Taking the Case by Richard (CCH Graduate 2017)

case-taking

Introduction
It is clearly very important to be able to get as much relevant and accurate information as possible when taking the case of a patient.  Without obtaining the information required it is impossible to select the correct remedies and potencies to cure the patient.  For Homeopaths this means covering the mental, emotional and physical symptoms and in some cases spiritual symptoms of the client because we believe these areas are all linked and have an important impact on each other – in other words we take a holistic approach to curing the patient.

The information needed by the homeopath to select the right remedy and potency and cure the patient falls into three categories:

  1. Knowledge of homeopathic philosophy and principles of practice
  2. Knowledge of homeopathic Materia Medica
  3. Knowledge of the patient

Taking the case is all about the third item on the above list namely knowledge of the patient and involves obtaining the symptoms through examination of the patient.   The first interview will take at least an hour maybe more where it is important to obtain both objective and subjective symptoms with accuracy and detail.

It is also important to mention that a  well taken case is a valuable experience for the patient as well because it becomes an opportunity to consciously examine the most crucial and intimate regions of his or her life. Whereas a poorly taken case will end up as frustrating for all concerned and remedy selected will most likely be based on mere guesswork

Aim of Case taking
The aim of case taking is to obtain symptoms on which the Homeopath can prescribe.  These enable us to:

  • Select a remedy
  • Make a good choice of potency
  • Assess need for any other appropriate treatment

It is important to point out at this stage that prescribing symptoms can be very different from the presenting symptoms which are those that the patient is complaining about.  Presenting symptoms may not be important to the Homeopath as they could just be an external manifestation of the real problem within the patient.   However as the presenting symptom is important to the patient it must be accounted for in the totality of symptoms but it may not carry much ‘weight’ for the Homeopath.

To get the good reliable prescribing symptoms the Homeopath needs:

Accuracy

We need to make sure we understand what the patient is actually saying.  For example the patient may say she is afraid of crowds, however there could be different reasons for this.  Is it because she has claustrophobia, dislikes being touched, worries something may happen to her etc. it is therefore very important to write down symptoms in the words of the patient so that we can always check things with the patient later if necessary to ensure understand exactly what is being said.

Precision

For example with pain we need to know exactly where it is in the head, so location is crucial.  Also is the pain shooting up a nerve or is it just in one place.  In addition it is usually much better to get patient to point specifically to where the pain is rather than using anatomical names which patient may not be familiar to the patient.  In other words assumptions are to be avoided.

Objectivity

It is very important for good case taking to ensure we remain the unprejudiced observer in other words uncoloured by our own prejudices. We therefore need to understand what is normal and what is not normal – to do this we need to have a good knowledge of ourselves and culture and environment that we live in.  For the homeopath finding out the characteristics of the case is crucial to selecting the right remedy and characteristics will be shown by those aspects of the case which deviate from the norm for the culture and environment the patient lives in.

The above can be condensed into two main objectives:

  1. Seeking that which is most individual in the patient, in other words their characteristics
  2. Seeking that point of change where the vital force was disturbed or altered. This will lead us to the causation.

To achieve these aims the Homeopath will need to obtain answers to the questions raised in sections below.

Type of Information required to get the characteristics of patient
The section above covered in overall terms the aim and direction of case taking.  This section goes into the detail of the questions that need to be asked of the patient to get the detail required.

Homeopathy treats the person not the disease so it is vital to get the characteristics of the person so that they can be treated Homeopathically. To get the characteristics the following needs to be covered.

