This document discusses case reports, their role in medical knowledge and education, and guidance for writing a case report. While case reports have limitations and fallen out of favor, they can still serve to identify new pathologies and conditions. The document provides advice for medical students on finding a suitable case to report, obtaining necessary permissions, structuring the report, and seeking publication. Key elements include conducting a literature review, obtaining approval from treating clinicians and patient consent, and including a discussion section to contextualize the case.

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Given the unpredictable and challenging nature of medicine,
many medical students will have come across a patient who has
not been a textbook case. The patient may have presented in an
unusual way, had a strange new pathology, or reacted to a medical
intervention in a manner that has not been seen before. The
publication of these novelties and curiosities as case reports has
for many centuries been a fundamental way of sharing knowledge
and conveying medical experience, and throughout history there
have been famous case studies that have helped shape the way we
view health and disease (box 1).
There are those who argue, however, that case reports are
increasingly irrelevant in current medical practice and education.1
Their obscurity and rarity appeal only to the specialised few, and
they add little to everyday medical practice. Their anecdotal nature
lacks the scientific rigour of large, well conducted studies, and
they have therefore fallen down the hierarchical ladder of medical
evidence (box 2). Sadly, many medical journals now refuse to
publish case reports.
Despite their limitations, case reports still have a role to play
in furthering medical knowledge and education. Their ability to
flag up novelty means that they are still used to identify emerging
pathologies. Case reports also hold valuable educational worth
as brief clinical caveats. Many people find abstract medical
knowledge easier to remember when linked to a patient. Different
areas of medical education such as physiology, pathology,
pharmacology, and anatomy are brought together in case reports
and help students and doctors to develop a more holistic approach
to patients.
Should I try and write a case report?
Case reports help students gain a deeper understanding of a
medical topic, but they also act as an excellent introduction
to academic writing. Doing a literature review, structuring a
manuscript, and learning how to submit and revise your article are
skills worth developing early on. In addition to this, a published
case report is a contribution (though small) to medical science and
a way to get your name in print; it is also something that can be
put on your curriculum vitae and help you stand out in future job
applications.
How do I go about finding a suitable case to report?
As a medical student it is difficult to know when a case is unique
or interesting enough to warrant reporting, and it is therefore
important to make the most of help from your seniors. If you’re in
a clinic or on the ward and you hear a consultant mention that a
case is rare, or that they’ve never seen one like it before, it’s worth
inquiring whether you could write it up as a case report. If you
don’t have the good fortune of coming across any suitable cases
it is also worth asking if any of the senior doctors have cases that
you could help them research and write up.
Writing a medical case report
Case reports have fallen out of favour, but they still have a role to play
careers
Box 2: Evidence needed5
Category I—Evidence from at least one properly randomised controlled
•
trial
Category II-1—Evidence from well designed controlled trials without
•
randomisation
Category II-2—Evidence from well designed cohort or case-control
•
analytic studies, preferably from more than one centre or research
group
Category II-3—Evidence from multiple case series with or without
•
intervention or dramatic results in uncontrolled experiments
Category III—Opinions of respected authorities, based on clinical
•
experience, descriptive studies, and case reports, or reports of expert
committees.
Box 1: Famous case reports
Multiple myeloma
HenryBence-Jones(left) andWilliam
MacIntyre contributedgreatlyto our
understanding ofmultiple myeloma by
recording the effectofthisdisease on
ThomasAlexander McBean.Theyfoundthat
Mr McBean’surine was“aboundin animal
matter.” Itisowing to thisobservation that
the protein foundin urine ofpatientswith
multiple myeloma iscalledBence-Jones
protein.2
Mental health disorders
SigmundFreud,bestknownforhis
psychoanalysisandtheoriesofthe
unconsciousmind,alsohadaspecialinterest
inrecordingthecasehistoriesofhispatients.
Manyofhiscasereportshelpedfurtherour
understandingofanumberofmentalhealth
disorders,suchasobsessivecompulsive
disorder(ratman),dissociativedisorder(Anna
O),phobias(LittleHans)andpost-traumatic
disorder(wolfman).3
Dysphasia
Broca’sarea,thespeechproductioncentrein
thebrain,wasnamedafterPaulPierreBroca,
aFrenchphysicianandanatomist.Hemade
hisdiscoverywhilestudyingthebrainsof
dysphasicpatients.Thefirstpatientthathe
examinedwasnicknamedTanbecauseofhis
inabilitytosayanywordapartfrom“Tan,”which
herepeatedoverandover.Onpostmortem
examinationBrocadiscoveredthatTanhada
fluidfilledcavityinthelefthemispherecaused
bysyphilisandconcludedthatthisareais
responsibleforspeechproductioninhumans.4

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STUDENT BMJ | VOLUME 18 | JANUARY 2010
Preparation
When you have found a suitable case it is vital to do a number of
tasks before you can start putting pen to paper.
