Monday, March 9, 2009

Case Taking with Homoeopathic Facial Analysis - - Grant Bentley

Case Taking with Homoeopathic Facial Analysis

 - Grant Bentley

 ND Dip Hom Grad Dip Psych. Th Prof Memb AHA AROH reg ATMS ANPA

- The argument between the academic and the practical

- Different roads leading to the one place?

- Being ideologically promiscuous

- Homœopathic Facial Analysis (HFA) – strong and unchanging

- The two modalities that exist in every chronic disease

- The mentals – not the key to unlocking the remedy

- Generals – more discriminating than mentals

- Physical form is unique – the human condition is not

- 90% of valid information is non verbal

- The body is a vault that keeps past memories alive

- Nature has our best interests at heart

- Our facial features have molded into a design most beneficial for our individual needs

A former patient of mine who has studied homoeopathy for more than twenty years, described HFA as the most usable system she has ever known because of its straight forward simplicity.

 

In any walk of life, professional or technical, there is an age old argument between those who are practical and those who are academic, and in homoeopathy it is no different. Accountants often disagree with economists, while builders shake their heads as they look at the drawings of the architect. There has always been a difference between theorists and those at the coalface. My patient was stating that HFA is coalface homoeopathy. It is designed for the clinic because it comes from the clinic and its membership is dominated by working practitioners whose bottom line is ease and reproducible results.

 

This does not mean theory is irrelevant, but the argument about whether it is practical, is too important to be overlooked. During a discussion I once had with an Osteopath who also studied homoeopathy, he mentioned how there were so many theories in homoeopathy by comparison to other modalities. I replied, 'Wouldn't that be a good thing? After all doesn't this show a thinking profession?' His reply was 'No, it shows a profession that has too much time on its hands!'

 

The problem for him when it came to homoeopathy was not the system itself, but the multitude of competing theories that kept emerging in reference to practice. Most disturbing is how many different theories are adopted by practitioners, as if they are interchangeable and saying the same thing. Some of these theories have entirely different opinions on miasms, remedies and even pathology. Some do not focus on miasms at all while for others they are the central core. Some have different ways of prescribing, different modes of delivering the remedy, different potency scales and different ways of taking a case, yet they are all being viewed by some practitioners as if they are different roads leading to the one place.

 

Many homoeopaths act in a manner that is ideologically promiscuous, sacrificing quantity for quality in a search to repeat the rush that comes from being 'amazed'. Promiscuity never delivers the comfort and depth we instinctively crave. Promiscuity is a short term fix to an insatiable need for stimulation. But a constant need for stimulation comes from a lack of sustainable fulfillment. This is the difference between eating porridge and chocolate. People don't crave what is nourishing and satisfying because satisfaction is the opposite of craving. Cravings occur when satisfaction is momentary but unsustaining, which causes our desire for more.

 

Regardless of whether it is food, drugs or knowledge, jumping from one to another is neither healthy nor productive. It is not professional development that is in question, but the search for the thrill that comes from 'insight' which can be addictive and even dangerous. It is addictive in the way any thrill is addictive, because it leaves you wanting more. This makes some research authors feel pressured into churning out 'discoveries' because of public demand. It also often makes continuous or annual discoveries look suspicious to other researchers, who know how much time it takes to research a project thoroughly. Theories that come out annually will be judged rightly or wrongly as more concerned with supply and demand, than advancing real understanding. This is a practical reality of life; supply and demand drives everything, including homoeopathy, but the problem as always is that anything mass produced often sacrifices quality for quantity.

 

HFA is not a market driven system, because once you know it – you know it. The system itself has remained virtually unchanged since its conception, which shows the strength of its foundation. While the philosophy continues to evolve and expand, getting progressively deeper yet simpler at the same time, (see Appearance and Circumstance and Soul & Survival) the process of applying HFA in the clinic remains fundamentally strong and unchanging.