Presenting Complaints
As mentioned above these may or may not be important to the Homeopath but in order to confirm whether they are also prescribing symptoms the following needs to be established:

Location – where is the location of the complaint, for example if the patient has a headache is the pain in the forehead, at back of head, on the temples or covering the whole head.
Causation – did something happen either physically, mentally or emotionally around time complaint started which may have caused it.  Are there any ‘exciting causes’ which affect the complaint or ‘maintaining causes’ which are going to have to be dealt with before the main complaint is addressed.
Modalities – what made the complaint better or worse.  For example this could be rest, open air, cold/heat/damp, motion, company, touch, time of day, pressure etc. When considering modalities it is vital to consider only those that are unusual.  Therefore if someone with a headache says they feel worse for noise this is not unusual and therefore should be discounted.
Sensation – taking the example of a headache again  is the sensation of pain, thumping, bursting, a dull pain etc.
Time and duration – Time of day that pain occurs.
Duration – for how long have they had the complaint
Concomitants – are there any other complaints that occur at same or appear to be linked to presenting complaint

General Health
As Homeopaths we need to get an understanding of general state of health of patient as clearly this can have big impact on symptoms.  If for example the patient is on medication this is likely to affect the homeopathic remedy so the first task of the Homeopath in this situation may be to get the patient off the medication.  The questions Homeopaths require answers to regarding general health are as follows:

  • Is the patient on any medications?
  • Does patient take any recreational drugs, alcohol or tobacco?
  • Is their diet different from a normal diet?
  • Are the bowel movements regular, what is their colour, are they smelly or burning and is there any blood in them?
  • In women Menstrual function and child bearing history need to be obtained?
  • Is regular exercise taken?
  • The functioning of various systems of the body i.e. the endocrine, circulatory, gastrointestinal, eliminative, respiratory, skin, etc.
  • What illnesses is patient most susceptible to?
  • Medical History from birth until present
  • This would include physical or mental events and where possible causes of the events.
  • In particular the evolution of state of patient should focus on the following major influences
  • Have there been any mental or emotional shocks occurring in patient life.  This might include such things as griefs, major financial losses, separation from loved ones, identity crises, and other life stresses.
  • Any major illnesses which might have affected the overall health of the patient .  Particularly venereal diseases, prolonged infectious diseases, mental breakdowns or imbalances.
  • Any treatments given throughout life of patient.  Since therapies can frequently be suppressive, this factor can have major importance in the evolution of the pathology into deeper regions.  For this purpose one must consider such things as drug treatment, surgery, psychotherapy, natural therapies etc. Also, cortisone, birth control pills, tranquillisers, antibiotics
  • Vaccinations that have been administered and patient reactions to them.

All this information should be collected into a chronological sequence so that the homeopath can see the stages of development of the current pathology.  Often this enquiry will be very useful for the patient as often they have considered all these factors in terms of their general health.

Family Medical History
Where possible medical history of mother and father should be obtained as well as medical history of maternal and paternal grandparents.  This gives a picture of any possible inherited weaknesses or miasms

Physical Generals
These questions often cover areas of the patient’s life which they may not have considered relevant but are important to the Homeopath to arrive at a totality of symptoms.

  • Tolerance to temperature, humidity, weather changes, sun, wind, drafts, closed rooms etc.
  • Tolerance to different seasons of the year
  • Quality of sleep, quietness or restlessness of sleep, position of sleep, times of waking and reasons for waking, do they like to be covered up, do they like window to be open or shut
  • Appetite, thirst, food cravings, food aversions and food aggravations.
  • Temperature – this would probably need to be observed.  However we need to know whether patient is unusually affected by heat or cold.
  • Dreams in particular ones that are associated with strong feelings or recurring dreams.
  • Overall quality of energy available to function in daily life and under stress or other difficult circumstances.

Mental & Emotional

  • Fears such as being alone, fear of animals, the dark, failure, crowds, death, robbers, heights, illness etc.
  • Emotional limitations – for example depression, apathy, lack of self confidence, irritability
  • Quality of patients life in relationship to loved ones, family, friends and colleagues.
  • Reactions to sympathy
  • Mental symptoms such as poor memory, inability to concentrate or comprehend, delusionary or hallucinatory states, paranoia.
  • What makes patient angry or sad
  • What aspirations do they have.

Observations
Observations such as physical appearance, eye contact, dress, body language, energy level, attitude, mannerisms etc. are very helpful in building up the total symptom picture.  For example a fat fair and flabby person would be a pointer to the remedy Calcarea Carbonica whereas the remedy Bryonia would more likely to be someone who is robust, of firm fibre and dark complexion, patients requiring Phosphorus likely to be tall slender persons narrow chested with thin transparent skin etc. These are clearly major generalisations but nevertheless they are useful in selecting the right remedy.

