Case taking in homeopathy is the first step in the process of cure. The process of cure actually starts from this point. Case taking is the foundation on which the structure of cure rests. Man is constantly exposed and reacting to the surrounding physical and psychological environment. Any maladjustment or incapability to cope with the pressure or expectations might result in the disturbance of his sensorium which in turn results in physical problems.
The only way to understand a disease is to understand the patient and his symptoms. An individualistic approach is more important in treating diseases. To understand the sick individual case taking is the only method. Case taking process is the most crucial part, not only because the physician witnesses the disease but also because it is an opportunity for the patient to vent his sufferings and get relief. Any negligence in this step will affect the outcome of the cure.
“A case well taken is half cured. Every time you take a case, you are entering into a new world.” – Elizabeth Wrighy
Definition: “Case-taking is the artistic process of ascertaining, understanding and recording the complaints of patient in such a way that based on the totality of symptoms collected, the physician can manage the case and prescribe homeopathic remedy on the basis of anamnesis and tries to cure the case.”
The case is not just the collection of symptoms, but it is the evidence of disease and the interpretation of the incidence of disease. The understanding of a case helps us to identify the alterations taking place in the physical, mental, and spiritual levels of the patient which homeopaths call, the individual examination. Man is constantly reacting to his surrounding environment, both in health and in disease.
The case study includes the study of the altered state of the patient and also the environment which is responsible for such change. Case taking is an opportunity for the physician to understand how a patient is reacting to social, psychological, emotional, hygienic, and mechanical causes.
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Case Taking Methodologies: A Discussion- “Individual Examination of the Patient”
“There are no diseases only sick individuals” – Hahnemann.
Homeopathy strongly believes that the patient as a person is suffering and not his anatomical organs. During case taking, the homeopathic physician has to remember that the totality of symptoms must be collected in such a way that he can compare them later with the suitable remedy in materia medica.
The physician’s concentration must be kept more on the patient’s constitutional, miasmatic, individual, peculiar, queer, rare, strange, and characteristic symptoms than on the pathological symptoms.
Dr. J.H.Allen in his “Chronic miasms” says, “Pathology becomes the servant not the master of our homeopathic art”. Further, he warns homeopathic physicians, “No lesion or pathological condition is the first cause of any disease, for the disease process precedes them all and the true cause always lies in the disturbed or distressed life force itself. We must go back to the life-force for all action and all changes in the structures of the organism itself.”.
“Our remedies deal with the miasms not the names of the diseases”.
Hahnemann says, “When the picture of the disease is once accurately sketched, the most difficult part of the task is accomplished”. The picture of the disease is not the pathological one, but the symptoms produced by the vital force in the most individualistic manner are the result of its derangement by miasm.
“Pathology and diagnosis do not seek for nor take into consideration the phenomena which are most significant from the stand point of the homeopathic prescriber.” says Stuart Close. But “neglecting the nosological symptoms altogether and not diagnosing case at all” is not recommended.
Even to us homeopaths, diagnosis of the disease is important for safer management of the case. It helps in removing the common nosological symptoms and prescribing for the uncommon symptoms. Diagnosis helps us in identifying the curable medicinal disease from the surgical diseases. Nosological diagnosis is important for a homeopath in predicting the prognosis of the case and not for prescription.
There are no specific remedies in homeopathic materia medica for nosological names of the diseases, but medicines have to be chosen according to the individual symptoms of the patient. Identification of miasm is possible only by individual examination of the patient. Numerical totality is not useful in homeopathic prescription. But the qualitative totality like characteristic, individual, uncommon and peculiar symptoms that indicate a remedy is important.
“A prescription can only be made upon those symptoms which have their counter part or similar in the materia medica”- says S. Close.
The physician has to be well versed with the symptomatology. He must be thoroughly aware of what to look for, when to look and how to look in a patient for the important symptoms? Hence, homeopathic case taking is a well-developed method of collecting the data from the patient but it demands specialized skill and interest from the physician’s side. It is one of the methods of the artistic application of homeopathic science. Master has given some guidelines in § 82-104 for the aspiring homeopath.
Points that Physician should keep in mind while case taking
1. Free from prejudice
Because a physician is also a human being; he may have prejudiced ideas regarding desires, aversions, habits, etc which he should try not to impose on the patient nor express his opinion on this subject during case taking.
Example: A slightly obese physician might overlook the problem of obesity. Physicians must consider every case as a new one and should not consider the present case as similar to a previously treated one etc. Selecting a remedy based on the physical makeup, and gait of the patient alone is definitely not a good sign of a true homeopathic physician.
