. Yin described a very simple and practical method on how to write a case study, providing solid guidelines on how to recollect all relevant events into an engaging and in-depth description. One of the most interesting aspects of the Yin’s guide, as well as one of the most critical aspects of writing a case report, is defining a set of pre-determined questions that will help the researcher develop a consistent article. Finding what are the relevant aspects of your research, will help you skim through all your recorded data. Medical records, interview transcriptions, pharmacological protocols all sum up to an intimidating amount of trivial information. Knowing what are the conventional question to ask is mandatory to avoid being buried under this overwhelming amount of data.
Getting to the core of your research: the what, the why and the how
The easiest and most direct questions to ask before writing your case report should be the what and the why. “What are we going to talk about?” is just a few inches far from the most significative aspect of your research: what the real problem is. Because every single case report, or even a clinical trial, will always focus on a problem. In other words, who cares if everything just goes smoothly? One of the first things a freshly graduated student will learn during his first days of work in a hospital is that real-life scenarios are way more than often very different from their standardized counterparts found in medical textbooks. Case reports offer the opportunity of evaluating an unexpected problem through the clinical experience of a fellow doctor. So dealing with the what question should be the priority of the researcher.
The why question comes as a direct consequence of the what one. The “Why is this problem relevant and/or important?” question is unavoidably intertwined with the previous one, and is a critical one to avoid putting too much focus on trivial elements instead of significant ones. The aim of a case study is, first and foremost, to provide useful information to the reader. On the other hand, a case study should be reported with rigorous and reliable methods that sink their roots in scientific literature. Knowing what is the theory behind a given research helps the researcher build a solid framework for his text, and at the same time answer to the compelling question about the how. The “How is this researched going to be performed?” question deals with the most quantitative aspect of your qualitative research. It puts the study’s design and investigation methods into perspective, and gives a consistent context to all the speculative information by supplying the reader with the empirical and logical aspects of the research itself.
The actors of your stage play: the who and the when
Clincial case reports should be put into context as they’re the cornerstone that represents the foundation of modern medicine. Knowing “Where and when this clinical case was explored?” helps the reader understand the cultural environment where they were conducted. Evidence-based medicine is still full of traditional knowledge and local treatment approaches, so providing a solid geographical background on the research itself is just as useful as telling the readers during what period you were investigating. We still read and teach Freud’s clinical cases in our universities after all, aren’t we?
Another key information for the reader is defining “Who wrote the research?”, as well who worked on it as a whole team. Medicine is full of different professional figures with very diverse backgrounds, specialties and, more importantly, therapeutical approaches. Defining the composition of your team gives to your audience a hint on how the research was conducted, and help increasing the objectivity and rigor of your study. Another critical who question hat needs to be answered is “Who the patient was?” Knowing the details about the patient life, as well as his comorbidities, treatment and health status doesn’t just help the reader immerse himself in the reading. It’s a fundamental instrument to give a practical overview of a condition or disease, how it manifests itself in a real-life scenario, and how it affects the lives of the patients who suffer from it. It’s not just a who question, it’s also a what question at the same time.
Solutions and Results: the final whats of your research
The final steps to reach an adequate conclusion of a case report show a striking similarity with the Methods and Results steps of a common science paper. After you answered the question about what the problem was, it’s now the time to answer to another what question. “What the approach used to solve that problem was?” Note that this question mostly relies upon your team’s approach to the issue, and needs to be fully detailed for several reasons. The first one is describing your research method, and how did your team face that challenge, providing your readers with a subjective perspective on how you worked on that case. It’s also the practical framework upon which your team built its individual approach, and it’s a critical step to move from literature to a real-life clinical experience. Finally, it shows how a clinical problem could be dealt with and offers a distinct overview on all the limitations your study had.
The last part of a case report research is describing its results. The question should be: “What the results of your clinical choice were?”. Clinical practice is all about choices: correct ones are usually those everyone strives for, but even wrong ones are of paramount importance. A clinical case report may help the reader understand what the dire consequences of a given choice could be, or provide him with a tangible answer to his doubts about what’s the best clinical approach. A case report is not a clinical trial and thus does not require to provide definitive solutions or answers. At the heart of your research, you should always remember that you’re just trying to provide a detailed description of what happened as a consequence of a given choice. It doesn’t matter if your judgement proved to be wrong, what really matters is if your story can be useful to other health care practitioners. And that’s the core of any qualitative approach over a quantitative one.
Article written by Dr. Claudio Butticè, PharmD.
- Yin, R. K. (2003). Case study research: Design and methods (3rd ed.). Thousand Oaks, CA: Sage.