Cases, casuistry, and clinicians | |
Clinical case reporting in evidence-based medicine. Milos Jenicek. Oxford: Butterworth-Heinemann 1999 (xx+154pp). ISBN 0 7506 4592 X. |
We all love
a good case report: meaty, clinically satisfying, and hopefully seasoned with that special sauce, entertainment value. Yet lately there has been a certain guilty pleasure associated with case reports; we feel that they are to be consumed furtively in private because they do not measure up on the new, unforgiving scales of evidence-based medicine (EBM). Yet, thankfully, there is a way of having case reports in the EBM cake and eating it too. In his brief but comprehensive guide, Clinical case reporting in evidence-based medicine, Professor Milos Jenicek elegantly brings the clinical case report into the realm of "serious" research. Introductory chapters explain the concept of "medical casuistics" and its place in the wider fields of human science and medical culture. Important and useful information for students and clinicians on how to prepare a clinical case report follows, along with an example of a "good" case report. A section describing the use of clinical case series clarifies their position in the medical literature and details useful recommendations for producing such series. Professor Jenicek also explores clinical case reporting in the context of systematic reviews and meta-analysis, using levels of evidence ratings and the concepts of qualitative and quantitative research to propose ways of integrating them to reach clinically useful conclusions. The final chapter, entitled "What next?", reinforces the components required for a good case report or series and predicts the future of the clinical case report, giving it a favourable and optimistic prognosis. An attractive aspect of this book is that the reader can choose his or her level of interest, reading only those sections that are relevant or delving deeper into the historical and philosophical aspects of the subject. The message that there is a place for the clinical case report in evidence-based medicine will surely be warmly received by the medical community; after all, it is those "special cases that advance the knowledge, research and practice of medicine" which form the basis of what we know and teach today. Tanya Grassi
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