Case Taking Ann Haw, September 2008 There are two important and distinct parts of Homeopathy: 1. Knowledge of the Materia Medica 2. Knowledge of the patient The art of Homeopathy is to match the picture which the patient presents with one of the pictures from our extensive materia medica. We often recognize parts of these pictures in patients, or ourselves, but it can be extremely difficult to decide which part of the case needs to be treated, and which of the symptoms best describe the central core disturbance, which runs throughout the whole case. Techniques of eliciting the information which we need, are absolutely essential to the successful practice. Having said that, I have also realized that every practitioner needs to develop their own style of practice. It is all about establishing a line of communication between you and the patient, so that the patient can show you, or tell you what needs to be treated. The patient can even name the substance which will heal him, if you can access the deep unconscious material. . What do we need to understand from the patient: - Diagnosis - The complete symptom - Accompanying changes - Generals - Mentals - Particulars ”. It is not really about which school of homeopathy you wish to study, but of the basic philosophy, that you need to enter into a relationship with your patient, which will allow you to understand their “dis-ease”, in a deep and holistic way. I try to use techniques which allow the patient space to give us all the information we need, keeping direct questioning to a minimum. The truth lies within each person. You have to believe that the patient would not have consulted you, if there was no chance that between you, you could work out, what needs to be healed, and how to heal it. Our anxiety about finding the correct remedy, can blind us. Trying to fit patients into remedies, stops us from listening and observing, and allowing the story to flow. I have had to discipline myself, not to start thinking of remedies, the moment I meet the patient. If you think of a remedy, write it down, and then forget about it. You might well come back to this later. Passive Case Taking: Receiving the case: This means sitting back in your chair, and inviting the patient to tell you everything about themselves, and what is troubling them. This might sound easy, but believe me it is really hard to sit back and say nothing. During this time it is important to observe everything about the patient. This might even start in the waiting room outside. How is the patient behaving? What are they chatting to the secretary about? What are they moaning about? How hurried or laid back are they? The secretary can be a big help here. Observations: - Clothing - Appropriate dress for the weather or otherwise - the seat they take - Posture - Handshake - Gestures Speech - Loud/ soft - Clarity - Vocabulary - Hesitation - Repeating - Words or phrases which are used often, in different situations, or to describe different things. - Words which are accompanied by hand gestures, particularly when these gestures are repeated in different parts of the case. - Words or phrases which are out of context, out of proportion, or strange, rare and peculiar Active Case Taking Here you will use more direct questions, and perhaps explore deeper, into parts of the case which you suspect might lead you to important clues of the central disturbance. Some homeopaths use this kind of approach right from the start. I find with some patients, you have to start like this, in order to get them talking. You can be flexible, and experiment with what works for you and your patient. Questionnaires Questionnaires given out before the first consultation may be helpful, but I find that you get more information about what the patient is like, by how he approaches the questionnaire, than the actual contents of his answers. Direct questions Answers to questions can only really be trusted, when these are given with enthusiasm or energy behind them. “Do you like heat or cold?” “Oh doctor I simply cannot survive the cold in winter, it goes right through me”, must be taken note of, but “I think I prefer the summer” is of no use. The Mumbai School: The Indians describe what needs to be healed as “Two songs being sung; the one is human, the other non-Human. It is this non human song which needs to be treated, so that, that which is healthy in human life can flourish The technique of accurately following peoples’ language is very interesting. When you pick up phrases which are being repeated, or which are out of context, or strange; particularly when accompanied by hand gestures, repeat the phrase exactly as the patient has said it, and ask him to tell you more about that. It is quite extraordinary how the person can open up like this. Never assume you know what he is describing. Ask him to tell you exactly what he means, or what he is experiencing when he shows you that. This can be like catching onto the tail of the tiger. Gradually as you follow it in, the whole picture suddenly becomes clear. The patient may start talking absolute nonsense, but you get a very accurate description of the sensation which they experience. Be careful of being too caught up in the story of their lives. It can be very time consuming, and it is easy to become drawn into emotional sympathies, which are sometimes distracting, to our objective understanding of what needs to be treated. Recognizing Themes: This can simplify your life greatly. It is a form of classification which helps to narrow down your choice of remedy.