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 AIM and ART of CASE TAKING

 

Case taking is one of the most important aspect of homoeopathy from the view point of patient and doctor, because every thing which leads to the selection of the remedy depends on the information obtained there of. If the information is precise and exact, definitely it will lead us to cure. Hence, it is rightly said that a well-taken case is half solved.

 

Many doctors prepare themselves to a premeditated style of case taking; some give Performa to be filled in by the patient, and some other do an exhaustive inquiry so as to bring out the inner man out. At times, the process becomes so lengthy and exhaustive that the patient becomes bored.

 

The first and foremost thing is that we have to be very clear about what we are going to search in a patient and how to reach there. Then the cumbersome process of case taking can be cut short and the meaningful information can be spotted easily.

 

Let's first understand what Dr. Hahnemann has instructed to do.

 

In the early year of his practice, when he tried to find the similibus and the affinity for that particular organ or disease, the Master faced failure. Then after deep thinking about the matter for a long time Hahnemann came to conclusion that what is taken for prescription is a mere fragment of the real sickness. It needs further and more reliable information so as to choose the right indicated medicine. What was that? - It is the man which has to be taken into consideration, not the organs or the diseases. After this experiment, it really brought the revolution in the field of his practice.

 

It means, the whole journey of the case taking is to understand the man who is in question at the moment. Every case needs a full exploration to understand to prescribe.

 

Now, the question which is very pertinent here is, 'What MAN?' Many people misunderstand it and start compiling the symptoms from head to foot, aggravations / ameliorations, concomitants and all that.

 

It is not a mechanical or mathematical sum of the symptoms the master had spoken of, but it is that scientific, logical information or the group of symptoms which establishes the individuality of the patient. it is the particular individual who is to be treated, and nothing other than that. The aim of case taking is to reach to this individual. Once the set of symptoms found, which establishes the individuality, it will give us the perfect similibus. 

 

Dr. S.F.C. Hahnemann has given utmost importance to that mental state of the patient, which he used us a decisive phenomenon, so as to select a remedy. No doubt, Master Hahnemann and his followers had also used physical symptoms very well to prescribe. But, Dr. J. T. Kent has written that Homoeopathy treats the man and man is in the mind. It is the mental state which establishes the individuality very precisely. Prescribing on mental state means directly touching the deepest layer of the man which uproots the disorder from the root.

 

Agreed that Dr. J. T. Kent also used physicals, but, it was very clear in his mind that 'Homoeopathy treats the man and man is in the mind'.

 

To understand the mental state of the patient is not an easy task. Even the most experienced man in the profession can be misled. It was Dr. Kent who stressed most on the mentals, but his literature shows that he used physicals also to a great extent. To bring out the mentals in each and every case is again a very tedious task, not possible for a new comer to the profession. So what happened? The mental section remained unused to great extent.

 

I would like to tell you that the most significant and most important thing i.e. the state of mind, which we need to prescribe on, patient gives us very vividly. But if we are not vigilant enough, it passes without our notice. We need not to do any premeditation or pre-assignments to make some exhaustive inquiry. What we need is to be alert and receive information from all the sources, as it is.

 

In the early days of my practice, i use to wonder, why some patients behave rudely with the physician, sometime very nicely and some others very impatiently, irritated, angrily, dictatorial etc.

 

Why a patient touches your feed whereas others quarrel. Many a time, patient quarrels with the doctor, which is really an embarrassing situation for any doctor. Why someone cries and other laugh in your clinic. Mind it! All these are very important. HOW and WHY, are two things which take you to your destination, to work out for the similibus.

 

Taking a case is very pleasurable job. The most you can do about it, is to vacate your mind before meeting a patient. Accept the things as they are coming to you, never color them. Don't paint them with your knowledge. Don't try to make a judgement which is very scientifically supportive. The only thing required in the part of physician is to have a pure OBSERVATION. Everything, every experience of the past is true, but what is happening before you at the moment of encounter with patient, is the only fact and most valuable in regard of that particular individual.

 

When a patient approaches you, it is very important to know that what made the patient feel like coming to you and to seek your help. Many a times, very decisive and eye opening aspects are explored very tactfully, to bring out the inner feeling of the man.

 

Following two lines are very precious:

 

  • What the patient says? How he says?

  • What he does? How he does?

Wherever we are in doubt, we should go ahead with the help of these above two lines, asking queries to the patient in the perspective of clearing our doubts. Please don't forget that during the whole discussion with the patient, utmost care should be given to the tone and intensity of language and words used. Many times, patients use a particular sentence time and again. What is the meaning of that in the patient's point of view? It is the most significant line in case taking and all the emphasis should be given to the patient's view point.

 

LET'S DISCUSS A CASE:

 

A case of persistent dry spasmodic cough came to me few days back. The lady complained that every time she lie down cough start and it does not stop. She said, "Doctors told me that it is in allergic problem, it can take sometime. If I take anti-allergic, I find relief but it recurs as soon as I stop it."

 

"Further, I cannot take those medicines because it causes lot of other problems. i cannot sleep at proper time because of this cough. I have other problems, like BP, pain in joints etc. Now, it is for quiet sometime, may be two years, My husband died three year back, our family is the joint family, many members of my family are taking medicines from you, and so I thought I should consult you."

 

This was the information given to me by the patient on her own. Now, the problem is from where I should start putting questions? is there my entry point? Yes! When you start exploration, never go away from the patient's context. The point of her interest which has become the issue for her is to be spotted out. What are those?

 

Patient's version is full of information which has to be explored. If we give a superficial look to this information, perhaps it is only cough which is the matter of concern. But to disclose about  family status, members and death of husband was a bit eccentric, which fascinated my attention.

 

Then I asked her a question 'How her husband died and what rest of the family members does?

 

Then she told me, "Doctor, you know that he was elder to everyone in the house. After his death, it is 'Me' who has to look after the house and every other thing. But this cough does not let me sleep at appropriate time and to get up at the appropriate time."

 

I asked her, "The medicines (allopathic), you are taking, gives you relief then why don't you continue those medicines?

 

She replied, "If I take those medicines, I get relief, but my sleep gets extended beyond morning time."

 

Dr. - "What else do you want?"

Pt. - "Actually, doctor, you know, if I would not wake up after midnight, anybody can enter my house and take away all the valuables? It is my responsibility, since I am the eldest in the house, to take care of everything and everybody. The elders are always supposed to worry about all these."

 

I reached t two things:

 

The lady has her own mind-set that she is bounded by principles of her socio culture traits to which she confirms her action. It gives us two rubrics:

 

  1. CONFORMISM

  2. RESPONSIBILITY - taking responsibility too seriously

 

I prescribed her a does of Kali-carb 30, which settled all the problems. She had relief in sleep. She could sleep and wake up accordingly to herself. Then, a lot of phlegm coughed out and ultimately she was settled in a very small time.

 

I visited that place again after two months and met her. She told me that she keeping fine. Moreover, the responsibility that seemed to be so important is not troubling her much. Now that feeling of responsibility has gone because of which she had to keep awake at night. She can sleep well at night.

 

So, what I mean to say that it is not always the say of the patient which matters, but what is behind it, is of great significance. 

 

Dr. Prem Sharma


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In the early days of my practice, i use to wonder, why some patients behave rudely with the physician, sometime very nicely and some others very impatiently, irritated, angrily, dictatorial etc.

 

 

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