Rangel has blogged eloquently about this subject – The humanistic paradox of the study of medicine. In this rant he cites A Great Case.
I will not repeat these excellent posts, but will offer my personal definition of how I encourage the use of these phrases.
- Great case – an interesting diagnosis (either an unusual disease or an unusual presentation of a common disease) and making the diagnosis leads to a cure. For example, we had a patient several years ago who had cryptococcus growing from his blood and bone marrow. This infection was secondary to hairy cell leukemia. We successfully treated his fungal infection and then hematology/oncology cured his leukemia. That is a great case .
- Interesting case – the diagnosis makes one think. The presentation is dramatic. An interesting case can become a great case, if the patient is cured.
- A sad case occurs when a patient has major morbidity or mortality and he/she has done nothing wrong. I rarely classify alcoholic cirrhosis as a sad case. The case that Dr. Van Hee cites is both an interesting case and a sad case.
I submit that all medical educators, housestaff and students should adopt this classification system. The meanings are clear and convey the right messages.
As physicians we can find a patient’s illness intellectually stimulating and yet unfortunate. That circumstand is not a contradiction. However, we should reserve great case for those patients who stimulate our intellectual needs and that we help dramatically. I (and all physicians) long for the truly great cases!
