Introduction
Medical Case Reports (MCRs) are medical recounts of a pathological condition about a single patient (Helan, 2012). Authors of the medical case reports, who are doctors, tend to experience unusual, unique or interesting medical aspects in patients' pathology about diagnosis, treatment and adverse reaction to the treatment. Therefore, they are purported to write medical case reports which represent unique or rear patient conditions that can influence new studies and hence increased medical knowledge. Although the medical case reports have for a long time been regarded as much inferior compared to medical research articles, they are becoming recognised as just equally important. Since they report information concerning individual patient's condition they will be more comprehensive and accurate than the randomised research articles (Kunt-Akbas, 2013). They are also perceived to go well with low budgets of most organisations and medical novice writers. Nonetheless, they are first sources of evidence-based medicine that many medical authorities take as the most scientific and rational when it comes to medical decision making. Therefore due to the significant weights they carry, this research will seek to carry out an analysis of medical case reports, as a genre of writing, about their properties to realise why they espouse them. Hopefully, after the study, the research, due to their properties, most medical professionals would recognise their importance just like other research papers, and adopt them to contextualise their service to particular communities.
- How has the genre been evolving from the 19th century?
- What are the contexts (kind of professionals and the community) of the medical case reports as a genre?
- What are the purposes of the communications that define medical case reports as a genre?
- What are the textual-structural properties of the standard medical case reports?
- What are lexico-grammatical features (vocabularies and grammar) that characterise the
text to meet its communicative purposes?
- How do medical writers move the structure of the text in order to attain the best presentation of their MCR reports?
Literature Review
According to the analyses in the British Medical Journal, on twelve case reports obtained, they revealed that the genre became prevalent, as early as in the second half of the
19th century (Berkenkotter, 2009; Helan, 2012). The writing of medical reports happens in the community and will, therefore, be contextualised according to the kind of medical professionals and the people in it (Mendez-Cendon, 2009).Thus, the reports published will be based on the diseases and other medical conditions found in that community, and in some cases, borrowing the language terms of the local community (Helan, 2012; Hung, Chen, & Tsai, 2014; Kunt-Akbas, 2013). Not surprising, some of the diseases and conditions are rear and mainstream academic journal articles could not have published them (Kunt-Akbas, 2013).Many authors have noted that the purpose of Medical Case Reports should be making original contributions to medical knowledge, by presenting phenomena that are completely rear (Hung, Chen, & Tsai, 2014; Kunt-Akbas, 2013). In this regard, they will present important scientific observations that current clinical trials do not normally detect, which will influence various researches to expand the community's medical knowledge (Kunt-Akbas, 2013).
The textual structures of the medical case reports are normally examined according to their text length and macro-structures (Hung, Chen, & Tsai, 2014; Kunt-Akbas, 2013). For textual macrostructure, it has to be in four main parts: abstract, introduction, description of patient, discussion and conclusion report. However, for Green and Johnson model, it should be in five parts: abstract, introduction, case report, discussion and conclusion (Mendez-Cendon, 2009). Further, some studies have indicated that the formal structure of the Medical Case Reports should be the schema of TAIMRad (Title, Abstract, Introduction, Method, Results and Discussion), followed by legal subsections such as competing interest, consent and references (Helan, 2012; Kunt-Akbas, 2013; Mendez-Cendon, 2009). Apparently, the medical case report presentation seems to be majorly composed of five major parts: abstract, introduction, report of the case, discussion, recommendation and conclusion (Hung, Chen, & Tsai, 2014; Kunt-Akbas, 2013). The other structural feature of the medical case report is its brevity in length compared to a journal article. Most of them range between 1000 and 2500 words in length. On lexico-grammatical features, the medical profession has developed with its language (Hung, Chen, & Tsai, 2014; Kunt-Akbas, 2013). Although English remains its lingua- Franca in academic and professional usage, there are also emerging slang languages. In moving the structure of the text, studies have found out that normatively, physicians introduce the case, describe the diagnosis, explain treatment, indicate patient outcome and comment on the case, in that order (Hung, Chen, & Tsai, 2014; Kunt-Akbas, 2013; Mendez-Cendon, 2009; Yanoff, 2014).