 

When a patient enters my clinic, there is nothing to differentiate the HFA system from standard classical homoeopathy. In the beginning the consultation centres around the patient's presenting complaint, examining the type of pain they experience including times, aggravations and other factors. Once this has concluded, the consultation extends into the patient’s life story. Generally this takes place easily and naturally because it is rare for any chronic disease not to have two primary modalities. The first modality is that the patient and their symptoms are worse when they are tired. The second modality is that the patient and their symptoms are worse when they are stressed.

 

While these two modalities seem obvious, the ramifications that come from understanding why they exist in every case of chronic disease is so broad they change homoeopathic philosophy completely, and yet still we ignore them.

 

Stars exist in the night sky; they are obvious and have always existed. As a result we don't pay them much attention and treat their existence with the contempt that comes from familiarity. Chronic disease with the modalities - worse when tired or stressed, is in the same position as the stars in the sky. Stars are not just little lights that twinkle when it gets dark, they are nuclear powerhouses that drive the material universe, and by understanding stars we can understand the origins and make-up of how life began. Accepting “worse when tired or stressed” without thinking, is the same as seeing the stars but not understanding their significance. Understanding why every chronic disease is worse when the patient is tired or stressed has the potential to reform homoeopathic philosophy and create the next leap forward - but it is must be properly understood. (See Soul & Survival for more about personal energy). This is the first big difference between HFA and contemporary homoeopathy.

 

Once a patient understands the link between personal energy levels and disease, it is easy to take them to the next step and review the impacts life has had by discussing their personal history. This is the second major difference between HFA and other contemporary methods. Contemporary homœopathy uses life stories to find the inner core of the patient. For some it is an attempt by the practitioner to uncover a subtlety to distinguish one remedy from another, a necessary process for those who practice 'personalised drug picture' type prescribing. In another approach, life stories are used as a way of getting the patient to delve into their pain until they reach the point of a primal scream and open themselves up to an epiphany. This approach is psychoanalysis dressed in a new suit. The process is not unsound, but psychological medicine was forced to drop this technique in favour of more practically based methods, because the process took far too much time and results were simply not proportional to effort. In HFA however, life stories are used as a way of ascertaining stress, exhaustion and repeating circumstances. Biographies sometimes yield good rubrics but not always, which is why in Homoeopathic Facial Analysis the mentals are not regarded as the key to unlocking the remedy.

 

Life themes are repeating patterns and HFA practitioners take them literally without interpretation. For example, if a patient came from an alcoholic background and made the decision that they themselves would never drink because of the damage they had seen alcohol do, but their partner or child drinks more than they should, then alcohol becomes a rubric because it is a repeating life theme. I do not ask how they feel about alcohol or what physical sensation it causes, I just accept the impact this substance has made and note it as an influential stress.

 

Some may find it unusual at this time to go against the tide of mental’s prescribing. Most current methods attempt to come up with ways of precision focusing on feelings or beliefs. HFA is the opposite and this is its third major point of difference. To describe why the mentals are not as discriminating as generals is a book in itself, but physical form is unique where as the human condition is not. The aspirations desires and needs of most human beings are similar and therefore not distinct, and certainly not as individual as a physical feature like fingerprints.

 

The theory has always been that mind and soul forms physical form but I am not so sure that is true. Other people's attitudes, attractions, opinions, repulsions, suspicions, friendliness, openness and sexual desire are driven by how we look, and what feelings our looks evoke in them. This in turn shapes how we view the world because of the people and attitudes that have come our way. A sexually vulnerable looking woman like Marilyn Monroe will have different experiences and beliefs about human nature than a woman whose looks are stronger, and as a result has not shared the experiences caused by having those looks. Men will act differently around these two women because of the feelings each create. Not everyone acts in the same way to the same person because looks interplay with life experience bringing forth different reactions depending on personal history. In one man, a woman's vulnerability may bring out a predatory side, while in another that same vulnerability can make some males protective or even paternal.

