When I was a labor/delivery nurse, I gave presentations for Grand Rounds, and wrote case reports for peer-reviewed journals. More recently, I’ve edited manuscripts for other people who describe cases in their presentations, peer-reviewed articles, or blogs. Here are common mistakes in writing case studies I’ve made myself or seen others make.
1. Don’t call it a case study unless it is
Most of the “case studies” I’ve reviewed aren’t actually case studies at all!
In health care, the words “case report” and “case study” are often used interchangeably. However, Porcino’s excellent article clearly delineates among case reports, case series, case studies, and single-subject research designs (SSRDs).
Differences include:
- Addressing unusual versus common clinical courses or treatments
- Describing comprehensive versus brief description of the case details
- Classifying the case as a form of research versus a form of instruction
- Ending with a hypothesis versus meeting a learning objective
- Carrying legal, ethical responsibilities versus teaching responsibilities
- Becoming part of evidence-based practice versus educational assets
Another source points out that a write-up or verbal presentation of clinical knowledge might not be any of the above-mentioned forms. Rather, it may be the clinical vignette. That’s what I’ve most often seen, rather than true case studies.
2. Remember that case studies ARE evidence
We often bow at the altar of systematic reviews or randomized controlled trials, and rightly so.
However, most authorities, including the famous Cochrane international network show us that evidence for practice is not egalitarian; it’s hierarchical.
Multiple authorities show pyramids, all a bit different, to depict the hierarchy of evidence for practice. But nearly all mention cases as a form of evidence.
In short, a case study is a well-established qualitative research method.
3. Content is almost always about something unusual
One of the common mistakes in writing case studies is describing a ho-hum case where readers can easily predict the end of the story. Instead of reading like a mystery thriller, it’s more like a documentary of a famous person where readers already know what happens in the end.
Here’s an exaggerated but illustrative example: No one wants to read about the effectiveness of penicillin. For nearly a century, we have all known that antibiotics effectively cure infections.
Hence, before doing your write-up, ask yourself if the case is truly unusual.
Your case should be about a rare disease, the efficacy of an intervention that hasn’t been described before, an unexpected side effect, or something along those lines. You want the reader to come away with new information, and some degree of questioning or intrigue.
4. Put the case report in a logical order
Whether you’re writing for a peer-reviewed journal or for your blog, you need an introduction, details of the case, and a discussion.
Kakoli Majumder gives a clear order in which to present the case details:
- Patient description
- Case history
- Physical examination results
- Results of pathological tests and other investigations
- Treatment plan
- Expected outcome of the treatment plan
- Actual outcome
The case is a story. That means you need to be a good storyteller. Otherwise, you’ve just made perhaps the biggest of the common mistakes in writing case studies.
I’ve lost track of how many clinical stories I’ve read where the author starts out telling the juicy part of the story, but I can’t figure out what came first, next, or last.
5. Make sure you use the correct terms
I could talk all day long about the hundreds of terminology mistakes I’ve caught.
Don’t be afraid to look up terms. I’ve seen “bowel rotation” (rather than bowel malrotation) and other words that were almost right, but not entirely right.
So yes, I’m talking about medical terminology, but I’m also talking about just regular old everyday terms.
Reading about an infant’s intake, I’ve often seen the word “feed” as a noun. No, sorry; when “feed” is used as a noun, it means “food given to (especially herbivorous) non-human animals.” Similarly, one manuscript mentioned the need to “arouse” the baby. Nope, wrong again! The word “arouse” means sexual excitation. Instead, the author should have said “rouse” the baby, as in stimulate from a sleepy state.
Be consistent when spelling terms, too. It probably doesn’t matter whether you say “cephalohematoma” or “cephalhematoma,” but pick one and stick with it.
Also, be sure to write a brief definition of a term if you think your intended audience won’t immediately know what it means.
6. Watch your level of detail
Sometimes, I read details of the case and find myself asking, “Wait! Did the client ever complain of [fill in the blank.]” Or, “Whoa! Was that drug given IV or PO?” If these or other details color the reader’s understanding of the case, they should be included.
Conversely, some details are downright distracting. If it’s not relevant to the case or to the point you’re trying to make, skip it.
You can avoid these common mistakes in writing case studies by thinking through details that would be make the case more convincing to the reader, or less boring.
7. You need the client’s permission to publish
In my young days, there was a common understanding that unless the patient was identifiable, you could publish details of the case. But not seeking appropriate permission is one of the common mistakes in writing case studies in today’s world.
If you’re planning to submit your article to a peer-reviewed journal, the editor is highly likely to ask you to provide written permission from the client. If the client is a child, you’ll need to get permission from the parent or legal guardian.
8. Don’t use images unless you have permission
I cringe when people use illustrations that they are not authorized to use, including scanned illustrations from other sources. I find this frequently.
There are plenty of sources out there. Some are free. You’d be astonished how many illustrations you can find for free (very simple ones like pdclipart.org or more interesting free ones). Be sure that it’s accurate.
9. Obey all of the rules of good writing
Yes, I mean pay attention to your spelling, grammar, and punctuation. But I mean much more than that.
Here are a few simple examples:
- Write a topic sentence in each paragraph.
- Avoid long, run-on sentences.
- Avoid redundancy.
- Be clear and concise.
- Make a point; don’t just ramble.
10. Include “the clinical so-what”
Decades ago, I wrote something — I don’t even remember what – and I asked my wonderful friend Debi Bocar RN PhD to read it. I remember her reaction, verbatim.
She said, “Yeah, this is all very interesting, Marie, but what’s the clinical “so what” here?”
I never forgot that.
Don’t bother to publish something unless you can drive home the real-life clinical point(s). Busy clinical experts don’t have the time to read a bunch of cool facts that are interesting or academic unless they can see the connection to real-life practice. Ask yourself, what’s the lesson to be learned here?
Resolve to not fall into the trap of making these common mistakes in writing case studies.
I published my first case series in 1991. I desperately needed some structure, and some simple pointers. After that, I’ve read perhaps hundreds of case studies. Although this post may not have told you everything you’ll ever need to know when you draft your case study, I hope it will help you to get started.
Which one of these common mistakes in writing case studies can you fix first in your own draft?