THE CASE BOOK.

DR. S. YOHANNA.2015 REVISION COURSE.

OBJECTIVES OF THE CASE BOOKTO DEMONSTRATE:1. BROAD KNOWLEDGE & SKILLS IN FM.2. APPROPRIATE USE OF RESOURCES.3. ROLE IN VARIOUS LEVELS OF CARE: - HEALTH PROMOTION, EDUCATION - DISEASE PREVENTION - TREATMENT - LIMITATION OF DISABILITY - REHABILITATION

OBJECTIVES

4. IMPACT OF DISEASE ON FAMILY, AND VICE

VERSA.

5. FOLLOW UP & CONTINUING CARE.

6. COMMITMENT TO C.M.E.

7. ATTITUDE TO PATIENT, FAMILY, AND

COMMUNITY.

SELECTION OF PATIENTS

• COMMON CONDITIONS IN FM.

• PERSONALLY MANAGED BY YOU.

• CLEAR LESSONS FOR FM IN NIGERIA.

• DEMONSTRATE OBJECTIVES OF THE CASE BOOK.

Before you start writing a Case report, ask yourself:

1.Which of the objectives am I trying to illustrate?

2.What key principle or concept of FM does this patient illustrate?

CASE DISTRIBUTION: 20

• OBSTET. - 2

• GYNAE. - 2

• F.P. - 1

• MED. - 3

• PAED. - 3

• SURG. - 2

• OPHTH. - 2

• E.N.T. - 1

• PSYCH. - 2

• ORTHO. - 1

• FAM. CASE STUDY- 1

CASE REPORT FORMAT.

1. PERSONAL DATA.

2. THE CASE REPORT.

3. DISCUSSION.

4. REFERENCES.

PERSONAL DATA.

• NAME . OCCUPATION• AGE . HOSP. NO.• SEX . DATE ADMITTED• ADDDRESS . DATE DISCHARGED

• Paed Cases: Add patient’s wt.• O/G Cases: Add parity, LMP, EDD (if preg)

THE BODY OF THE CASE.

• HISTORY

• EXAMINATION

• PROVISIONAL DIAGNOSIS

• INVESTIGATIONS

• TREATMENT

• FOLLOW UP

History

• Presenting complaint• HPC, including FIFE• Review of (relevant) systems• Past Medical History• Family & Social History• Drug history

History: Additionally ...

• In children:– Pregnancy & delivery history– Growth & dev history– Nutritional history– Immunizations

• In women/Obs & Gynae cases:– Obs & Gynae history

Examination

• General• Systemic, starting with the system directly

affected

(Provisional) Diagnosis

• Should arise from the history and examination findings.

• May be reviewed after relevant investigations, or as the illness evolves.

• Helpful to have one or two differentials – but not mandatory, especially where the presentation is very obvious.

Investigations

• Factors to consider:– Relevance: will this investigation influence your

diagnosis, or management of the patient?– Cost-effectiveness: are there cheaper alternatives,

can this patient afford the costs?– Feasibility, time to obtain results, etc– Availability in your locality

Treatment

• Consider similar factors as in Investigations• Must be evidence-based• Must be rational: correct diagnosis, correct meds,

correct combination(s), correct doses, frequency of administration, correct duration.

• Don’t be the 1st to experiment with a new drug, and don’t be the last to abandon an old one.

• As far as possible, the treatment should not be worse than the illness being treated.

Follow up• Shows evidence of continuity of care.• At least 1 – 2 follow up visits, could be more,

depending on the illness.• Home visit is helpful, but not mandatory. There must

be a clear aim for such a visit. • Ideal to have discharged the patient from follow up

before you start writing the case report.• Avoid “inconclusive” cases - where patients

absconded, defaulted etc.• Preferable not to have too many patients that ended in

death.

DISCUSSION.

• DEFINE OR DESCRIBE THE PROBLEM

• DISCUSS THE PATIENT (NOT THE DISEASE) WITH ADEQUATE LITERATURE REVIEW.

• SUMMARIZE KEY LESSONS FOR FM

• MAKE RECOMMENDATIONS, WHERE NECESSARY.

THE DISCUSSION MAKES THE DIFFERENCE

BETWEEN A GOOD CASE REPORT AND A BAD ONE.

DISCUSSION.

• Explains the basis for arriving at a particular diagnosis.

• Demonstrates good literature search and understanding of current concepts regarding the care of patients.

• Details possible management options, and clarifies why the particular options adopted for the index patient were used.

• Provides answers to controversial decisions and management issues.

DISCUSSION

• Brings out clear lessons, and recommendations.

• Demonstrates that the case report meets the specified objectives for the Case Book.

• Justifies the inclusion of the case report in your Case book.

• Attempts to answer questions that could arise in the examination.

REFERENCES.

• ABOUT 10 PER CASE.

• GOOD BLEND OF LOCAL AND FOREIGN

LITERATURE.• NOT MORE THAN 10 YEARS SINCE

PUBLICATION.

• VANCOUVER METHOD.

PRESENTATION.

SIZE OF THE BOOK: 150 pages recommended.This comes to about 7 pages per case report

LAYOUT: Refer to Residents’ Handbook• TITLE PAGE.• PRELIMINARY PAGES.• INTRODUCTION.• THE CASE REPORTS.• CONCLUSION.

CHECKLIST: GENERAL.

1. Layout of the Case Book.

2. Use of English.

3. Distribution of cases.

4. Style of presentation of the cases.

5. Illustrations & Figures.

6. References.

REFERENCES.

• Vancouver.

• Local & foreign references.

• Textbook & journal references.

• Date of publication.

GENERAL HINTS.

• Start early: Part 1 Stage. Finish in good time.• Relate well with your trainers.• Write one case at a time.• Peer Review – but avoid plagiarism.• Accept corrections, at least till you get your

FMCFM. Cf Rehoboam• Review 2-3 times before the Exams. • Faith and works: It is God’s grace & favour.

“The race is not always to the swift.”

THANK YOU.