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JAMA 100 Years Ago
December 2, 2009

THE VALUE OF INDEXED CASE RECORDS

JAMA. 2009;302(21):2379. doi:10.1001/jama.2009.1652

To those who are unfamiliar with the advantages of a system of classifying and indexing case histories the keeping of such records may appear like an entirely unnecessary and laborious piece of work. If the habit is once formed, however, it will be found to be of the greatest help in clarifying the worker's conception of the field in which he is working, and an incentive to more precise observation. If an effort is made at regular intervals—once a week, for example—to record in black and white the diagnosis of every case that has been seen during that interval it will afford a very interesting and instructive review, and the perspective thereby gained will not infrequently serve to clear up obscure points and to suggest practical points as to prognosis and treatment as well as diagnosis. If the observer is thoroughly honest with himself and takes refuge in no obscure terms or uncertain diagnoses it will inevitably be found that in a fair proportion of his cases a decision must be definitely or indefinitely postponed. Necessary data will be found wanting in certain cases; diagnostic points which have been overlooked and which might throw light on the problem come to mind, with the result that at the next interview with the patient these points will be noted and the condition will be better understood. As the records grow, their value will be constantly increased by a properly made index, rendering early material available for study and comparison with recent cases. This advantage of the index will be enhanced if, besides the record of diagnoses, there is kept an index of signs and symptoms. While such an indexed record would necessarily be voluminous, it could be kept within bounds by recording only the important and unusual phenomena, while the observer could accumulate data on any particular subject in which he was interested to the limit of his material and time. An outline of a system for classifying and indexing case records was published in THE JOURNAL early this year.1

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