In addition identifying what psychological type a patient is will also help in remedy selection.  In other words are they extrovert or introvert, are they intellectual thinkers or are they more orientated towards feelings.

Each symptom that is obtained from the answers to the questions above should be explored further for accuracy and intensity.  For example if the patient says they have depression it is important to find out what the patient actually means by this – it could be suicidal desire, suicidal thoughts, despair, discouragement, lack of self esteem, anxiety, pessimism, apathy, lethargy etc.

Also it is important the Homeopath establishes what the symptoms actually mean to the patient.  When a generalised symptom is mentioned by a patient the homeopath should ask such questions which show how the symptom manifests itself in life of patient – for example:

  • If a wife says she feels unsupported by her husband the homeopath needs to establish how this issue manifests itself for patient – does it mean she feels angry, abandoned, rejected, sad, confused, anxious. The remedy selected will depend on response.
  • If a patient says they are anxious you need to establish what makes the patient anxious and what happens emotionally when they are anxious

Seeking that point of change where the vital force was disturbed or altered
As can be seen from the above sections there is a fair amount of information that needs to be obtained from the patient.  However it is not just an accumulation of facts which can be analysed that is important.  The purpose is to accurately arrive at a totality of symptoms which expresses the disturbances and so leads the Homeopath so that inner disturbances of the vital force can be understood and acted upon.

Obstacles to good case taking
When taking the case it is also very important for the Homeopath to be aware of difficulties they may face getting the information they need.

Major events in patient lives:
People are born with certain constitutions – for example slim, attractive, extrovert types.  Identifying this for the Homeopath is an important factor in selecting the correct remedy.  However if for example a major emotional upset has happened to change the behaviour of that person from being extrovert, trusting etc. to being unsocial and less friendly one of the remedies that person really needs could easily be missed by the Homeopath.

This is because the ‘picture’ presented by that person is not their true nature it is in effect a layer on top of the constitution they were born with.  The layer of course needs to be treated but it is also crucial to treat the constitution.

It is often that the symptoms the Homeopath most needs to treat are the very ones the patient least wants to discuss either consciously or unconsciously.

Difficult Cases:
Although as described above the:re are certain pieces of information that need to be acquired in order to make a proper prescription all cases are taken in an individual manner.  However there are certain types of patient who pose particularly difficult problems in getting the information needed:

Timid or withdrawn patients:
These patients either withhold symptoms or describe them with far less intensity than is the reality.  They may also feel the interviewer is not interested in their problems and thereby mislead the Homeopath into prescribing the wrong remedy.  In this situation observations of the patient such as restlessness, excessive irritability,  time taken to answer questions, blushing, perspiration etc. are possibly only way of accurately getting the information needed.

Hypochondriacs:
These people are not only very anxious about their health but go into enormous detail about their health problems as well as greatly exaggerate  so it becomes difficult to see the wood for the trees.  They often want to impress the Homeopath with how sick they think they are.  In this situation the Homeopath needs to keep a strong perspective on what is going on so that they can focus on the real issues.

Intellectuals:
They tend to think that everything is explainable and therefor if something is not explainable they tend to block it from their minds completely.  Therefore they will often explain away or not tell Homeopath about the very symptoms that are the most important ones i.e the most individual or characteristic.

In these situations the Homeopath can end up with many symptoms but all are qualified by the patient for one reason or another and it becomes difficult to assess which are prescribing symptoms.  In other words intellectuals tend to focus on exciting causes for their problems whereas the Homeopath needs to focus on susceptibility to those causes but is often left with a very confusing picture by the patient.

Conclusion
Taking the case is far more than just listening it is asking the right questions at the right time to find out why people react in the way they do both mentally and physically so that their characteristics can be established

Homeopaths trust that the organism knows how to cure itself and is already in the process of doing so but sometimes needs external strength in the form of remedies to achieve cure.  Ensuring that one helps the process by giving the right remedy in the right potency is down to taking a good case taking.

 

 

 

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