Case reports: A case report

I magine if you will: you have removed the testis and cord of a 55-year-old and are popping onto your EMR to review the pathology when you see it, "Eosinophilic infiltrate with histiocytes and monocyte-lined pseudocapsule."A bagel-caked Grinch smile widens.A medical student in another clinic in another building shudders inexplicably.Seven days' gestation and it's born: 12-pt Calibri.Margins 1.5 cm.Double-spaced.2940 words."Eosinophilic infiltrate with histiocytes and monocyte-lined pseudocapsule of the testis: A case report."You don't have to imagine.This is a classic hurdle in the aspiration gauntlet for trainees, and the chaff that grows attendings' CVs three sizes.You coolly tell your Facebook Aunt that just because someone had a heart attack a week after a vaccine doesn't mean the vaccine caused it, then switch windows back to Word to explain why a patient with an ACL tear after 18 months on funkalutamide is a compelling reason to counsel patients against sports 16-20 months after starting funkalutamide.Your editor is here with a thought experiment: what if you didn't write it up and simply continued living your life?Ok, too dark!And patently wrong.Rare things occur commonly (?!) and can be informative, helpful, and revealing of previously unseen mechanisms and sequelae.I get it!Rare diseases (and those they impact) go unrecognized unless someone is motivated to write about it.New imaging interpretations add to differentials and expand our diagnostic umbrella in the service of our patients.New approaches to surgical technique create efficiencies or mitigate against complication.New complications, signs, or symptoms improve physicians' thinking or reveal themselves as sentinels in otherwise baffling or frustrating clinical situations.I can't question the value of shining light into these unseen corners but I'm here to say that it's not clear that the status quo of sprinkling unstandardized, half-baked cases throughout the peer-reviewed literature is serving these virtues.They're hard to find and collate and the information they contain varies massively in portability and usefulness.Archetypal case reports have a few characteristics.One group is the unexpected finding after a routinely managed case (see the made-up testis histology above).Occasionally, a pathology slide is served alongside, but rarely any other data.The patient is afforded a few weeks of followup (because the manuscript is borne of the surprise pathology report at the postoperative visit) and the case is briskly written.Another group is the rare complication or adverse event.Followup is similar, but care is taken to remind the reader that the patient's sorrows originated "at an outside institution."Long-term outcomes are rarely presented; the case is not parked at discovery and revisited a year later; rather, the paper is conceived and submitted hastily.A moderate-length review article serves as the discussion, often curiously tangential to the core discovery of the case.Reports of dozens of prior instances are oddly missing from the references.Critically, future users are left without a sense of how they ought to modify their future behavior as a result of this case.They don't know how it really turned out, or if they could avoid or plan for the next instance.An aside -case report authorship is invariably downloaded upon trainees.This is ostensibly because writing a case report is a "good introduction to research, academic writing, and publication."Prepare your mantle for a CanMEDS Scholar award!This is untrue.Case reports are more akin to organizing one's thoughts for patient handover, multidisciplinary rounds presentation, or M&M reporting -all important in trainee development (prepare your mantle for a CanMEDS Collaborator award!).Writing a case report is completely unlike conducting an academic study or pulling together a research manuscript, outside the literature review and submission hoops.Case reports offer quick turnaround, essential in time-limited application cycles like CaRMS or fellowship.They offer lines on CVs for applications or promotion, where bulk matters to some adjudicators.Think for a moment: if the nut of the PubMed ID disappeared, what would happen to case reports?What should happen?Case reports: A case report EDITORIAL

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