The case of a patient with unresolved upper abdominal pain and weight loss was written up and submitted by her family doctor to a journal that publishes interactive case reports. The intention was to present it as an unfolding story in three parts over five weeks. Responses would be invited on the journal’s website from readers to questions about diagnosis and management, and about what to say to the patient. Several expert commentaries would be commissioned to accompany the third part of the case history. Patients are always asked to give written consent to publication. And the authors are asked to explain that the case will be discussed “live” on the journal’s website and to invite the patient to read the rapid responses and write a commentary about their health and experience of having their story discussed in this way. To date, the patient’s real first and family names have been used in these case reports, with their consent, and they have described patients whose problems have been resolved. Would it therefore be ethical to publish this unresolved case, given that the patient may be exposed to all sorts of opinions on her health, some of which may be very frightening? Can consent in this situation be truly informed?
- There is a duty of care to safeguard the patient’s psychological health. - The potential harm is completely unpredictable. - Why is the patient named? This will only increase the possibility of harm. - This is tantamount to “reality medicine,” akin to a Victorian freak show. - The patient should not take part as it is not in their best interests. - It would be difficult to obtain consent in this case, as it is a work in progress with huge risks.