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.
A well taken case is half cure
The Do’s of Case Taking
What Can Be Done during the homeopathic case-taking is in detail described by Dr. Hahnemann in Organon of Medicine
1. Always remember you are taking a case so that you can compare it with the materia medica later. So give much importance to the individualistic study of the patient. You are dealing with a human being and not a pathological specimen.
2. Always leave the patient at freedom. When the patient is talking, listen to him carefully. Do not interrupt him in between. This interruption will break the chain of thought of the patient and what the patient actually wanted to convey to you may not come out properly. The patient may forget to tell about some minor complaints.
3. Note down every detail told by the patient, in detail. Note down the symptoms of the patient in his own very expressions. These expressions help in understanding the sensations of the patient.
4. Request him to talk slowly so that you can make a note of them clearly. Leave space between one symptom to the other so that you can fill it up later by asking the patient in detail about each symptom. Begin a fresh line for each symptom.
5. Try to elicit much information about each individual symptom. Collect the data like onset, location, sensation, modalities, and concomitants of each symptom. Simply make each symptom a grand symptom. Every minutest detail regarding the above-mentioned criteria has to be collected.
6. After collecting the data, read it out to the patient as a method of confirmation.
7. If the collected data is insufficient, then the physician is at liberty to ask questions at his convenience. The physician can elicit symptoms by asking the details regarding each individual symptom by going one after the other patiently.
8. Always concentrate on getting the peculiar, queer, rare, and strange symptoms of the patient, and try to individualize the patient.
9. Study the patient spiritually, emotionally, mentally, socially, and physically.
Example: how the patient behaves during his visit, whether he was morose, quarrelsome, lachrymose, anxious, sad, hopeful and observe his expression of eyes, etc.
10. Give attention to the patient’s personal details. The physician has to make a note of what he observes in the patient during the visit.
Example: his dressing pattern, sitting posture, mannerisms, etc.
11. Always give importance to the symptoms observed by the physician than the symptoms told by the patients and their attendants because patients and their attendants can alter the symptoms for many reasons
12. Try to collect the personal history of the patient like his habits, relationships, etc. Treatment and medicinal history like treatment by any other physician before and the medicines prescribed by them will provide some hints in prescription. If a patient is under the influence of antipathic palliative medicines, the symptoms narrated by the patient are not the whole picture of the disease. This is because the antipathic medicine has removed or suppressed the chief complaints of the patient.
Example: history of any suppression, or palliations and overdosage of drugs or hypersensitivity to any drug, etc.
13. Only in the case of comatose patients, infants, and unconscious patients, we can rely on the symptoms narrated by the attendees like mother, parents, friends, etc.
14. “Always try to prescribe for the acute attack and the symptoms related to it”, says Kent. Even in chronic cases, if any acute exacerbation comes, treat it first and the symptoms of the chronic cases can be deal with later. It is always easy to sketch the picture of an acute attack. This is because all the changes in the patient’s body are very fresh in the memory of the patient. Even the physician can notice the symptoms picture easily. The symptoms of the disease are more prominent and easily expressible
15. Take gynecological, obstetrical history in females without fail . Example: last menstrual period, inquiry about deliveries, the flow of blood, frequency of periods and duration of the periods, etc.
16. Always be alert from the “hypochondriac and the hypersensitive patients”.
Hypochondriacs are patients who exaggerate their symptoms in vivid colors. They think that the physician will prescribe a powerful medicine if they do so. They may present their imaginary symptoms because they are much worried about their imaginary disease. It was believed that these people have their symptoms in the abdomen hence the name “hypochondriacs”.
Hypersensitive patients. They exaggerate even minor problems as great suffering. They do so because they cannot bear even the slightest suffering. Hence, they explain their pain in a dramatic way. The hypochondriacs present imaginary symptoms, whereas the hypersensitive ones exaggerate even the minutest symptoms. (The other group of people is called feigners, who falsely act as sick in order to obtain some gain).
17. Also try to rule out the “indolents”. Indolent are those patients who do not explain their sufferings properly either due to false modesty or because of their dull and sluggish nature and weakness of mind
18. Write down every symptom told by the patient in his own language. The very own expression of the patient should not change. This indicates the subjective symptom of the patient, which is very useful for the homeopathic prescription.
