Case taking points

from A Brief Study Course in Homoeopathy by Elizabeth Wright-Hubbard

A case well taken is half cured, one of the masters said. For a good homeopathic prescription a great deal of information is essential which is not needed in ordinary medicine. The homeopath must know his patient, spiritually, emotionally, mentally, physically and sociologically. He must give as much time as he needs to acquiring this knowledge. He must not prescribe anything but placebo, in a chronic case, until he has it. In an acute case he must know these same factors in so far as they affect the acute condition. Let us suppose that a new patient comes into the office of a homeopath. What is the procedure?

1. The physician must be receptive, like a photographic plate ready to receive the image of the patient. He must clear his mind of other preoccupations and of previous opinions about the patient. He must be tranquil, cordial, and after the first greeting and question What brings you to see me? or Tell me what is that troubles you, he must be silent.
2. The physician must allow the patient to tell his own story in his own way. Questions or interruptions of any sort detail the patient at this stage, and may cause the doctor to lose essential information.
3. The physician must observe from the moment the patient enters. The office should be so arranged that the light falls on the patient. The main points to be noted are:

1. The personality of the patient.
2. His apparent state of mind both in himself and in relation to the doctor (whether depressed, shy, suspicious, secretive, afraid, ashamed etc.).
3. His apparent physical status (signs of disease in gait, complexion, difficulty in breathing, etc.).
4. Traits of character as shown in dress, cleanliness, neatness, pride, etc.

4. The physician must record every item which seems to him important, in the words of the patient, both in what the patient says and in what he himself observes, in a column at the left of his paper, leaving at least an inch blank between the items to be subsequently filled in as the patient reverts to that subject or later, when the physician questions about it. He may prefer to put facts pertaining to history on one sheet or in one column, those pertaining to actual physical symptoms in another, and mentals in a third, but this requires experience and adeptness. It is safer for the beginner to list them all as they come and sort them later in the working out of the case.
5. When the patient has come to a full stop the physician may say, What else? and by waiting elicit much more and often much more valuable information. If the patient is reticent or gives only brief and objective data, and the physician is unable to persuade him to give more, this passive method may have to be abandoned in favour of active questioning. The object is to drain the patient dry of what he knows of himself. If the patient is loquacious, time may necessitate the prevention of irrelevancies and the utmost tact is needed to keep him on the main track and yet not loose important side lights.
6. When the patient is through with his story a few remarks by the physician may be in order as to the aid that can be given though our remedies and the necessity for special knowledge of the patient as a whole and many details ordinarily overlooked. This pleases the patient and insures cooperation in answering the often rather intimate questions which must follow.
7. The data needed for an ordinary medical history may hardly have been touched on up to this point and should not be inquired into even yet. If by this time the consultation period is over, if the patient is not in acute pain or distress, or has not come from a long distance, a subsequent appointment should be made for the next day if possible, and the patient should be definitely told that the physician must do a complete physical examination and the necessary routine laboratory tests at the next visit. Instructions for bringing a 24 hour urine specimen should then be given. This makes the patient realize that in addition to the interest to all details of the case the physician is going to be thoroughly scientific.
8. The physician should now take up each item that he has noted on paper and get the patient to tell him more about it. When the patient has exhausted all that he can tell about each item the physician should bring out the modalities, if, for instance, the item is pain in the stomach and the patient volunteers that it is burning and has no relation to meals and no radiation, the physician must find what aggravates or ameliorates it, what time it occurs, its concomitants, its relation to mental states, if any, etc. When each item has been so modified and filled in, the physician must run through the list and see which of the possible mentals, generals, particulars, and modalities have not been mentioned and question the patient about each of these.
9. All questions that the physician asks must be so put that the patient cannot reply with a simple Yes or No but must think before answering. The physician must be careful never to suggest an answer by the form of his question and must guard against questioning for the symptoms of a particular remedy which may have come to his mind. If he has seen a fairly definite remedy picture in the patient's story and wished to clinch it he must take special care not to lead the patient into the answer he desires, and may even suggest the opposite, and watch the reaction.
10. When the physician has covered the fields outlined above in detail, according to a systematic out line, which the novice should have before him during the interview and which the master knows by heart (we append a suggested one), he must make sure that he has questioned the patient on every system and function, otherwise some important detail will be missed which might prove a keynote suggesting the study of one or more remedies.
11. The mental symptoms and characteristics of the patient (which, as will be brought out in a later lecture, are the most important if strongly marked) should usually be elicited last when the patient's confidence has been more fully gained. Especial tact and insight on the part of the physician are needed to evaluate the emotional causes of disease, for instance, few patients would know that ailments from mortification might be the most important symptom in their cases, or that suppression of sex needs or anger might rank as a leading cause in their illness.
12. At the close of the interview the patient must be made to feel that the physician is deeply interested in his case, that he will take the hours needed to thoroughly study up) (to repertorize) the case, and that the special method of homeopathy can bring not only relief but also a fundamental improvement in the whole constitution which will tend to ward off subsequent illness and increase the powers and well being of the patient. A thorough physical examination and the routine laboratory work, or any extra tests suggested by the history, must be done on every new patient and at least yearly on old patients, and the patients instructed as to why they should not use other drugs during homoeopathic treatment what the dangers of suppression are, when they should report back, and what they may expect as the immediate results of the treatment. One other point may be valuable in knowing the patient and that is to get the version of the immediate family or close friends. This is sometimes dangerous, as nervous patients hate to know that they are being talked over, but the wise physician can take much contradictory evidence and arrive at a more just and sympathetic evaluation of the case. By this time the physician should have a remarkably accurate picture of the patient in all his phases subjective, objective, pathological. From this totality of symptoms he can, by correctly evaluating the symptoms as we will show in a subsequent lecture, derive a true image of the patient and the remedy.