Emerging Perspectives in Medical Case Report Writing: How Guidelines Support Inclusion of Patient-Reported Outcomes

ABSTRACT

This article examines the patient perspective as an emerging feature of medical case report writing, and through analysis of technical reporting guidelines and a corpus of published reports, shows how the biomedical community incorporates patient-authored perspectives into processes of research and publication. The author concludes by discussing the value and complexities of patient inclusion efforts and the potential for scholars of rhetoric and technical communication to take part in shaping those efforts.

KEYWORDS:

• Medical case report
• patient perspective
• reporting guidelines
• patient-reported outcomes
• genre studies

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. A related construct, the patient-reported experience measure (PREM), is similar to the PRO but emphasizes information that can be used to determine “patient-centeredness of existing services as well as areas for potential improvement regarding healthcare delivery” (Bull et al., 2019, p. 1024).

2. I would also refer the reader to an article by Doody (2023) that offers a precise and conceptually rich reading of the scholarship on metagenre applied to research and writing in interdisciplinary life sciences doctoral programs.

3. The concept of “macro-genre,” per Żelazowska-Sobczyk and Zabielska (2016), refers, in general, to “elemental” features of the case report that can be realized through a range of “types” and practices. In this article, I rely less on the theoretical implications of this particular approach and more on the fact that scholars are using genre to capture the diversity of case-based writing in health and medicine.

4. Individual “cases” of COVID-19 had been reported well prior to May 2020. I mention this to confirm that the concept of “case” has multiple meanings in the field of health and medicine and that other journals had been publishing “case reports” prior the BMJ-CR’s first article on the subject. The questions I explore here do not focus on all case reports related to COVID-19 but, rather, on ways in which the genre contributes to the emergence of patient perspectives within the research literature. With that aim in mind, the BMJ-CR is exemplary: my research to date suggests that case reports published in BMJ-CR include more patient perspectives than any other journal in the field (a point I return to below).

5. Based on this passage, the patient perspective in this context could be considered a patient-reported outcome or patient-reported experience. My analysis described next suggests that it exhibits features of both while extending beyond common instruments (e.g., validated questionnaires) used to gather information from patients regarding their health status, quality of life, or experiences with various aspects of health care delivery.

6. These types of publications are common in the reporting guidelines discourse and provide the biomedical community with opportunities to revise standards and respond to exigencies in research and reporting over time.

7. It is difficult to say whether this number is low or high. To offer a point of comparison, I examined a selection of case reports on the subject of COVID-19 published in other journals throughout the same period. A search for “patient perspective” using PubMed yielded 167 hits (not including BMJ-CR) distributed across over 100 journals. The Annals of Medicine and Surgery accounted for eight articles that included a section or call-out devoted to the “patient perspective;” the Journal of Ayurveda and Integrative Medicine accounted for six. It thus appears that BMJ-CR has made a commitment, both in their submission guidelines and publication practices, to create space and publish reports that include patient perspectives as a discrete focus. Refer to Calvache et al. (2020) for a study that examined uptake of CARE guidelines and patient perspectives in medical journals.

8. For example, the case may involve a child or incapacitated adult. These type of situations – e.g., where a patient is unable to provide firsthand perspective – raise questions about consent that warrant further exploration. I return to these themes in the Discussion section.

9. I use the term “author” here in reference to the “Patient’s Perspective” rather than the case report (which, for reasons of anonymity, does not typically name the patient or caregiver in question). I nonetheless believe author is an appropriate and even important term to use when describing the rhetorical work patients and caregivers are performing.

10. It is important to note that, in the reports I examined, authors did include statements of consent. The BMJ-CR systematizes this process through a header, following the body of the report, that reads “Patient consent for publication.” Authors respond in different ways to this prompt, but in general, they include brief statements to signal adherence to the process of consent without detailing that process. One example I found repeated in the corpus: “Patient consent for publication: Obtained.” Further research could explore how consent is conceptualized and enacted in research and publication processes.

Additional information

Notes on contributors

Chad Wickman

Chad Wickman is an Associate Professor in the Department of English at Auburn University where he teaches undergraduate and graduate courses in writing, rhetoric, and technical communication. Informed by scholarship in these areas, his research explores intersections between writing and knowledge making in disciplinary and professional communication.