Shahar Madjar, MD

What can we learn from one person’s story? In medicine, a story such as this is called a case report in which the patient is the main protagonist and the narrative is a detailed description of the experience of that single patient.

When doctors are called upon to provide their opinion, they frown upon case reports as a reliable source of information. They call these case reports anecdotes to denote their unscientific nature. A story of a single patient, scientists and doctors claim, is just another story. Science, on the other hand, should rely instead on careful observations made on large populations and on case-control studies that carefully examine the effect a particular intervention has on health related trends and patterns.

And yet, doctors often read, rely, and retell the stories presented in case reports the way all of us are eager to absorb and disseminate the stories of our fellow human beings. We all hold on to these stories the way a drowning man clutches at a straw. Why? Because these stories often hold a survival benefit. They can teach us a lesson, point at a better path, and warn against danger. They are a source of knowledge and inspiration.

Doctors are no different. They tell their patients’ stories because of the inherent value embedded in them. These stories, told and retold, save lives.

It’s a tradition as old as Medicine. Here are some interesting examples: An Egyptian papyrus, circa 1600 BC, describes a case of dislocated jaw bone; In the Philosophical Transaction, a publication of the Royal Society, a case report was published in 1739 under the dramatic title: “A Girl, three Years old, who remained a quarter of an Hour under Water without drowning;” and, in the 19th century, Sigmund Freud, the father of psychoanalysis, wrote a series of extended case histories based on his experience with selected patients he had seen in his private practice.

The modern case report often reads like a thriller and sometimes like a novel. Every week, when I hold a new issue of The New England Journal of Medicine, my eyes immediately search for the section Case Records of the Massachusetts General Hospital. The weekly case often involves a dramatic presentation of a patient in critical condition. Solving the mystery and saving the patient are often a chase against time and against all odds. Tests are ordered, results are interpreted, decisions are made. A well written case report is a glimpse into the way doctors think and operate.

Sometimes, a case report is elevated to a level of literature. For those of you interested in such stories, I recommend the books of Irvin Yalom (a psychiatrist who wrote Love’s Executioner), and Oliver Sachs (a neurologist, author of The Man Who Mistook his Wife for a Hat).

Of special interest are case reports written by doctors and scientists about themselves. In these stories, the author performs an experiment on himself and shortly thereafter rushes to tell his story in a scientific journal, or in front of an audience at a scientific conference. Here are two curious examples:

Case number 1: Professor Mark D. Haub from Kansas State University who decided, in 2010, to embark on The Twinkie Diet. His goal was to demonstrate to his students ” … that in weight loss, pure calorie counting is what matters most, not the nutritional value of the food.” Spoiler alert: He succeeded in his mission.

Case number 2: , 1983, at a medical conference, Dr. Giles Brindley suggested that injection of vasoactive agents into the penile erectile tissue would result in an Standing in front of the audience, Dr. Brindley then exposed his penis. He revealed that moments prior to the presentation, in his hotel room, he injected himself with papaverine. Now, to their horror, everyone could witness the results. Dr. Brindley’s penis was fully Dr. Klotz, a urologist who was present at the lecture hall, described the reaction in the audience: There was not a sound in the room. Everyone stopped breathing. He waddled down the stairs, approaching … the first row (to provide the audience with a closer look) … his erection waggling before him. Women in the front rows threw their arms up in the air, seemingly in unison, and screamed loudly.” These vasoactive agents were the first treatment for erectile dysfunction and are still in use today, helping millions of men who do not respond to treatment with oral medications such as Sildenafil (Viagra).

A case report is often only an anecdote. At times, it is educational and illuminating. Sometimes it serves as proof of a concept that was never before entertained.

EDITOR’S NOTE: Shahar Madjar, MD, MBA, is a urologist and an author. He practices at Schoolcraft Memorial Hospital in Manistique, and in Baraga County Memorial Hospital in L’Anse. Find his books on Amazon or contact him at smadjar@yahoo.com.