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Integrating clinical understanding through case histories


Rolf Wynn

UiT The Arctic University of Norway, NO
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In many health care systems, patients experience a fragmented service where different clinical specialities are not well integrated. A lack of clinical overview can be missing as each clinician focuses on his or her part. This lack of overview can have consequences as patients can be given sub-optimal care and it may also affect doctor-patient communication (1).


We focus on how the scientific genre of the medical case history can help clinicians gain a more integrated overview of patients' history and treatment and how the process of composing case histories may be conducive to better integrated clinical work. The clinical case report has a long tradition in medicine (2,3). Following a period when this genre was less popular, it has recently had a renaissance in part due to the availability of online publishers and the open-access movement (3,4).

Results and Discussion

In a clinical case report, a patient's medical history is briefly presented. A case report will often include some contextual  information about the patient, but the focus is usually on a clinical phenomenon or an illness (1-4). Sometimes, the case is presented because it has scientific value, other times it is the educational value that it highlighted (4). Many patients with illnesses that are rare or otherwise challenging to diagnose or treat are treated by different types of clinical specialists that cooperate to a varying extent. While optimal clinical cooperation may sometimes be difficult to achieve due to how clinical work is organised in many hospitals, collaborations across specialities and departments where clinicians in retrospect work out case histories are probably often easier to achieve (4). The most interesting case reports may be those where the authors are able to integrate perspectives from different parts of patient's treatment, for instance medical and surgical or medical and psychiatric (5,6). Especially novice clinicians can learn much both about the integration of clinical work and scientific method by working out case reports together with clinicians from different areas of medicine (4).

Conclusions/lessons learned, limitations and suggestions for future research

Working out case reports may help clinicians get a broader understanding of the medical history and clinical challenges of individual patients, and may also be conducive to better cooperation between clinicians from different specialities. More research is needed to examine to what degree working on case histories can result in better clinical integration.


1. Wynn R. Provider-patient interaction. Oslo: Norwegian Academic Press, 1998.

2. Nissen T, Wynn R. The history of the case report: a selective review. JRSM Open 2014;5(4):2054270414523410.

3. Nissen T, Wynn R. The recent history of the clinical case report: a narrative review. JRSM Short Reports 2012;3(12):1-5.

4. Nissen T, Wynn R. The clinical case report: a review of its merits and limitations. BMC Research Notes 2014;7:264.

5. Nissen T, Wynn R. Clenched fist syndrome: a case report.

Journal of Medical Case Reports 2018;12:168

6. Nissen T, Rørvik P, Haugslett L, Wynn R. Physical restraint and near death of a psychiatric patient. Journal of Forensic Sciences 2013;58:259-262.

How to Cite: Wynn R. Integrating clinical understanding through case histories. International Journal of Integrated Care. 2021;21(S1):232. DOI:
Published on 01 Sep 2021.


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