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This year, several issues of Arthritis Care & Research have included a clinicopathologic conference. Such publications, known in the professional vernacular as CPCs, are a time-honored approach to the teaching of medicine. CPCs were made famous by their appearance in The New England Journal of Medicine, beginning in 1923 and continuing to the present (1). However, the tradition of CPCs dates back even further; such exercises were proposed first in 1900 by Walter B. Cannon, then a Harvard medical student and later a renowned physiologist (2). During the first years of the 20th century, CPCs were honed to a high art through the teaching of Dr. Richard C. Cabot, an internist at the Massachusetts General Hospital (3) (Figure 1). Long after Cabot died in 1939, the weekly CPC exercises at the Massachusetts General Hospital were termed “Cabot Rounds.”

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Figure 1. Dr. Richard C. Cabot in front of the Bulfinch Building (Massachusetts General Hospital archives).

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Rheumatic diseases lend themselves well to presentation in CPC formats. This is demonstrated in part by the frequency with which rheumatologic diagnoses comprise “the answer” in The New England Journal of Medicine cases. Yet CPCs have never been a consistent feature of rheumatology journals. We hope that the regular addition of a CPC to Arthritis Care & Research will serve as a compelling avenue for the description of clinical challenges and scholarly writing about patients. All CPCs published in Arthritis Care & Research will be peer-reviewed by experts on the disease in question.

Arthritis Care & Research CPCs will be modeled on those in The New England Journal of Medicine in many respects. There is one exception: the “Discussant” in Arthritis Care & Research CPCs—who remains “in the dark” until the revelation of the diagnosis—will be the reader. The diagnosis might be derived by a variety of methods: by the classic CPC conclusion, an autopsy; by a revealing biopsy of an involved organ; through specialized or routine laboratory investigations or genetic analyses; on the strength of radiologic findings; or simply by careful history taking or a meticulous physical examination. In addition to discussions that emphasize the thought process underpinning the correct diagnosis, we will also consider for publication cases in which the diagnosis is straightforward but the more difficult clinical questions relate to management.

We anticipate that multidisciplinary expertise will be a hallmark of many CPCs published in Arthritis Care & Research. Whenever possible, the CPCs will emphasize new ideas in medical science that shed light upon the approach to diagnosis, disease management, or an emerging aspect of pathophysiology. We welcome queries about cases that might be appropriate subjects for CPCs, and invite submissions of CPCs by the general readership. Guidelines for the preparation of CPCs are the same as those for full-length manuscripts except that no abstract is required.

There exist strong similarities between writing CPCs and preparing manuscripts that report original research. All successful peer-reviewed medical writing involves rigorous planning, clear thought, painstaking attention to detail, and concise presentation. With CPCs, however, the telling of the tale in a logical (if not linear) manner is perhaps even more crucial. As the record of an individual patient's clinical story, the CPC must recount the sequence of events in a way that allows the reader to follow each step, despite the haphazardness of the way things happen in real life (and including the occasional red herring tossed in to keep the hunt interesting). Good CPCs entice the reader to assume the role of the clinician and, in the best of circumstances, impart lessons that last and foster clinical wisdom. The CPCs published in Arthritis Care & Research will be those that not only get the facts of the case and the fine points of the diagnosis correct, but do so in a way that engenders learning. Even material that is highly appropriate for a CPC is likely to require a round or more of editorial input, followed by revision of the text by the authors.

It is perhaps worth cautioning at this juncture that “getting the right answer” is not the ultimate goal of participating in a good CPC. The late Dr. Benjamin Castleman, editor of The New England Journal of Medicine CPCs for nearly a quarter of a century, observed that “It is less important to pinpoint the correct diagnosis than to present a logical and instructive analysis of the pertinent conditions involved … (If) the discusser emphasizes the practical clinical problems, it doesn't matter if the answer is wrong” (4). Competitive readers can choose to disagree, but do so at the cost of their own egos.

We invite you to test your diagnostic acumen against cases presented in the CPCs and—right answer or wrong —to enjoy the state-of-the-art discussions that accompany each publication. Send us your feedback, ideas for possible CPCs, and (most importantly) meritorious submissions.

REFERENCES

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  2. REFERENCES
  • 1
    Case Records of the Massachusetts General Hospital (Case 9431). Boston Med Surg J 1923; 189: 595608.
  • 2
    Cannon WB. The case method of teaching systematic medicine. Boston Med Surg J 1900; 142: 316.
  • 3
    Cabot RC. Case teaching in medicine: a series of graduated exercises in the differential diagnosis, prognosis, and treatment of actual cases of disease. Boston: D.C. Heath; 1906.
  • 4
    Castleman B, Dudley HR, Jr. Clinicopathologic cases of the Massachusetts General Hospital: selected medical cases. Boston: Little, Brown; 1960.