2. Sound senses
Individual examination of the patient requires alertness of the physician throughout the case taking. Physicians may have to employ their senses in an undisturbed, uninterrupted, and unbiased way to identify the peculiar, uncommon, and characteristic symptoms of the patient. The clue to unlock the case might come from any sphere of the patient. During case taking the physician may see, listen, smell or touch any abnormality in the patient and his behavior.
3. Correct and complete observation of facts and phenomena
This is possible only by proper attention. He must be so alert that no abnormality regarding the patient escapes his notice. Hahnemann in his “Medical observer” writes, “True is, that the careful observer alone can become a true healer of disease”. “A great part, I believe, of the art is to be able to observe”, says Hippocrates
The observation of the phenomenon must be careful and accurate. Any amount of belief and fantasy and personal bias has to be avoided during case taking. Non-observation and mal-observation are offenses on the part of a homeopathic physician.
Faithfulness to homeopathic principles is a must. The recording of the data must be as per the guidelines given by the master. The complaints of the patient should be written in his own words. The principles of homeopathy are formulated in accordance with the ultimate nature’s law. The proper homeopathic case-taking is possible only by faithful adherence to the principles laid down by the master.
5. Properly recording the facts without omission
Each and every symptom told by the patient may prove beneficial in the future in the proper management of the case. Hence every expression exhibited by the patient has to be noted down patiently.
A few other remarkable points are:
6. He must understand the patient spiritually, emotionally, mentally, physically, and socially. A good physician on first hand must be a good human being.
7. Skillful in developing fruitful rapport with the patient
8. He must understand that pathology is not a basis for the prescription but helps in only understanding the nature of the disease.
Physical Requirements for Case Taking
1. Clinic Set-up
Case taking is an interpersonal relationship (rapport) or an interview between the patient and the physician, with cure as the motto. It is social intercourse between the patient and the physician. Hence there is a necessity for a proper and comfortable setting for the interview.
The waiting room in the clinic must be adequately arranged with seating facilities and properly ventilated. The waiting time of the patient must be reduced as much as possible. The longer the patient waits, the more impatient he may become and this could spoil the entire process. Healthy literature or periodicals can be provided to the patients in the waiting room.
Case taking in chronic diseases is a time-consuming process, hence “consultation by appointment” system may be introduced to reduce the waiting time for the patient. As the patient enters the room, he must be welcomed with a comfortable, warm wish, and proper seating has to be offered. The physician must provide calmness and privacy in the consultation room.
The patient has to be assured that every detail he reveals during the consultation will be kept confidential. Arrangement of lighting must be such that preferably natural light falls on the patient. Exhibiting good bedside manners will boost the confidence of patients in physicians. Homeopathic prescriptions are based on the psychosomatic aspects of the case, so making the patient comfortable will help the physician in ascertaining reliable symptoms in the future.
Special instruction of case taking in epidemic cases
1. Hahnemann believed that every epidemic or sporadic disease is different from each other. No epidemic disease or sporadic disease should be considered by a homeopath as the same old one that occurred in the past.
Example: Two cholera epidemics occurring in two different localities cannot be considered the same. On careful observation of the patient’s symptoms, we can find them to be different from each other.
2. The physician has to consider the picture of every prevailing disease as a new and unknown one. The old medicine that worked effectively at that particular time cannot be used to treat the present epidemic.
3. On careful examination, we can find that the present disease phenomenon of an epidemic is unique and different from the previous epidemic disease. In this context, Hahnemann excludes the fixed miasmatic disease smallpox and measles, etc. where the contagious principle always remains unchanged.
Inquiry and Observation: Usually in a case of an epidemic, just by investigating one patient the entire totality cannot be understood. Because though the causative principle (acute miasm) of the epidemic is the same, different patients exhibit different types of symptoms according to their constitutions. So the physician has to closely investigate several cases in that epidemic area till he collects the maximum number of signs and symptoms.
In this process of carefully collecting the symptoms, the picture of the epidemic becomes clearer. After collecting this “group totality”, the physician carefully removes the general symptoms, and based on the peculiar, uncommon symptoms, he selects the specific remedy for that particular epidemic. However, a careful observer by just investigating the first or the second patient itself can find the nature of that particular epidemic based on which he can select the suitable “genus epidemicus” for that epidemic disease.
