Case Taking - quotes

“A properly taken case is more than half cured…” - Garth Boericke, M.D. [6]

1. Attitude

• Start with a clear mind and be polite. [1]
• Let the patient know you are concerned for their health and that homeopathy will bring fundamental constitutional improvement (immune system strength) to them. [1]
• It is of utmost importance that the interviewer be interested and concerned with the welfare of the patient. [9]
• There should be no implication of judgment by the homeopath. Advice should not be offered and moral injunctions should be avoided. [9]
• Restrain your conversation. Let them tell their case their way without interruption. [1]
• We are told in our allopathic studies not to believe the patient, ask as few questions as possible and believe only what we see. The homeopath must do his best to create an atmosphere of confidence and benevolence and try to comprehend the human being who comes to be helped. [3]

2. Interrogation

• Extensive description of the precise kind of information needed in homeopathy and particularly the use of homeopathic questionnaires should be avoided. This makes the patient focus on insignificant details. [9]
• Ask What brings you to see me? or Tell me what is that troubles you, and then be silent. [1]
• When they have finished, ask “What else?” Keep the talkative patient on track with small comments and the quiet patient talking with questions like “Anything else about…?” [1]
• Elicit the more delicate symptoms by commenting about the beneficial way that remedies affect the entire person and the importance of knowing the whole patient [1]
• After the patient’s story go back to each item and get the details that didn’t tell you such as the modalities. Question them about any they have left out. [1]
• Refer to Schmidt’s wonderful questionnaire after the patient’s story. [7]
• Don’t ask yes-or-no questions. (“Are you thirsty?”) [1]
• Don’t suggest an answer (“You don’t stand the cold very well, do you?”) [1]
• Don’t confirm a remedy that has come to mind with questions. Schmidt calls this the torpedo method or torpillage. (“Are you generally worse between 4 and 8 p.m.?) [1, 3]
• Don’t ask the patient to choose between two alternatives. Let them find their own choice. (Do you prefer dry or wet weather?) [3]
• When questioning about one symptom, finish it before moving to another one. Skipping around confuses the patient and scatters your ideas. [7]
• If a question brings no answer let it alone, for he does not know or has not noticed. Questions giving a choice of answers are defective. [5]
• When asking what illnesses the patient has had and how he recovered, pay attention to whether they fully recovered or they say “hasn’t been well since.” [7]
• Keep an outline of questions handy until you know it. [1]
• Go after the more delicate symptoms of mental and emotional states at the end after you have been with the patient for awhile to gain confidence and better details. [1]
• If you have the ability to get a close family member’s or friend’s information about the patient without making the patient nervous then you may learn more. [1]
• Verify symptoms with cross-questions when you don’t think the patient well understood or well answered the question. (He feels worse after meals... Ask “If you have an important matter to decide, or a delicate letter to write, or some important call to make, would you do it at 2 p.m.?)[3]
• Accept no diagnostic suggestions or pathological theories or former opinion of other physicians as these are deceptive guides for the selection of a drug. [6]

3. Observation

• Observe closely: [1]
  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.
• The chief signs are those symptoms that are most constant, most striking, and most annoying to the patient. The physician marks them down as the strongest, the principal features of the picture. The most singular, most uncommon signs furnish the characteristic, the distinctive, the peculiar features. [8]
• Gathering concomitants that all point to the simillimum will create a true characteristic, otherwise just ignore them. An affected organ may only be able to show concomitants which then becomes the only guide for selection of a remedy. [2]
• Most subjective symptoms are so indefinite or so common that they have little importance. If it occurs in an unusual place, that’s important. [2]
• A reply without a change in expression regarding likes and dislikes doesn’t really indicate a symptom. [3]
• Notice any alternation of symptom groups, such as bronchial symptoms, skin manifestations, gastric, and rheumatic complaints. Also seasonal and periodical variations. [6]
• Listening actively means using your imagination and sensitivity to live the experience of the patient. This pondering of what makes the symptom in the patient will allow you to ask questions that further reveal the symptom. [9]

4. Recording

• We cannot depend upon our memory in taking the case, and getting the case properly before us for analysis. The picture must be preserved in indelible form so that you can review it without leaving out any important symptom. [7]
• Always get the patient’s age, occupation, marital status, hair color, eye color, complexion, any peculiarity of the patient as to form, appearance, size, etc. [4]
• Get relatives death causes, consumption, asthma, cancer, tumors, scrofula, hives, erysipelas, skin diseases of any kind, or any other chronic complaint, or any peculiarity of either side of the family. [4]
• Record all the important points in the words of the patient, both in what the patient says and in what he himself observes. [1]
• Put the symptoms 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. [1]
• Arrange your record of symptoms into three columns. The first one contains the dates and prescriptions. The second contains the distinct symptoms as headings and the third are the modalities. Otherwise, it’s defective. [5]
• Put a mark by or underline the symptom that you need to go back and ask about later to get more details or verify. [3]
• Use underlining to prioritize the symptom’s clarity, intensity and spontaneity in the following manner: [9]
  1. No underlining: Symptoms are hazy, not given spontaneously, and not perceived as very intense by the patient.
  2. One underline: Symptoms of greater clarity and greater intensity, yet still elicited only upon questioning.
  3. Two underlines: Symptoms of great clarity, moderate intensity, and volunteered spontaneously.
  4. Three underlines: symptoms with the highest clarity, great intensity, and given entirely spontaneously by the patient.

• You should have a bound book. Use the left hand page for recording symptoms and the right-hand page for the modalities. [10]
• Discount symptoms to be expected from the pathology present. Thus anxiety in heart disease, paræsthesia in anæmia, œdema in nephritis, hunger in thyroid and gastric ulcer, and depression in constipation. [6]
• If you are dealing with an acute condition, don’t dip into the chronic symptoms that have been present at other times. The chronic will retreat in an acute explosion and at the end of the acute attack, the chronic will return instead of what people think is the aftermath of the acute symptoms.[7]
• Note results of previous diet, local and physical treatment, for often the true symptomatology is obscured by previous treatment and a period of observation is desirable before homeopathic treatment is instigated. [6]

5. Time management

• End the appointment after the patient’s story and continue in another session if necessary unless they are in acute pain or distress. [1]
• A medical history, physical, and lab tests should be done at the end of the questioning.[1]
• The maximum number of chronic cases that you can do in a single day is hardly two or three. [10]

Bibliography

1. A Brief Study Course in Homoeopathy, Elizabeth Wright-Hubbard, M.D.

2. The Study of Materia Medica and Taking the Case, C.M. Boger, M.D.

3. The Art of Interrogation, Pierre Schmidt, M.D.

4. What the Doctor Needs to Know in Order to Make a Successful Prescription, James T. Kent, M.D.

5. Lectures on Homeopathic Philosophy, James T. Kent, M.D.

6. A Compend of the Principles of Homoeopathy for Students in Medicine, Garth Boericke, M.D.

7. The Principles and Art of Cure by Homeopathy, Herbert A. Roberts, M.D.

8. The Lesser Writings of Samuel Hahnemann, Samuel Hahnemann

9. The Science of Homeopathy, George Vithoulkas

10. Chronic Disease - Its Cause and Cure, P.N. Banerjee