Methods
Primary research will involve interviewing experts and other hospital staff members that involve in drafting medical case reports. Researchers will interview them mostly on their purpose and structure before embarking on contextual properties, textual properties, macrostructures and text lengths and periodic evolution in the genre. Moreover, the researcher will overlap interviews with field observations in the hospital. As there will be interview transcribers, field observation will involve video recording and transcriptions. Primary data analysis will involve statistical strategies and modified grounded theory. Using the modified grounded theory, transcripts and videos will be read and analysed by five researchers, which will code the emerging themes using NVivo qualitative data coding software. In this regard, in addition to statistical strategies, there will be a word count, tense analysis, structural and textual analysis, contextual analysis and other themes (Schryer et al., 2014).
Researchers will contact secondary research at the university librarian where they gain access to medical case reports from three medical journals; Journal of Medical Case Reports, Journal of the American Medical Association and the British Medical Journal. It is important to note that three articles from each journal will be picked to represent each decade period from 1850. In analysis, the study will analyse the texts according to their purposes, contextual properties, textual properties, and macrostructures and text lengths, periodic evolution in the genre. Lexico-grammatical techniques will be employed to examine quantitatively linguistic features of the text. MS Word programme will be important in noting the ratio of passive to active tenses, whilst the GATE software will count noun phrases. However, the structure of the texts will be examined according to the Swales (1990) suggested lines.
Results
In both primary and secondary data, results will be grouped into context analysis, communicative purpose, textual analysis, lexico-grammatical analysis, move analysis with evolutionary features being noted. For communication purpose, both results will show the compelling reasons behind authors publishing the MCRs. Textual analysis will involve showing structures of the reports. By text length, researchers will have to be counting the number of words that each report has. Lexico-grammatical analyses will look into tenses, active and passive voices, pronouns, noun phrases, slang, or community language among others. Moreover, researchers will have to count the ratio of passive to active tenses. Lastly, the analysis will be conducting move analysis to unravel structural organisations of the medical reports. In this way, readers will be able realise how certain chronological progression suits a certain medical context. Since the analyses will be demarcated according to periods, the reader will be able to note evolutionary changes in the genre. Importantly, there will be critical comparisons of data from both primary and secondary researches.
Discussion
The discussion part will serve a good purpose of relating how the results would have answered the research hypothesis. Comparisons between primary and secondary data will help researchers to realise common points and discrepancies so that clear explanations can follow. In both cases, the study will relate why the structural properties of various medical reports vary according to where they written or published. It will also explain how the move structure and therefore chronological progression of a medical case report will depend on the medical event in question. Moreover, following the evolution of the structure, and therefore its vocabulary, analysts will show why the report majorly adopts narrative structure rather than formal academic language of research articles. However, strengths of the study such as contributing to the medical literature by emphasising on the community contextualization of medical situations by medical professionals in the MCRs will be discussed. Likewise, weaknesses of the study such as using few sources to obtain candidate medical case reports and interviewing few people in one hospital for analysis will be disclosed.
Conclusion
There will a conclusion to highlight the merits of the MCRs as a form of presentation and its uniqueness as a genre. Moreover, it will highlight why it has acquired such narrative structure due to the context, and hence it’s local and informal lexicon, brevity in length, through its evolution as seen from the British Medical Journal. Lastly, there will be an emphasis on the medical professionals to consider the MCRs with equal importance as they do with academic research papers.
References
Berkenkotter, C. (2009).A Case for Historical "Wide-Angle" Genre Analysis: A Personal
Retrospective. Iberica, (18).
Helan, R. (2012). Analysis of Published Medical Case Reports: Genre-Based Study. Brno:
Masaryk University.
Hung, H., Chen, P. & Tsai, J.(2014).Genre analysis of medical case presentations: a
comparison between case presentations written by native and Taiwanese physicians. I nternational Journal of the Humanities, 18(2), pp. 167-178.
Kunt-Akbas, S. (2013). A Genre Analysis of Medical Case Reports. Ankara: Hacettepe
Mendez-Cendon, B. (2009).Combinatorial patterns in medical case reports: an English
Spanish contrastive analysis. Journal of Specialised Translation, (11).
Schryer, C.F. et al. (2014).Structure and agency in medical case presentations. Waterloo:
Yanoff, K. L. (2014).The rhetoric of medical discourse: An analysis of the major genres.
Scholarly Commons. Retrieved on 15 November 2014 from http://repository.upenn.edu/dissertations/AAI8824810/