Genus epidemicus is the remedy selected homeopathically for those diseases in which several people have similar sufferings from the same cause. This genus epidemicus can be used not only as a curative but also as a preventive against that particular epidemic only. For every new epidemic disease, the physician has to select a new “genus epidemicus “separately
How to do Psora’s Case Taking
Especially in chronic diseases, the “Psora” has to be investigated. Psora is the fundamental cause of all chronic diseases. The Psora has to be investigated from the totality that we get from the patients. The fundamental cause for the suffering of each patient will be different. Hence, the basic cause of psora has to be individually investigated in every case.
Few patients exhibit few symptoms and the others, few. So only by the complete survey of the patient’s history, the physician has to select the anti psoric remedy. Thus, a detailed case study of the patient has to be made in chronic cases. Once this important yet industrious study is done and the disease picture is accurately sketched, the most difficult part of the curative task is accomplished.
Then the physician uses this collected data for the following:
- Investigating and picking out the characteristic symptoms.
- From this list of characteristic symptoms, a suitable homeopathic remedy can be selected.
- During the treatment in the next visit of the patient, the physician can understand what symptoms have been removed by the administered remedy.
- He strikes out the list of symptoms noted down at the first visit that has been ameliorated. If new symptoms have arisen, he can enter them again in the record. This record-keeping is very important in the homeopathic management of diseases.
2. Importance of Record Keeping
Homeopathic case taking is the individual examination of the patient. Individual examination and understanding of the peculiarity of a person’s suffering is not a simple task. So, noting down all the minutest symptoms of the patient is mandatory. No human brain can remember or recall all the symptoms of each patient for a long period of time. Hence it is mandatory to note all the symptoms narrated by the patient in a legibly recorded form.
A well-noted case can be used as a clinical record for further reference, teaching, and as a reliable source of research work. In homeopathy, after case taking is over, the recorded data is used for analysis and synthesis of the case and the evaluation of symptoms.
In the footnote to § 104, Hahnemann criticizes the allopathic physicians for not showing much importance in record keeping. “No allopathic physician, as has been said, sought to learn all the minute circumstances of the patient’s case, and still less did he make a note in writing of them”. Hence, for a homeopathic physician especially when dealing with chronic cases, “Record keeping” becomes inevitable.
The clinical record of the patient must contain a minimum of the following items:
- The preliminary data of the patient (like name, age, sex, occupation, marital status, address, religion, etc).
- The symptoms were collected by the patient, attendees, and the physician himself, in chronological order. The complete and comprehensive history of the patient and his sufferings.
- The past, present, treatment, and personal history of the patient.
- The clinical and laboratory findings.
- The diagnosis of the condition.
- Analysis of the case.
- Evaluation of the symptoms and case analysis.
- The first prescription and general management
- The follow-up.
No fixed format for case taking is recommended by Hahnemann. Based on his requirement, the physician can adopt a method that perfectly suits the condition. Most private practitioners follow “the bound register” method for record-keeping. Either the “leaf folder method” or the “card system” is adopted by the medical institutions.
Uses of Record Keeping
1. The record-keeping helps in the “trinity of diagnosis”. The recorded symptoms guide us in “miasmatic diagnosis”, “constitutional diagnosis” and “remedial diagnosis”. In each area of diagnosis, symptoms are the only source.
2. The record-keeping helps in the selection of the remedy. From the recorded symptoms we can easily strike out the common symptoms of the disease, and the remedy can be selected on the basis of individualistic symptoms.
3. Record keeping helps in writing down symptoms told by the patient in his own words. This helps in understanding the subjective feelings of the patient as they are. Even in the long course of time, the case remains fresh as narrated by the patient.
4. Dr.Kent says, “Without the record you are at the sea without compass and radar”.
5. H.A.Roberts says, “We cannot depend upon our memory in taking the case. So as the first requisite in taking the case, you must have your records with you to note down the case as it is taken”.
6. Evaluation and analysis of the cases are after taking the case. Only by record-keeping, one can do such a task.
7. The record-keeping helps in the follow-up of the case. In making the first and subsequent prescriptions, for observing the appearance of new symptoms and the disappearance of the symptoms “record keeping” is a must.
8. The record-keeping helps in predicting the future course of the disease. Recording the symptoms in chronological order helps the physician in understanding the curative order of the symptoms. It also helps in observing the law of direction of cure in a case.
9. The recorded case can be easily communicated to the other medical fraternity. It helps in getting a “second opinion” from experienced, senior physicians.
10. Homeopathy claims of curing some difficult and incurable diseases as termed by allopathy. Such claims can only be proved as facts by record keeping as it works as evidence-based claims.
11. For research-oriented work, record keeping is a must, as research believes in the quantitative study as well as a qualitative one. All the above reasons highlight the importance of record-keeping in managing the case in a credible, legible, and successful manner.