Case taking and analysis www.facultyofhomeopathy.org

What is a homeopathic consultation? When does the consultation become homeopathic ? Ask the audiencewhat they think What makes them think of a homoeopathic approach ? www.facultyofhomeopathy.org

Why choose to open up the possibility of a homeopathic treatment ? You were recently on a course Colleague referral Patient request Well established indication Strange, rare or peculiar symptom Importance of attending courses “Fat” notes and “heart sink” patients Colocynth and colic Burning pains > heat www.facultyofhomeopathy.org

Two Goals of The Homeopathic Consultation Understanding the patient’s illness Finding the remedy Chase the remedy, lose the patient 5 Failings of Physicians, The Yellow Emperor’s Classic of Medicine (200-300 years BC) 1. failing in diagnosis 2. failing in treatment, when physician neglects the patient’s emotional experiences 3. failing in deductive reasoning, without careful observation and history 4. failing in counselling, lacking compassion and sincerity 5. failing when simply inept and careless when administering medical care, www.facultyofhomeopathy.org

Koelher p. 68 - 85 “ The aims of case-taking are initially the same as in modern medicine generally. A diagnosis is to be made where possible. The prognosis is determined and assessed. A treatment plan is drawn up.” The Handbook of Homoeopathy Gerhard Koehler Organon para 3 If the physician clearly perceives what has to be cured in disease (knowledge of the disease) if he clearly perceives what it is in medicines which heals (knowledge of medicinal powers) if he applies in accordance with well-defined principles what is curative in medicines to what he has clearly recognised to be pathological in the patient, so that cure follows i.e. if he knows in each particular case how to apply the remedy most appropriate by its character (selection of the remedy), prepare it exactly as required and give it in the right amount (the correct dose), and repeat the dose exactly when required, and, lastly, if in each case he know the obstacles to cure and how to remove them, so that recovery is permanent, then he knows how to treat thoroughly and efficaciously, and is a true physician www.facultyofhomeopathy.org

Koelher p. 68 - 85 “A patient’s signs and symptoms provide the material for finding the appropriate homoeopathic drug ...................... the next stage is the encounter with the patient.” www.facultyofhomeopathy.org

The “Encounter” Understanding the patient Ask the patient for examples Try to put yourself in the patient’s shoes The practitioner’s attitude www.facultyofhomeopathy.org

Koelher p. 68 - 85 Preconditions for good history-taking calmness, time, patience, unbiased attitude, careful attention Organon 83 This individualizing examination of a case............................demands of the physician only impartiality, sound senses, attentive observation, and faithfulness in recording the disease picture. www.facultyofhomeopathy.org

Vithoulkas p. 169 -189 “the environment should be quiet, with harmonious, simple, esthetic decor.” Vitoulkhas The Science of Homoeopathy www.facultyofhomeopathy.org

The Homeopathic History Presenting complaint Past Medical History, Family History, Drug History, Social History, Allergies “Complete Symptoms” ? normal so far What is a complete symptom ? www.facultyofhomeopathy.org

What is a “Complete Symptom” ? Aetiology Localisation Sensation Modality What preceded it? Where exactly is the symptom experienced? What exactly is the sensation ? What kind of pain ? What if anything modifies the sensation ? www.facultyofhomeopathy.org

The Homeopathic History Generals Appetite Food Aversions Desire Aggravations Thirst Sleep and Dreams Typical physiological questioning www.facultyofhomeopathy.org

The Homeopathic History Generals Temperature Perspiration Weather Time Menses Hot person or cold person? What about in bed? Are there any time patterns - either locally or generally www.facultyofhomeopathy.org

The Homeopathic History Other systemic enquiry Mental symptoms www.facultyofhomeopathy.org

The Homeopathic History Mentals How would you describe yourself ? How would others describe you ? May want to actually ask others - eg. parents of child www.facultyofhomeopathy.org

The Homeopathic History Mentals Anxieties Fears Depression, apathy Lack of self-confidence Irritability, anger Sensitivity, tears Do you worry about anything? Are you afraid of anything - dark, animals, thunder? Do you get down? What makes you angry? What things upset you? www.facultyofhomeopathy.org

The Homeopathic History Mentals Quality of relationships company consolation confrontation contradiction jealousy sexual function Emotional responses revealed in human interactions Can the audience name any remedies with clear features around these areas? www.facultyofhomeopathy.org

The Homeopathic History Mentals Cognitive function Memory Concentration Mistakes Delusions Poor memory for what? - repertory - Memory and forgetful - esp. “words” - “word-hunting” - patient with Bothrops Concentration difficult - studying - and cross-reference thoughts wandering, studying (ham, phys) Mistakes for what? www.facultyofhomeopathy.org

Recording the History Where to record the history www.facultyofhomeopathy.org

Recording the History How to record the history one symptom per line underlining clarity intensity spontaneity Organon 84 He write everything down exactly, including the verbatim expressions of patient and relatives. Whenever possible he remains silent to let them finish what they have to say without interrupting them, as long as they do not digress unduly. Organon 85 The things the patient or his relative say should be written down on separate lines so that all the symptoms appear seperately, one above the other. In this way the physician can add to any one of them that is too vague, in the begining, information subsequently stated more clearly. Vithoulkas p 182 No underlining. Symptoms which are hazy, not given spontaneously, not perceived as intense by the patient 1 underline. greater clarity and intensity but elicited only on questioning 2 underlines. great clarity, mod. intensity and volunteered spontaneously 3 underlines. highest clarity, great intensity, entirely spontaneously given www.facultyofhomeopathy.org

Recording the History How to record the history margins for remedies marking selected symptoms with an asterix recording sheets www.facultyofhomeopathy.org

Making Sense of it all Diagnosis Prognosis www.facultyofhomeopathy.org First understand what is going on then have some idea of where it might go - with and without treatment www.facultyofhomeopathy.org

Quality or “Precision” of symptoms Characteristic, striking and unusual symptoms Spontaneous symptoms - with emphasis “Complete symptoms” Long-standing or new symptoms which are deteriorating Relationship to Vithoulkas’ underlining scheme www.facultyofhomeopathy.org

Making sense of it all What symptoms are important to the patient? What symptoms are you trying to “treat” ? “Complete symptoms” “Strange, rare and peculiar symptoms” Where is the level of disturbance ? What is the centre of gravity of the case? www.facultyofhomeopathy.org

“Complete symptoms” Aetiology Localisation Sensation Modality www.facultyofhomeopathy.org

The level of the disturbance Peripheral - “local” Physiological - “central” or “general” Mental cognitive emotions ? examples injury thyroid disease grief PNI - the connections www.facultyofhomeopathy.org

Ranking order of symptoms SRPs - Strange, rare and peculiar Aetiology Mental and intellectual symptoms General symptoms relating to the whole person Local symptoms with modalities &/or concomitants www.facultyofhomeopathy.org