“Listen to your patient, he is telling you the diagnosis”
—Dr. William Osler
We are proud to launch JACC: Case Reports after several years of growing the concept and vision for the journal. JACC: Case Reports is an open access journal, serving as a forum for promoting clinical cases and clinical problem-solving. We will accept everyday educational as well as rare clinical cases, but either should be well described and contain clear learning objectives. Furthermore, JACC: Case Reports aims to serve as a publication vehicle for early career cardiologists and members of the cardiovascular care team, as well as a forum for mentorship on the review and publication processes. Our target is to engage training directors and fellows in training and to bring them together within this mentoring platform.
For this journal, we put into place a comprehensive strategic plan that focused on the following primary objectives: 1) to educate through clinical cases from everyday clinical practice; 2) to promote teamwork and multidisciplinary decision-making in clinical problem-solving; and 3) to engage fellows in training and senior cardiovascular clinicians and researchers in a mentoring platform that will connect reviewers—across the world and at different stages of training—through constant interaction. Those who will engage with JACC: Case Reports will learn how to prepare and how to appropriately grade a clinical case.
We treat patients every day. We are hands-on physicians. We remember patients who have made an impact on our clinical practice and those cases who have made an impact on how we treat our future patients.
A patient’s clinical condition is a multiparametric approach, and within our authors’ instructions, we provide guidance on how to consider organization when you write a clinical case (Figure 1). We would encourage you to start from a good medical history, including not only the history of presentation, but the past medical history. Here, it is important for every health professional to have good communication skills and to interact not only with the patient alone, but also with his or her family.
Figure 1.
How to Organize a Clinical Case
The next step is physical examination. More than a decade ago, one of my mentors in cardiology listened very carefully to a female patient who was treated for aortic endocarditis and ready for discharge. He spent at least 10 min listening to her heart, at which time he adamantly told us: “She has an aortic abscess.” We replied: “It can’t be. She has been treated with antibiotics.” Ultimately, he was right. A physical examination was the correct approach, and he saved a patient’s life before she was discharged, when we confirmed that she had an extensive abscess and she underwent an emergency operation. He was a wonderful clinician and a wonderful mentor. This is the allure of medicine.
Nowadays, many physicians do not dedicate appropriate time to the physical examination, starting from the top to the bottom, focusing on heart as well as chest auscultation, and learning how to estimate jugular venous pressure. We encourage you to investigate for peripheral signs of heart failure or other diseases, such as endocarditis, congenital heart disease, or even indirect signs of cardiomyopathies. Feel the patient, listen to him/her, and spend time observing. Physical examination is a treasure, during which you can discover the unique ailments of your patient. We hope that our case report submissions reflect this devotion to patient examination.
In addition to clinical cases and clinical case series paper types, the Editorial Board and I also established “Heart Care Team/Multidisciplinary Team Live,” which should be a stepwise clinical problem-solving with questions and answers on how to approach the patient and in relation to the guidelines. Why, for example, is it that left ventricular outflow tract diameter may not be the best echocardiographic index for low-flow low-gradient aortic stenosis? Here is an article type where you may expand your knowledge and teach the audience—across the cardiovascular care team.
Also, in JACC: Case Reports, we will have an opportunity for Clinical Vignettes, or a stand-alone figure/video or multipaneled figure with a short legend of 500 words. The same features will be available for electrocardiography (ECG) vignettes, wherein our electrophysiology colleagues will work together with you in promoting educational ECGs. So often an ECG is the first investigation that takes place in an emergency department, and it applies not only to the cardiologist but to every physician who comes across a patient, including general practitioners. This is one of the reasons we would like to emphasize the importance of ECG knowledge.
Another important section of the journal is our Global Health Reports, wherein we aim to demonstrate what is happening in developing countries. These submissions should include what are the needs of the patient population and how we can join forces to help our clinical colleagues. These are questions that will improve daily practice but also harmonize health care needs globally.
In addition to those article types, we felt that JACC: Case Reports would be incomplete as a mentoring platform if we did not provide an opportunity to demonstrate the well-being of the physician or the patient’s perspective. Patient experience is a metric of our contribution as physicians, and their experience starting from communication skills, discussion of the management plan, and the whole treatment experience has a tremendous impact on our clinical practice.
In a similar way, we recognize that physicians—both junior and senior—have concerns and questions on training, research, and practice. Younger physicians may feel overmentored but underpromoted, while both junior and senior cardiologists may feel burnt out. We are here to help mentor and promote younger colleagues, and potentially create a generational bridge. We are encouraging our readers to write about their personal experiences—including about the balance between work and life—through our “Voices in Cardiology” section. Also, we invite fellows in training to interact with senior experienced colleagues on topics to improve daily practice and physician wellbeing in this section.
Often, the editorial board reflects diversity and inclusion of physicians from all stages of training. We seek to pair junior and senior colleagues as this will be a learning process for all of us. We learn from you; we appreciate your innovative ideas and hope that you will learn from our scholarly output in JACC: Case Reports.
In summary, we hope that within next 5 years, we will create a successful mentoring platform, teach clinical cardiology, and develop new pathways into clinical education. Most importantly, we hope that we will publish a plethora of impactful clinical case reports and case series. If you have such a case, we encourage you to submit on our platform, and if you would like to receive our bi-monthly publication, we would ask that you sign up for e-alerts.