 

Experts agree that 90% of communication is non-verbal. One study at UCLA indicated that up to 93% of communication effectiveness is determined by nonverbal cues. So why are homoeopaths not using or embracing such vital information, particularly when clinical effectiveness is totally dependent on gathering the facts? The reality is that up until now it has been impossible because we didn't have the right tools, but with Homoeopathic Facial Analysis there is now an effective way of gaining this vital information. The reason we need to dig and delve to look into the labyrinth of the unconscious mind, is because we are only getting ten percent or less of the information we need, the rest is hidden in our body. Ninety percent of the facts are missing because they cannot be verbally acquired, regardless of intellectual promises to the contrary. Homoeopathic Facial Analysis solves this problem, because it is the only available homoeopathic system designed to read facial structure in a clinical and exclusively homoeopathic way. This is one of the reasons why its success rates are so high.

 

The body expresses more than pain. It is a vault that keeps the memories of the past alive to be used in the present when necessary. That is the purpose of evolution, to adapt to the constant stresses of the past so the present has a better chance of survival. But what homoeopathic system caters to this jewel of nature apart from Homoeopathic Facial Analysis? – None. Chronic disease is hardly ever a disease in the infectious sense of the word. There is no asthma virus or cancer germ because chronic disease is an outcome. It is a result of all the events and stresses that have come before it. Chronic disease tells us the story of the patient, how they have lived and what they have endured. The body is designed to store memory. How can new life be created without the physical transference of memory via genes?

 

Over time ducks evolved webbed feet because they spent so much time hunting in the water. As a result benevolent nature decided that the duck would benefit if its feet were webbed. Because we know how to read the signs, we can tell that any animal with webbed feet spends a lot of time in or around water. We don't have to intellectualise this information because we accept that physical form in animals remembers, and adapts to consistency or stress. Why do we think human beings are any different? Why would nature be less benevolent to us than to a duck?

 

Have you ever tried to convey an emotion to another person while keeping a deadpan and unchanging face? Try conveying real anger without intonation or facial expression. It cannot be done and do you know why? Because the human face is specifically designed to be the main conveyor of emotion. Not just the emotions we feel but also as a medium of communicating what emotions we need to get from others. Every practitioner knows that certain patients keep attracting the same type of people and this is why. Not only do we instinctively and unconsciously through our face display our emotional needs, we are also unconscious experts at reading what others through their face are asking of us. Some who respond will do so with honour but others will capitalise on this request.

 

This is the fourth major area of difference between HFA and more contemporary methods. HFA knows how to read this unspoken facial language and its practitioners can read what memories are locked in the patient’s unconscious.

 

After the patient has finished their story, what we call a “top to toe” examination is verbally conducted, asking the patient a totality relating to any pathology or pain they may experience. This is called a top to toe because we start with the head and work our way down. Starting with the head my questions will be

 

* Do you suffer from headaches or migraines?

* Do you have any skin condition of the scalp?

* Is there any problem with your hair?

When there is an affirmative reply, a check is made to find any modality that accompanies the symptom. Once all the information about this symptom is found further areas of the body are checked – this involves a lot of leading questions

 

* Do you have any problems with your eyes?

* Are you prone to conjunctivitis or any other repeating infection?

Once this process is complete the physical generals will stand out. The headache was worse of the right and at night, so too was the knee pain. The liver pain is a constant problem (

 

Because the body is designed to adapt, being able to read it is vital. When a body builder trains in a gym their muscles adapt to the heavy weights, gaining size and mass. If that same person decided to take up marathon running instead, their body would become a different shape, shedding fat and bulk in an effort to make them lighter for long distance running. The same happens inside the brain. The more we focus our attention on a subject or skill, the more the neurons in our brain break past links to create new ones. The key to what happens with the body and brain is frequency. Nature is a system that ensures that physical form adapts itself to need. In the past whenever human beings concentrated on a task, either physical or mental, it was because that task was important to survival. Nature helps us with important tasks by allowing our body to readjust and adapt quickly to any repeated task. This is why practice makes perfect and why habits and addictions are difficult to break.

