ďMedicine has always been based on the cases that we seeĒ
Michael Kidd, the president of WONCA World, will be one of the leading figures of the 19th WONCA Europe Conference. The Australian general practitioner will deliver in Lisbon a presentation built around one of his greatest passions: case reports. This critical tool for scientific production and dissemination is often disregarded, considered a refuge for beginners. But in actual fact, many scientific discoveries that astonished the world originated from case reports You are going to give a presentation in Lisbon about the importance of case reports.
Could you describe a little better the message that youíll be sharing with your colleagues?
Itís an interesting topic, the one that the organizers have asked me to speak about. We are going to talk about innovations in Family Medicine and look at the changes which are happening and having an impact on the quality and safety of the care that we provide and on the way we deliver our care, as family doctors, to our patients and our communities. One of the focuses which the organizers have asked me to look at is the role of case reports in the 21st century. Medicine has always been based on the cases that we see; we gain experience as family doctors through the patients that we encounter throughout our careers, from the very first moment we started as medical students, right to the end or our career. We are continuingly learning, both from the knowledge we receive and the experience that we gain through our patient care. One of the innovations that Iíve introduced, over the last few years, is the establishment of a new journal, called Journal of Medical Case Reports. Iím working with family doctors and people from other disciplines, from right around the world, seeing how we can gather and centralize the information from case reports, in order to determine what new knowledge we can uncover.
As part of developing the journal, we have also developed a database of cases. So, if people are interested in doing research in a particular area and want to find out if there are any documented cases, they can go the database and search for such cases. At the moment, we have over 20.000 cases sitting in the database, so there is this great richness of information for people to look at.
The database you refer to is available on a free basis to any doctor, no matter the location? Itís a free and open-access database, available through the publisher of our journal, BioMedCentral. I should mention, by the way, that itís called the Cases Database. A significant number of colleagues, particularly from Europe, have got involved with the journal itself and are now working on it, as editors, looking at the cases which are coming through.
But do these case reports, collected in the database, come specifically from family doctors across the world, or from other health professionals?
The journal covers all medical disciplines, but in fact many of the case reports are coming from family doctors.
It is important to remember that we see things in Family Medicine which havenít been described in the medical literature before. We may see patients with new and emerging conditions, the first reports of new associations, patients with co-morbidities, which are almost always excluded from the research studies which we base a lot of our evidence from. If we are going to have evidence-based practice, we need practice-based evidenceÖ And that evidence comes from our encounters with patients.
What are your plans for the future, in terms of developing the potential of both the journal and the database?
Well, ours is an on-line journal, itís not physical and printed out, but you can print out individual articles if you wish, which means that we publish continually. On the other hand, the way people use the database is up to them. Itís the same way as many digital resources. We provide the resource and people look at the data Ė from different angles Ė and work out what they can use it for. Weíve seen researchers, who work in a particular field, using the database to find genuine case reports related to their clinical area that can help them, in any way, improve their work and clear up doubts. Weíve also had researchers looking for new research ideas, since historically a lot of great research ideas have had their origin in Family Medicine.
The fact that family doctors are involved in a large number of diversified clinical procedures will, surely, contribute to the array of case reports you receive?
Yes, family doctors are in the front line in a multitude of ways. They come across a number of situations every day and often say something like: ďI donít think Iíve ever seen a case like this before!Ē. A typical example involves people who start taking new medications and come in with side effects, often side effects that have never been reported. Frequently, family doctors are the ones that are able to detect the first side effects related to new medications. Now, you may see one person with it and not think very much about it, but if a thousand of your colleagues are also seeing one person with that side effect from a new medication, then it may be something thatís actually really important. We have witnessed some examples of that pattern; when the first effective HIV medications were introduced, they were used widely and saved lives, but family doctors noticed some of the relevant side effects that were occurring in relation with those drugs, like lipodystrophy and lipoatrophy. In Portugal, family doctors complain about the lack of support, time and tools required to launch themselves into research activities.
Do you believe a database and a journal like yours, focused on case reports, might facilitate that step towards research?
A lot of family doctors are interested in research. They might not call it research, but they are curious about their patients, the conditions that we see and looking at different ways of treating people within their communities. One way to kick off a career in research is to start publishing. And one thing we can all publish (because we see patients everyday) is case reports related to the people we meet in our consultations, particularly when we cross paths with someone who brings us an element of the unknown, which may or may have not been published before.