A letter to the editor from reader A was received by our journal concerning a published case history from author B. Reader A questioned the choice of treatment and author B's conclusion regarding the reason why the patient died. We believe this case raises at least two interesting questions.
首先，患者，或者在这种情况下，患者的亲属可能通过他们对挑战的事件的理解来遭受额外的负担。关于卫生人员或其他人的治疗和课程的猜测，他们不知道患者超越公布的历史，可能会使患者/亲属暴露在缺陷的担忧。我们的期刊需要同意在出版案例历史时从患者/相对的出版，但同意本同意书适用于已发布的文章。因此，它不包括在出版后的其他人或出版后的其他人的进一步讨论或评论。人们可以争辩说，在同意时，这是隐含的，但人们不能指望患者知道或反思这些问题。换句话说，同意真的被告知吗？
Secondly, the authors have access to a lot more medical information about the patient than they have chosen to publish. The consent only applies to the published material. In further discussions, they cannot answer properly without breeching confidentiality or collect further consent. Hereby the risk of a delayed debate, a debate that gets too general and in which the opponents (who are only able to speculate about the further details) get the last word.
The case was resolved by carefully moderating the letter to the editor in cooperation with reader A.
Planned further steps by the journal for future cases:
• Such debates must be modified with the patient's interest in mind.
• Include a sentence in the consent form informing the patient about the possibilities of post publication debate.
• Possibly include a disclaimer on such debates, informing about the limits of such debate?
• Possibly include a reminder about the patient's perspective in the author guidelines for debate?
Question(s) for the COPE Forum
• Is it justifiable, ethically, to let readers speculate on the patient's diagnosis, the choice of treatment, etc?
•是否有任何论坛成员在各自的期刊上进行了类似的讨论？
• Are the steps taken/planned reasonable?
• Does the Forum have additional advice on how we can avoid such problems in the future?
该论坛表明，期刊作为诉讼方式的步骤是良好合理的。如果通知发布后发表评论，那么发布它们可能很好，但必须仔细完成。同行评审可以在这里有所帮助。
Letters to the editor commenting on case reports could include disclaimers, and it is important to remind people to think about the patient and their family.
While an ethical framework is needed, the journal also has a responsibility to encourage debate, but in a sensitive and cautious way. For example, this can be an opportunity to allow input from people with whom the patient might not ever have access. The framework within which this happens is important.
The most intriguing case reports often have an aura of ‘mystery’, treading a fine line between the ‘obvious’ versus the ‘suspense’ of whether the patient did get the right treatment but this should not compromise accurate reporting or condoning poor practice. Authors need to be upfront about the details of the case, including the diagnosis. Authors should not disclose additional information after publication. Post-publication speculation must be handled carefully as it can be distressing for the patient and the patient’s family.
COPE has a discussion document onBest Practice for Consent for Publishing Medical Case Reports.
What patients can expect when they give consent will be included in the document when finalised. Patients should be warned that there may be academic discussion after the case is published.
编辑认为特定案件已关闭，期刊正在努力实施案件中概述的计划步骤。