Response

Dear Sir

Dr Gabbard’s welcome letter launches what I hope will be an extended conversation about the writing and presenting of case histories. For a start it would be wonderful if we did have data about the disguise of histories, and I certainly did not mean to say that any were available. My own impression and that of numerous colleagues that I queried was that case conference presentations were regularly undisguised, and the reported cases in journal articles were only casually disguised. But some firm data to rebut my impression would be most appreciated. In terms of Dr Gabbard’s other points, I can answer briefly:

1Disguising features of a patient may or may not have an impact on the meaning of the case. Our experience in preparing a new casebook is that it is not so simple, and even seemingly minor changes have a significance that escapes an author’s notice.

2Of course we aim to disguise a patient report to conceal identification from others, but some patients may object to any reports about themselves. Do we get a patient’s consent for what Dr Gabbard feels is our goal? Once again, a disguise is a very complicated affair.

3Cautioning us not to write about patients currently in treatment means either that it will affect the treatment or lead to difficulties in one’s objectivity. Does this mean that one should not even plan during a treatment to write up a case or even take notes with such in mind?

4The problem of patient consent depends not only upon the above question of writing up patients currently in treatment but seems to require one to ask a patient for permission after the treatment is over. This is also a complicated affair. One suggestion which has very little chance of being realized is that all patients be told of the probability of being written up in disguised form at the beginning of treatment, just as our candidates inform their patients about supervision. Although this is probably a stillborn idea, it does have the virtue of uniformity and would solv