Medicine in Translation

Beautiful sentiments, Dr. Ofri. As I read your essay, I had some thoughts on clinical case-studies. It seems many medical case-studies that are presented are often the complex, ground breaking, or controversial type; those which seem, most likely woudl be the easiest to engage an audience so they are excited to evaluate the case. I then started to question whether or not these type of "landmark" cases deserve the prominence they receive by journals and medical educators when presenting case-studies in publications and lectures. These ground breaking cases are great, don't get me wrong, for they are wildly interesting, however, it just seems that the medical community as a whole might benefit more greatly by reading or listening to cases describing day-to-day encounters, the ones of which you describe, not those that illustrate a medical anomaly or the rarest clinical discovery.

After thinking about the importance of each type of case, I started to really think about the role that case studies, either those that selected by journal editors for next month’s edition or those chosen by chief residents for the following week’s grand rounds, have in medical education and training. Does their didactic strength revolve around how strengthen a person skepticism of certain diseases? Perhaps it’s all about enhancing a physician’s diagnostic skills? These seem reasonable considerations, however, even though I’m only an aspiring med student, in reading your article and some work on narrative medicine, I’m lead to believe that the day-to-day encounters are equally, if more important to present than the cases that discuss the latest clinical anomaly or discovery. I can't support my claim with any experiences I've had directly treating patients or teaching medical students, but it just seems that the feelings aroused by those who read the patient's perspective of the poorly-dressed physician would have a longer lasting impact, in more ways, and in more doctors, regarding the effective care that this reader might eventually provides, on readers/listeners than those that discuss the 30-year-old man who underwent penetrating keratoplasty (PK) for keratoconus (this week's case reported in the Lancet). Again, even though I’m not a doctor, in thinking about this patient’s experience with his poorly-dressed physician, after a hectic day at work, long night of class, and tiring night in the library, just when I’ve reached that point in the night where I know having my head on my pillow is going feel so good, I won’t forgo taking the few extra minutes needed to iron a dress shirt, select a sharp looking tie, reflect upon the day’s work, while thinking about what lies ahead, because, as we see in your story, it’s the subtle things like these that take part in realizing a good day at the clinic.

All in all, I am not saying that the medical community should replace all the rare and unique case-studies with those that narrate a man’s experience with the sneaker-wearing doctor nor do I think my fourth grade home-economics class might one day prove to be invaluable to my career as a physician. Rather, I think medical journals and department grand rounds might impact their audiences more profoundly if they started to present case-studies, which encouraged reflection on the everyday medical encounters after or before these audiences sat before the presentation of a rare course of illness. I think patients and doctors alike might all benefit as such, if our journals decided to decrease the size of the images revealing the toothpaste-like discharge protruding from the 77-year-old man's elbow in a journal or a slide show (this week’s NEJM “image of the week”) so there room to include a picture that reveals some of the more subtle aspects of day-to-day encounters between doctors and patients. Lastly, I'm really looking forward to the day when a NEJM “image of the week” reveals a fatigued-looking 29-year-old internist ironing his white coat, a guy who is, most likely, deep in thought reflecting on the current day, and thinking about what lies ahead for his next patient.

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