How to Write Your First Medical Case Report: A Step-by-Step Guide

Why Case Reports Still Matter

Case reports have a bad reputation in evidence-based medicine circles — they sit at the bottom of the evidence hierarchy, can't establish causation, and are prone to reporting bias. All of that is true. And none of it changes the fact that they remain one of the most important publications for early-career medical students and doctors.

Here's why they matter for you: a published case report proves you can take an unstructured clinical observation and turn it into a piece of scientific writing. It introduces you to peer review, ethical approval, the process of choosing a journal, and responding to reviewer comments. And it gives you a first author credit — which is harder to get than a co-author credit and means more to selection panels.

Done right, a case report is a 3–5 month project that produces a verifiable, citable publication. This guide is about how to do it right.

Choosing the Right Case

Not every interesting case is worth writing up. The cases that get published share one or more of the following:

Unusual presentation of a known condition. A disease that presented atypically, with features that could easily have led to misdiagnosis.
Rare or novel finding. A condition that's genuinely rare, or a previously unreported drug interaction, complication, or outcome.
Teaching value. Something that other clinicians, residents, or students would benefit from knowing about — especially if the lesson is hard to find in a textbook.
Unexpected outcome. A treatment that failed or succeeded unusually, in a way that prompts useful clinical questions.

If you have to stretch to explain why the case matters, it probably doesn't. The best case reports have an obvious answer to the question: "Why are you publishing this?"

Patient Consent and Ethical Approval

Before you write a word, you need written patient consent. This is not negotiable. Most journals require a signed consent form as a condition of submission. Your hospital's ethics or research office will have a template.

Check whether your institution requires a full ethical approval for case reports — most don't, but some do. Either way, document your approach early. Ethical concerns raised at the submission stage will delay publication significantly.

The Structure

Most journals follow the CARE guidelines for case reports. The core structure is:

Title. Should identify the key educational point. "A rare presentation of X leading to diagnosis of Y" or "Unexpected remission following Z in a patient with W."

Abstract. 150–250 words. Introduction (why this case), case presentation (key findings), conclusions (what clinicians should take away). Write this last.

Introduction. 1–2 paragraphs. Why is this case worth reporting? What is already known about the condition, and what does this case add? Keep it short and cite recent literature.

Case Presentation. The clinical narrative. Patient demographics (age, sex, relevant background), presenting complaint, examination findings, investigations, working diagnosis, management, and outcome. Be specific but concise. Anonymise appropriately.

Discussion. This is where most first-time writers struggle. The discussion is not a literature review. It's an argument: what does this case teach us, how does it compare to published cases, and what are the implications for clinical practice? Aim for 3–4 focused paragraphs, not a dump of every paper you found.

Conclusion. Two or three sentences summarising the key clinical lesson.

References. Vancouver format for most medical journals. Use a reference manager (Zotero is free and excellent).

How to Choose a Target Journal

Start realistic. First-time authors are better served by a publication in a credible but accessible journal than by a rejection from NEJM.

Good starting points for first case reports:

BMJ Case Reports (widely indexed, well-recognised, open access option)
Journal of Medical Case Reports (open access, broad scope)
Cureus (free to publish, rapid review, indexed in PubMed)
Specialty-specific case report journals (many exist for internal medicine, emergency medicine, neurology, etc.)

Check the journal's scope carefully. Look at recent case reports they've published — is your case similar in style, length, and subject area?

What Editors Actually Look For in an Abstract

The abstract is often the only part of a case report that an editor reads before deciding whether to send it for review. It should:

State the condition and what was unusual
Give the key clinical finding or turning point
State the management
Deliver the lesson

Avoid vague language ("this case demonstrates the importance of clinical vigilance"). Give the specific takeaway.

Realistic Timeline

A straightforward case report, written with one experienced co-author, typically takes:

2–4 weeks to draft
1–2 weeks for co-author review
2–4 weeks for ethics/consent
4–8 weeks to get a journal decision
1–4 weeks of revisions

Total: 3–5 months from draft to acceptance. Plan accordingly.

Getting a Mentor or Co-Author on Your First One

Do not try to write your first case report entirely alone. You need at least one co-author who has published before — ideally a senior resident, registrar, or consultant from the clinical team who treated the patient.

Approach this early. Ask before you've written anything. The conversation is easier: "I'm thinking of writing this case up — would you be willing to co-author and guide the process?" Most senior clinicians appreciate the initiative and remember the mentorship they received when they were in your position.

Join Multidiscipline to find mentors who can guide you through your first case report — from choosing the case to submitting to journals.