Case Reports in the era of Evidence-Based Medicine

Had a debate at the recent Warwick Medical School Journal Club workshop on case reports.

“This house believes that case reports are a waste of time in the era of evidence-based medicine.”

The  students from medical schools over the UK came up with many of the arguments for and against the motion.

for the motion and against case reports

  • case reports are rarities that are of no relevance outside the case
  • n=1 is often not of much use as it doesn’t lend itself to statistics

against the motion and for case reports

  • first line of evidence especially for new treatments / conditions or harmful drugs
  • they provide a trail of evidence especially for rarer conditions
  • educational especially for those topic areas that don’t lend themselves to quantitative study

I’ve discussed these arguments before in what shall we do with case reports?

It was a really useful way for setting the scene for discussing what makes a good case report and, in particular, what BMJ Case Reports looks for in submissions. This was the purpose of the workshop and there was a lively discussion and many queries afterwards about certain pictures that might make a good “Images in …” article and a lot of questions about patient consent.

The main interest among the students was that case reports are a good way to learn about academic writing – by responding to criticisms from colleagues, editors and peer reviewers – and a first step in publications. Whilst not wanting to encourage any and all case assignments (which would make for dreary reading) we did explore some suggestions for choosing good cases that they may want to start writing up.

  • Present your case at medical meetings and see what discussion (if any) occurs afterwards. This will help identify the key messages and whether they are educational or scientific. If there is no discussion then maybe it isn’t that interesting a case.
  • Learn to search the medical literature and find existing case reports, evidence and opinion, already published that are relevant to your case. Even if something has been published before does not necessarily mean a well written, educational reminder linking the often un-cited existing reports together can be a useful publication.

It was a very enjoyable event and well organised by the WMS Journal Club.

Looking forward to taking the BMJ Case Reports roadshow to other medical schools / societies / colleges … but perhaps when the snow has thawed.

Dean Jenkins
Editor at Large