 

The human face is part of nature's adaptable make-up and plays a vital role in acquiring need. Most of the time we don't need to be told that our patient is anxious, exhausted or tense, it shows itself in how they carry themselves but even more, it is etched on their face. The process of evolution is remarkable and it shows that nature has our best interests at heart. But evolution and adaptation are long term processes that rely on holding the memories of the past. Snow leopards for example, have changed their coat colour to better suit their surroundings. In the jungle the yellow and black of a large cat’s coat is perfect for the sun and shadows. In the snow this jungle coat would be a hindrance not a help, so nature allows the coat to change into white so the leopard can now blend with the snow. However these adaptations are only useful provided the environment doesn't change. If the snow leopard suddenly moved to the jungle its coat would be a hazard because it is the wrong reaction to the environment.

 

Human beings have these same forces of nature and we also adapt to our most stressful and dangerous environment. However, before nature commits to any physical change, the stress or conditions in the environment must be long-term and stable.

 

Every one of us has physically adapted and evolved to suit the changing needs of survival, and the area where this physical change has been most prevalent is on our face. This is because our most consistent threat comes from the group we live in. Human beings are less shaped by weather than other animals although obviously environment plays a part, especially with blue (syphilitic) people but that is a much longer story (see Soul & Survival). While Africans look different to Europeans or Asians we are anatomically all the same. Weather is less of a physiological impetus because we can build shelters and fires.

 

Our peripheral body does not have to continually adjust to life in the elements because that is not where our greatest threat to survival comes from. Our body does however have to adjust and find a survival edge to life in a group. Like all group animals each human being's greatest threat is the person next to them, because individuals within groups must always compete for resources (see Soul & Survival). Evolution is only successful when it adapts and stores the challenging circumstances of the past. Evolution is playing the odds with the snow leopard, betting that the cold and icy conditions of the past will continue to be the prevalent stress in the present. Human beings have also faced generations of tribulations and have adapted to the physical demands of living in groups. Our body language and facial features have molded and etched themselves into a design that is most beneficial to our individual needs. Homoeopathic Facial Analysis not only helps us select a remedy, it helps the HFA practitioner recognise each person's basic requirements for survival within a group. Human communities survive by individuals performing different niches and these traits along with emotional needs are displayed, as one would expect, to anyone who knows how to read them. Now let’s return to facial analysis in the clinic.

 

After completing the physical examination I then take photos of my patient (see Homoeopathic Facial Analysis). This is major difference number five between HFA and contemporary homoeopathy. After taking my pictures I leave the patient in the waiting room while I examine their facial features for shape, size and symmetry (see Homoeopathic Facial Analysis). Each facial feature is then classified into a designated colour group of yellow, red or blue, each colour group represents a miasm; yellow is psora, red is sycosis and blue is syphilis (see Appearance and Circumstance).

 

Homoeopathic Facial Analysis determines the dominant miasm of my patient. While Hahnemann focused on finding the dominant miasm within remedies, analysing the dominant miasm in people has not received the same attention. Once my repertorisation is complete and I know the dominant miasm of my patient, all that remains is to give the repertorised remedy with the same dominant miasm to my patient. Normally a repertorisation based on the generals will leave up to twenty remedy possibilities, but if I know my patient is syphilitically dominant and Mercury, Conium and Aurum are in my repertorisation, my choice of remedy shrinks from twenty possibilities to three. If my patient is blue (syphilis) then so too must the remedy otherwise we don't have a perfect similimum - and that is how Homoeopathic Facial Analysis is done. With the HFA method, practitioners no longer have to struggle over essence or wait like Kent suggested for ten years or more, just to become proficient. Many graduates can achieves results of 80% and upwards after studying Homoeopathic Facial Analysis for only a year even in the most difficult cases of chronic disease.

 

Developing Homœopathic Facial Analysis (HFA) has been a rewarding journey for both myself, my fellow practitioners and my students. Clinical success is consistent and the insight attained through studying the link between behaviour and facial features has opened my eyes to universal laws and how homœopathy taps into this phenomena.

 

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Grant has been working and studying in various fields of natural therapies since 1987. Grant’s qualifications include Homœopathy, Naturopathy, Clinical Hypnosis and a Post Graduate Diploma in Eriksonian Psychotherapy. Grant is the current Principal and senior lecturer of the Victorian College of Classical Homœopathy, a position he has held since 1995.

