Therapeutic reasoning in case reports: Insights into current reporting and learning opportunities

While case reports can help to train diagnostic reasoning, will they improve therapeutic reasoning as well? Prescribing the right medication is difficult and prone to error, which can lead to patient harm. Therefore, good therapeutic reasoning skills are essential. To determine the educational value of case reports with regard to therapeutic reasoning, we analysed the extensiveness and motivation for therapeutic choices in published case reports.

Review of clinical case reports published in 17 high-impact medical journals (4 general medicine and 13 clinical pharmacology journals). The reasoning behind the choice of each prescribed medication was assessed, using a score form based on the World Health Organization 6-step method.

A search of the PubMed database identified 143 case reports (516 drugs prescribed) published in 2023. The reasons for a specific drug being chosen were given for <10% of the drugs prescribed.

Although case reports have the potential to develop clinical reasoning skills, this opportunity is underused for therapeutic reasoning. Key aspects, such as a complete description of drug choices and the underlying rationale, are frequently omitted. This gap limits the educational value of case reports. We recommend incorporating a structured approach to therapeutic reasoning in case reports, such as elements of the World Health Organization 6-step method, to enhance their clarity, educational impact and practical relevance. There is also a role for clinical pharmacology journals to actively highlight and promote high-quality therapeutic reasoning in the case reports they publish.