Jane Doe: A Cautionary Tale for Case Reports

Historically, clinical case reports have played an essential role in the professional communication of medical and psychiatric knowledge. Case reports continue to play important roles in the initial identification of new syndromes or unusual variants of established conditions. Case reports and case series also serve to alert clinicians to preliminary evidence of the efficacy of novel treatments or adaptations to new populations. The Jane Doe Case provides a seminal example of the ethical/medico-legal dilemma arising from a patient's right to confidentiality versus the principle of independent review/replication as a necessary requirement for scientific credibility. As a result of being the subject of dueling case reports concerning the validity of her delayed recall of childhood sexual abuse, Jane Doe's identity was revealed. Consequently, she suffered significant emotional distress, bankruptcy, and the end of her career as a naval officer and aviator. Current medical journal guidelines call for protection of confidentiality of the patient's identity; yet, scientific credibility requires the possibility of an independent outside review if there are legitimate reasons to question facts or claims advanced in a case report. A potential solution is proposed as a starting point for resolving the dilemma posed for case study subjects and authors by the conflicting requirements of patient confidentiality and, if warranted, the possibility of an independent scientific review.