Preserving Confidentiality in the Writing of Case Reports

One year ago former Editor-in-Chief David Tuckett (2000) wrote an editorial in these pages outlining his concerns about a statement issued by the International Committee of Medical Journal Editors (ICMJE) regarding the reporting of clinical events (ICMJE, 1995). In that statement the Editors argued that clinical accounts of patients should not be disguised in any way whatsoever. In addition, they suggested that informed consent must always be obtained from the patient who is the subject of a clinical report. In his editorial, and in an accompanying paper authored by one of the current Joint Editors-in-Chief , the ICMJE's approach to the publication of clinical reports was challenged for its rigidity and its poor suitability for psychoanalytic writing. We have since developed a more flexible strategy that we believe is more protective of the patient's privacy—a special concern in psychoanalytic writing that is ignored by the ICMJE statement. We feel strongly that the ethical need to protect the patient can coexist with the scientific need to maintain the integrity of clinical reporting. In the spirit of that compromise, we have adopted the following policy:

Writing about patients is essential for the advancement of psychoanalytic knowledge. Yet the need to communicate our clinical experience places analysts squarely in the middle of a conflict between the needs of the profession and the privacy of the patient. There is no perfect solution to this dilemma. Nonetheless, there are several time-honoured approaches to achieving a balance of scientific integrity and patient anonymity. Authors may choose to disguise superficial details of the patient's external life so that the patient is essentially unrecognisable to a reader. Some analysts may ask for written consent from the patient in addition to disguise. If one is writing about a clinical syndrome involving a group of patients, it may be possible to use case material that is a composite of several patients. When an ana