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Separating the patient from the case report?

Discussion in 'Surgery and Surgical Subspecialties' started by amakhosidlo, Aug 15, 2011.

  1. amakhosidlo

    amakhosidlo Accepted
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    This is something that's been bothering me for a long time: I work with a bunch of fellows at a big-name research institution, and they're always on the hunt for publish-able material. We see quite a few zebra-level cases (Like WTF, man) and every time I see the fellows just salivating at the possibility of writing up the case.

    The problem is that there's never ANY discussion of the patients themselves, or apparent concern for their eventual outcomes (That I can see, anyway)

    To residents with case reports under their belts: How do you separate the case from the person lying in the bed? Granted a crazy example of XYZ is exciting, but ultimately that excitement is at a patient's terrible misfortune. Is it normal to be genuinely disturbed by this?

    I'm only an MS-2, but I'm hoping to go into a surgical field and this almost feels like a conflict of interest of sorts ( I know it isn't but it still bugs me...)
     
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  3. SLUser11

    SLUser11 CRS
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    Not all case reports end with the patient dying...some actually get better. It's okay to be excited about unique presentations or findings because it ultimately increases the knowledge in your field of work. Also, the lit review involved could very well lead to that fellow learning a lot about the disease state and its treatments, and can lead to better care for that patient.

    Now, is it okay to get super-excited about a case report in general? That's a whole other issue.

    I think what's bothering you is the apparently calloused approach to the situation. As you become more experienced, this will make mroe sense. I don't think it should deter you from a career in surgery.
     
  4. OtoHNS

    OtoHNS ENT Attending
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    Yep, I wrote several case reports in med school/residency and all of them had a happy ending.

    Ultimately, you have to develop some emotional distance from your patients and their problems. The trick is striking the right balance between that emotional distance and empathy/compassion. You can't be breaking down in tears everytime you deliver bad news.
     
  5. amakhosidlo

    amakhosidlo Accepted
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    Right, that's not what I'm saying though. What I'm concerned about is focusing so intently on the disease process, or using a case to publish, that you forget entirely that the disease is occurring in the context of someone's life.
     
  6. LucidSplash

    LucidSplash Wire Jockey Trainee
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    No one "forgets." It might seem that way to a med student in the preclinical years, but the point OtoHNS was making stands. If you don't learn to find a balance between treating the disease process (and writing it up or what have you) and treating the patient, you're going to find yourself emotionally exhausted. Its hard to understand as a preclinical student, but we see crappy situations with poor outcomes for good people pretty much every day. You need to learn to compartmentalize your compassion and not have your heart bleeding out all over the floor every time you see a patient in pain. You don't "forget" the patient is a person, but you do what you have to to have emotional stamina and longevity in your career.
     
  7. tussy

    tussy Senior Member
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    case reports really are only publishable if they add something to our medical knowledge. So, by publishing them you may help some future patient.

    Most patients, on learning that they have been published as a case report, are really excited about it. They are happy that someone might learn from their disease and might help someone else in the future.
     

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