Why patient consent is best practice

Thumb through this issue of JRSM and you will not find a single case report. Times have changed. Once JRSM published several case reports each month; now case reports only occasionally appear. The blame, of course, rests entirely with the current editor. Case reports are a good read and readers tend to enjoy them. Almost every clinician and medical student has presented a case report at some point. It is easy to empathise with the struggle of authors.

Yet case reports are usually deemed the lowest form of evidence. What can you really learn from a single case? JRSM will certainly publish case reports in its Grand Round section but they need to remind readers of a useful clinical lesson, and it is hard to interest a multispecialty readership with a case that is both important and sufficiently widely relevant. JRSM also publishes case reports that are first reports of a drug side-effect or a description of a new clinical discovery, which is again a difficult task. ¹

Case reports, then, often describe rare events or focus too narrowly on one speciality to merit publication in a print journal with a broad readership. JRSM Short Reports, the online open-access sister journal to JRSM, publishes many case reports precisely because online publication allows readers to seek out what's of unique relevance and interest to them. ² Indeed, it is entirely appropriate that JRSM Short Reports will soon publish a narrative review of case reports in medical journals. ³

A fundamental issue with case reports is the important matter of patient consent to publication. Experience tells us that anonymity is not possible. Patients or their relatives can recognise who the case is about, even many years after publication. Open access publication policies, and lifting of website access controls after a defined number of years, make this revelation ever more likely. The General Medical Council encourages full patient involvement in decisions about care, which includes publication of a case history. ⁴

Still, many authors submit case reports to JRSM and JRSM Short Reports without patient consent, raising two particular concerns. First, a surprising number of authors are unaware that patient consent to publication is best clinical practice. Second, a surprising number of journal editors are unaware that patient consent to publication is best editorial practice.

On the contrary, patient consent to publication is essential for case reports submitted to JRSM and JRSM Short Reports. You can even download and print a patient consent form specifically created for these two journals. ⁵ Use it or, without apology, your mesmerising case report will not be published.