Importance of Integrating the Patient’s Perspective into Case Studies

By Zack Merhavy

Although case studies have been around and used as a teaching tool long before Harvard incorporated them into their curriculum in the 1870s, the first medical journal to start accepting them for publication wasn’t until 2001. Case studies are now known for being incredibly useful tools for physicians in the field to gain different professional perspectives on a specific disease or illness, diagnostic criteria, workup models, and much more. They provide a way for physicians and other healthcare professionals to learn more about how a disease or illness might present and gain a better understanding of the specific subject or the field itself.

Image found at https://steemkr.com/life/@onepiece1/two-different-perspectives

Two decades since the first commercially published case study, it has become clear that they are some of the most widely accepted, and frankly some of the easiest to write, publications. But, with how many are produced, there is a sense of redundancy among these studies: you learn about the disease and treatment plan the care team took and move onto the next one. This cycle has been rinsed and repeated so many times with the same diseases and illnesses that it begs the question, “what are we still getting out of this?” If the original premise was to use case studies as a way to learn new information about diseases and illnesses, why then are we stuck in a seemingly never-ending loop of the same type of publications? Where is the innovation? What can still be learned? Heck, I’ve been part of a few published case studies that aren’t anything novel or exciting.

Sure, you could make the argument that every case study has their own spin on them; but the one thing I’ve come to realize by doing those kinds of case studies is that there is one incredibly important thing missing from these kinds of publications: the patient.

Just about every case study that gets published talks about the disease and disease state of the individual, treatment plan, diagnostic tests, etc., but no one ever really talks about the patient. When I made this realization, I went searching for any case study I could find that talked about the patient themselves rather than the disease; and although some do exist, they were few, and difficult to find. Coming into medicine wide-eyed and fresh to the experience, I was always under the impression that patients should always come first. So it’s hard to understand why it has become common practice to take the patient out of written patient care.

As a scientist, I can appreciate and understand creating an objective, “just focus on the facts”, kind of approach as it makes the novelty of it all explicitly clear. But patients are not always as we see them in the textbooks, and this is something we are told all the time; so, why in the world are so many case studies published in the same vein?

As a future physician, I want to know what my patient would be feeling, how they will communicate with me, what prior experiences they’ve had with other healthcare professionals before me, etc. I would want to be exposed to some of that subjective information that only patients can communicate. This will help me learn to be a more understanding physician and truly connect with my patients. I want to read a case study that talks about what the patient said and how they felt in their own words rather than more clinical terminology that doesn’t tell me what I might hear a patient say.

Reading studies with this information could potentially help so many physicians begin to better identify patients’ illnesses and potentially make a more accurate differential earlier on, especially in the less-common instances. As such, patients’ perspectives should be part of case studies.

Everything that case studies do now is great, but adding the patients’ thoughts, words, and feelings can only further enhance the literature and move medicine closer to patient-centered care where it belongs.