Dr Stuart Close’s instructions on case taking in Homoeopathy

Dr Stuart Close’s instructions on case taking in Homoeopathy  Based on  chapter XII- “Examination of the patient ”  from the book  ‘‘ THE GENIUS OF HOMOEOPATHY ’’

Dr Jayadeep BP BHMS MD(Hom)

First of all he is reminding us that the purpose of our examination of a patient is to make a successful homoeopathic prescription

The physician should keep in mind that our method of examining a patient varies according to the particular end in view that is ‘homoeopathic prescription’

The technique of an examination for the purpose of diagnosing the disease is quite different from that of the examination for making a Homoeopathic prescription

He says physician, as an ideal, is greater than any medical specialist

He assures that the student who knows the nature, constitution, forms & varieties of symptoms necessary for the homoeopathic prescription will find many things in a case than that of others who are specially trained only in pathology & general diagnosis, as they will entirely overlook

The selection of the homoeopathic remedy is based very largely & sometimes almost entirely upon the phenomena or deductions drawn from the phenomena of subjective, conscious experience, perceived only by the patient & stated by him to the examiner

The most important thing in case taking is that with very few exceptions the most valuable indications for the remedy are to be found; they include  -subjective morbid sensations & phenomena which come with in the sphere of the patient’s own experience & are perceptible to him alone and  objective signs

We must of course, depend entirely upon the statements of the patient himself

In our special examination we should endeavor to put ourselves upon such a footing & in such personal relation to the patient as will best favor a full frank revelation by him of all the circumstances & conditions that have led up to his illness & his sufferings

We can brief to a new patient about the special purpose of homoeopathic examination & to point out how it differs from the ordinary examinations

GUIDELINES FOR CASE TAKING

• Consider two parts in examination of a patient
  • Getting the history & symptoms from the patient’s stand point first and
  • Physical examination
• If the physical examination is made afterward when the patient is composed there will be less danger of confusing or prejudicing his mind
• The first part should be done in an easy, semi-conversational manner. We should make him forget that he is under examination
• We must first gain patient’s confidence & relieve him from the sense of restraint & embarrassment

The physician’s attitude should be

• Calm & dignified, quiet & sympathetic
• A demeanor confident, but not pompous
• Simple & direct, but not aggressive
• Cheerful but not flippant
• Serious, but not grave or funereal
• Should be painstaking & systematic without being overformal
• Senses must be on alert, mind clear, logical faculties acute
• Sympathies & prejudices held in abeyance

We should try to put the patient at his ease by adapting ourselves to his personality and mood

Should not confuse the patient by a too penetrating gaze at some objective feature which may attract our attention; if patient sees us gazing fixedly at some part of his anatomy, he is likely to become anxious & forget other matters which are important

Nervous patients will easily gets distracted by some simple procedures of examination so it is best to postpone such examinations in them

The patient should be encouraged to tell his story freely, in his own way without interruption & keep the patient talking but say little yourself during an examination

Patient should feel that he is relating his troubles to a sympathetic friend who has resources at hand to help him

We can give a starting by asking when & how his trouble began

We shouldn’t laugh at him nor pedantically correct his errors

We shouldn’t ask leading questions nor put words in his mouth because afterwards we can analyze, complete, correct & interpret his statements in accordance with the homoeopathic principles of symptomatology

It’s well to leave a space between the symptoms so that we can easily glance back over the pages & helpful to complete the symptoms by putting few more questions

To make 3 vertical columns in the page for collecting symptoms like

[1] Date & remedy             [2] symptoms                   [3] modalities or conditions

• Shouldn’t hurry a patient in his narration, may quietly keep him to the point & prevent him from rambling inconsequential statements by maintaining an attitude of business- like absorption in the medical features of the case
• He should determine what features of the case are medical, surgical, psychological, hygienic, sanitary etc
• Should keep some working classification of symptoms as- general, particular & common symptoms in mind
• If we are to generalize correctly we must have all the facts & be sure of them
  • First analysis –facts from patient’s statements, nurse’s, relative’s, or friend’s statements & then our own observations
• Then synthesis- review & study of symptoms & construction of the case
• Comparison of symptoms of the patient with the symptoms of materia medica, in repertory & final selection of indicated remedy
• It’s well to practice on the simple cases first, in order to become familiar with the technique
• Asking to read “Organon of medicine” as it helps to frame our questions
• Laziness, selfishness & easy conscience are responsible for more homoeopathic sins & shortcomings than anything else. The physician should get rid of these
• There must be a constant warfare within ourselve, until they are conquered by the establishment of correct methods & practice & a genuine interest in the work is evolved
• Prejudice & doubt may be overcome by reflection, study, self discipline & autosuggestion by cultivating the scientific spirits, strengthening morale & correcting mental attitude  & should develop a more accurate, more practical & comprehensible technique
• Obstacle like modesty from patients, from young & inexperienced physicians to be overcome

GUIDELINES FOR CLINICAL HISTORY RECORDING
Getting a good clinical history is one of the most important & usually most neglected part of case taking. Following Instructions should be followed

The complete list of patients previous diseases, from childhood down to the present, in chronological order with ages at which the attacks appeared, their nature, symptoms, duration, severity & sequel should be recorded-in both acute & chronic diseases

• In women & girls enquire about the menses, age at which established & regularity of the periods, deviations from the normal; time & influence of marriage, childbirth etc
• Vaccination history and Treatment history should be inquired into
• Personal history like accidents, mechanical injuries or any mental shock should be inquired
• Occupation, habits of patient, diet, exercise, sleep, use of tea, coffee, tobacco should be noted
• Family history- a brief history of diseases, causes of death, predisposition & tendencies to diseases & individual peculiarities of brothers, sisters, father, mother, uncles, aunts, grandparents etc if possible
• These all examinations gives the patient a confidence in the physician’s professional ability & skill & feels that he is interested in them & their families & “knows all about him”
• A properly & systematically structured case record will facilitate the process of good history & case taking
• The examiner should be alert & observing while making an oral examination
• If the patient is confined to bed the examiner will observe his position in bed, his manner of moving or turning, his respiration, the state of his skin, color or odor of perspiration, odor of exhalations from mouth or body; physical appearance of excretions, relation of the patient’s sensations to atmosphere & temperature as shown in amount of covering, ventilation of room, ice bags, hot water bottle etc will be valuable guides in the choice of remedy
• Mental symptoms are of higher importance & getting them by observing general behavior, the conversation, the expression of countenance, desires & aversions & the manner of sleeping, voluntary verbal expression etc
• Expertness in observing & analyzing these features of disease should be cultivated because right conclusions & effective treatment often depend more upon the physician’s own observations & directions than upon anything that others or even the patient are able to tell him.

Conclusion

• Attention should be directed to the use & importance of logical analysis in the symptomatic examination of a patient
• Should have close analysis to all elements of the case
• Concludes that to discover & bring out the facts of a case & give them form & individuality as a whole is an art