19. Listen to the patient carefully. Neither give too much interest nor give too little. The patient neither should feel that he is talking to a wall nor should he feel that the physician is making fun of him.
20. “Friendly approach” towards the patient is the key to success in homeopathic practice. This removes the hesitation of the patient and helps in understanding his true personality of him.
21. The questions we ask must be simple and easily understandable.
22. Some patients feel free in writing down their symptoms than expressing them in front of the physician. If such a thing is observed, encourage him to do so.
23. Always maintain a record of symptoms for future reference.
24. Try to collect all the symptoms the patient is having. Dr. Garth Boericke says, “the more the symptoms, the better will be the prescription.”
The Don’ts of Case Taking-
1. Avoid a tense atmosphere. Leave the patient always in freedom, the patient should not feel that he has been dominated by the professional.
2. Try to cut down the waiting time for the patients in the waiting hall. Long waiting can irritate some patients. If possible, provide a “consultation by appointment” system.
3. Avoid using technical or medical words as much as possible during consultation. Even discourage the patients from using medical words. Because this will lead to misinterpretation of the actual problem the patient is having. The patient might use the term in the wrong meaning because of his medical ignorance. Examples: acidity, flatulence, and indigestion problems are commonly called by the patient “gas problem.”
4. Do not get emotionally involved with the patient. Remember that you are a professional doctor; your duty at the case-taking hour is to get the true totality as it is in an “unprejudiced manner”. Try to be neutral in your comments on sensitive issues. Try to be an intelligent observer because the case-taking episode is too early to pass any judgment or to give counseling.
5. Do not interrupt the patient when he is narrating his problems unless he diverts from the topic to unrelated and unnecessary talk.
6. No “leading” questions are to be asked. The leading question is the one for which the patient either answers in “yes” or “no”. These are also called the hinting questions, direct questions, multiple-choice questions, or suggesting questions. Such leading questions will never lead to good case taking. The patient is answering either to please the physician or out of indolence.
Example: If the physician asks, “Is not your headache burning type?” Do you get disappointed easily? Do you like sweets? Do not you get angry if someone criticizes you? Invariably the answer will be “yes” or “no”. This is the wrong way of interrogating the patient. There is no scope for subjective analysis of the type of pain.
7. You cannot totally rely upon the patient. Whatever the patient says may not be the true totality of symptoms because
i. The patient currently may be under the influence of other medications. Some symptoms of the natural disease may have been either palliated or suppressed by the current medication. In such conditions, what the patient says may be a partial totality or the medicinal diseased one.
ii. The symptoms told by the patient may be a mixture of the medicinal disease and the miasmatic disease.
8. Do not prescribe unless you are sure about the remedy you have selected, especially in chronic diseases. If you are not sure about the remedy, prescribe “placebo”, the second-best remedy says Kent.
9. No “double barrel questions”. These questions are those which contain two different types of questions enrolled in one question. Never ask two questions at one time. Example: When does your headache increase? Is it by bending forward or bending backward? Tell me about the nature of your headache and its relation to menstrual flow? In such questions, either the patient forgets to answer the second question or tries to find some relation to each. This may not give the true picture of the disease.
10. One sitting may not be sufficient to elicit the entire picture of the patient. This is exactly true in the case of chronic diseases. The reasons are
i. The patient may have forgotten to express some symptoms which are not currently troubling him.
ii. Accessory symptoms of the patient: Some symptoms may have become habitual to the patient. They consider them to be a part of their own life and not a symptom at all. He forgets to mention them during case taking because he thinks that “this is his habit and not an abnormal condition. This does not bear any importance to the physician in prescription”. Such symptoms are called the “accessory symptoms of the patient”.
iii. Some symptoms the patient hesitates to discuss or hides to himself. He may not like to discuss this matter with the other person.
Example: symptoms relating to sexual habits and abnormal structural defects of the body etc.
11. Do not record the symptoms abruptly. Write the symptoms in “chronological order” i.e. according to the time and order of their appearance. This helps in the future to find out the curative order of movement, i.e. Hering’s law of cure. This is the only way to know in the future whether the indicated remedy is curing the patient or not. We can observe that the symptoms are disappearing in “the reverse order of their appearance”.
12. There is no case-taking format recommended by Samuel Hahnemann. The physician according to his convenience, can design his format. The ultimate aim of case taking is to understand the patient’s suffering in a better way and to select a proper remedy.