Literature review
A literature review on a medical database such as PubMed, Ovid, or
Medline can be used to check if there have been any similar cases;
this helps you gauge how rare your case is.
Liaising with doctors in charge
It is very important to discuss writing a case report with the senior
clinician in charge of the patient’s care. Not only must you gain
their permission, but they will also help to provide guidance
and advice. In addition, it is also worth discussing the case with
clinicians of other specialties (such as pathology, radiology, and
microbiology) who have played a role in the patient’s care.
Gaining consent
Check the journal guidelines carefully. It is extremely important to
gain written consent from the patient if you wish to include pictures
or clinical details from which they may be identiied. During the
consent process you must explain why you wish to share their case
with others, the risks and beneits of doing so, and you must answer
any questions they may have. Get senior help for this.
Data collection
When you have done your literature review, liaised with the senior
doctor, and gained consent from the patient you can start bringing
your patient’s case together. This involves inding his or her
medical notes, laboratory results, imaging, and any other relevant
material.
How do I structure a medical case report?
The basic structure of a medical case report is as follows:
Abstract
• —This section is read by people trying to decide whether
they wish to go on and read your full case report. It is therefore
vital to keep it concise (no more than 150 words) and snappy, and
to encompass all the important aspects of your case, particularly
highlighting what this adds to medical knowledge.
Case report—In this section you are presenting your patient to the
•
reader. This should include a concise history and any relevant
examination and investigation indings. It is important to include
any relevant negatives based upon the potential diagnoses, but
do not clutter this section with unnecessary detail.
Discussion—When you have presented your case to the reader
•
you are expected to put it into context in the discussion section.
Here you give information about the condition or intervention
in question, such as the basic epidemiology, pathophysiology,
clinical presentation, investigations, and treatment. As you
paint this picture it is extremely important for you to show
how your case has difered from the norm and how this is
contributing to medical understanding.
Where can I get my case reports published?
Given the reluctance of many journals to publish case reports these
days, where are you to turn when you wish to share your newly
written up experience of an interesting case?
Fortunately, the vastness of cyberspace has allowed for the
development of a new breed of medical journal. A number of
new online journals such as BMJ Case Reports (www.casereports.
bmj.com), Cases Journal (www.casesjournal.com), the Journal of
Medical Case Reports (www.jmedicalcasereports.com), Radiology
Case Reports (www.radiology.casereports.net/index.php/rcr), and
the Journal of Dermatological Case Reports (www.jdcr.eu) allow
the publication and dissemination of notable case reports. These
allow doctors from all over the world to share their experiences
of new and interesting cases. Although still in their infancy, these
journals have the potential to act as large case banks that allow
doctors to search for cases similar to ones that may be puzzling
them, to help guide their management.
Aimun A B Jamjoom foundation year 1 doctor, Lincoln County Hospital, Lincoln
LN2 5QY, aabjamjoom@googlemail.com
Ali Nikkar-Esfahani final year medical student, University of Nottingham Medical
School, Queens Medical Centre, Nottingham NG7 2UH
J E F Fitzgerald specialty trainee, general surgery, Medical Education Unit,
University of Nottingham Medical School
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
YadavH.The philosophyofthe medicalcase.
1 studentBMJ 2006;14:133-76.
Kyle RA. Multiple myeloma: an odysseyofdiscovery.
2 BrJ Haematol 2000;111:1035-44.
HellerS. Freud A toZ.Wiley, 2005.
3
Schiller F. PaulBroca: founder ofFrench anthropology, explorer ofthe brain. Oxford
4
UniversityPress, 1992.
HarrisRP, Helfand M,WoolfSH, Lohr KN, Mulrow CD,TeutschSM, etal. Currentmethods
5
ofthe USpreventive servicestaskforce: a review ofthe process. Am J PrevMed
2001;20:21-35.
Citethisas:StudentBMJ2009;17:b5274
WILL
&
DENI
MCINTYRE/SPL
If you are writing up a patient’s case, attending the case review
meeting will be useful
Further reading
Anwar R, Kabir H, Botchu R, KhanSA, Gogi N. How to write a case report.
studentBMJ 2004;12:45-88.