Case reports: when a consent could become a barrier to medical education

Cristina Ferrario

In a viewpoint published on JAMA Oncology, experts from University of Texas MD Anderson Cancer Center, Houston, have raised the question whether it is always convenient to ask patient consent before publishing case reports. The value of this kind of report is well recognised by clinicians and academics, given that it could help researchers generate hypothesis and often represents the only evidence to learn about a spectrum of illnesses and its management. “Teaching in medicine is often patient based, relying mostly on case discussion”, wrote Akhila Reddy, corresponding author for the article. But we should look at a caveat, namely the patient and caregiver consent for publication. It’s a matter of privacy protection and ethics. Behind every case report there’s a person who has – at least nowadays – the right to be informed about the publication of a paper inspired by his/her case and also has the right to say no, the authors argue.

“The publication of case reports did not previously require patient consent provided that patients were unidentifiable” the authors wrote, adding that now this consent is considered mandatory by many journals and institutions, like The BMJ journals or University of Texas MD Anderson Cancer Center. “As medical professionals, we take thorough precautions to conceal any and all patient identifiers” authors claimed, concerning that these requirements by some institutes and journals may interfere with clinicians’ reporting of cases with ‘delicate’ details.

Maybe a compromise is needed and a waiver of the patient consent can be considered, provided that anonymity is secured. As Reddy and colleagues wrote, it is not always practical to obtain consent for case reports of abuse, injuries, medical errors and other similar issues, possibly opening the door to lawsuits. Nonetheless, missing those reports could generate a void in learning of future generations of health professionals. Moreover, it is noteworthy that patient consent is not required before presenting a case at institutional grand rounds or discussing it with other consultants. “We recognize that certain case reports cannot ensure patient anonymity, and a signed patient consent form may be required. However, in instances in which patient anonymity is ensured, is it ethical to block the dissemination of medical knowledge by strictly enforcing the requirement of patient consent for publication of case reports? Would such actions affect medical professionals’ ability to learn, teach, and then serve?” authors asked the medical community.

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