Advice and Importance of Patient Cases for Clinicians

PracticeUpdate: How do you know when you have a case that's worth presenting?

Dr. Grant: I feel pretty strongly that really any case can be worth presenting. Again, it really goes back to who's participating in the discussion and what's able to be extracted, but really, I've learned something from every patient that I've treated or that I've seen. And there are definitely cases that fall into areas that are gray areas in the literature. Talking about those patients can really be valuable for people to think through issues and maybe challenge their clinical practice if it hasn't been challenged like that before. But I think any case can be valuable. And I think a lot of people jump to the zebras whenever they have a case. They want to present something that has not been reported or turns out to be really rare or very pathologically troubling for a lot of people.

But I think that bread and butter cases need to be discussed, and not even so much bread and butter, but cases that come up in routine practice. Those are the ones that I find most useful and most interesting because there's always something different, and there's always something to expand your practice and to expand your knowledge base.

PracticeUpdate: What advice do you have on delivering effective case presentations?

Dr. Grant: This is something that I think I'm definitely still working on and that I think is a process throughout your medical training and into your career. But one thing that I've had to learn to do is to filter information that may or may not be useful. I think your inclination, when you first come into medicine and you're presenting cases is to put all of the information out there, to put everything about the patient's history, medical history that you think maybe you can't apply, but somebody else would want that information, somebody else may think differently about the patient case if they had that information. And often, that risks going off track and of being distracted by things that are not contributing to the situation at hand for the patient.

I think concise is a good word that I would use as a driver, and clarity. The other thing that I think we need to be cognizant of is protecting personal health information. So oftentimes I will change the details of a case if I want to put this out there and to get the community's thoughts on a case. For example, the tumor boards that we do. I'll often change things that would be potential identifiers for the patient, really because it serves two purposes. It protects the patient's rights, and it also can help you to not distract from the information that you want to discuss and that you want to open up to the community. So those are a couple of things that I'll focus on, and I think they serve a couple different purposes.

PracticeUpdate: Why do you like writing patient cases?

Dr. Grant: I think the presenting patient cases can do a couple things that can sort of help you as a clinician. We talked about the role that it plays for the community. We talked about the role that it plays for the patient. I've really enjoyed writing about patient cases and contriving certain aspects of the patient case to drive the discussion. I think it's a great way to exemplify some of the gaps in medical knowledge and in the literature base. But I also just think it's therapeutic. It's good to highlight things and to raise awareness to certain topics that need to be discussed a little bit more. It really is very much more interesting than just talking about data and trials and things that lack the humanistic characteristics. So that's also one thing that I enjoy about patient cases, either reading them, participating in them, or writing about them.