His first book, Appearance and Circumstance(2003) details the nature of miasms and how facial analysis can be used to determine the patient’s dominant miasm. Homœopathic Facial Analysis (2006) continues this work with detailed descriptions and examples of facial analysis. Soul & Survival (2008) defines how miasms influence us in our daily lives and define our individuality.

 

Grant has lectured in Australia, New Zealand, the Middle East, USA and Europe.

 

Further information about Grant Bentley’s research and his books can be found on the Victorian College of Classical Homœopathy website http://www.vcch.org/miasm.html and the Soul & Survival website http://www.soulandsurvival.com/


Osho on Therapy

 

We are the cause of our own suffering. All therapies are Toys to Calm the Anxiety in our mind and relieve tensions from the Body. Therapies do help us for a while but they are not a permanent solution. We need to go to the root cause of the Disease and most of time it’s our life style and our Vision towards Life.

 

When we do any wrong act then our soul immediately intervenes but if we ignore that voice again and again, slowly that voice of our soul gets feeble and feeble and one day we cannot hear it.

 

When ever we suppress anything, that feeling is stored in our body at a particular place, over the period of time will lead to disease. It does not mean that we should hit other person when we are angry but we need to be more meditative. Meditation is the only solution.

 

We seek for Quick Remedies for a problem. They are certainly quick to show result but they are definitely not the Solution for that problem.

 

As one goes deep in meditation, slowly, slowly, feelings of jealousy, anger, hatred decreases. In short, the control of mind over us decreases and we become the master of our life for the first time. All meditative therapies like “Osho Mystic Rose”, “Osho No-Mind”, and “Osho Born Again” are techniques to be in touch with our real nature.

 

In these therapies all those hurtful feelings and emotions which we have suppressed in ourselves gets released and we feel very lighter. We become younger and fresh.

 

As these suppressed feelings are released, we get glimpses of our real nature and the joy which we used to feel as a child. Our spirit become alive like a child and the body looks younger in numbers.

 

Whenever the garbage our mind is carrying is thrown out in these meditative therapies and a deep silence is the next outcome of these therapies. This is one of the reasons that Meditation is the essential part of these therapies. Osho has designed them very scientifically. First the catharsis of suppressed emotions is done which is followed by Meditation.

 

Therapies are also wonderful in relieving disease and dealing with emotions. But at the same we should not become dependent on them and should change our life style that is causing the disease.

 

No therapy can give us permanent change unless we co-operate with it. Because, old patterns of life style and mind come back again. So to stop falling to old patterns of life one needs to be more meditative. All therapies should be followed by Meditation.

 

Nature is the Best therapy. Early Morning walk, Fresh Air, Lush Green Garden, Nutritious food prepared with Love, Sight of Sunset with beloved, sound of Rain drops and flowing water is all heals us. Any thing that connects us to our real nature or brings us close to nature can act as a therapy.

 

The Healer

 

The whole is the healer. To be healed means to be joined with the whole. The function of the healer is to reconnect it. The healer touches the body of the ill person and becomes a link between him and the source. The patient is no longer connected directly with the source so he becomes indirectly connected. Once the energy starts flowing, he is healed. Healing is one of the most delicate dimensions. And the delicacy consists in the healer not doing anything in it. To be a healer really means not to be. The less you are, the better healing will happen. The more you are, the more the passage is blocked.

 


Psychosomatics in Homeopathy

________________________________________

By Gina Tyler DHOM.

 

  For thousands of years, various cultures have known the connection of the mind and the body that illness and disease originate not only from external chemical toxins, but from the traumas within the emotional and mental states.

 

Modern medicine has relied on suppressive mood altering drugs to combat the extremes to allow humans to be "perfectly flawless" in society. This includes the suppression of anger, grief, fears, hyperactivity, melancholy, obsessions, sexual urges, depression, mood swings, etc.. What if these suppressions were causing the illness, as we find with simple suppressions of a bad cough or fever? If the avenues of elimination are blocked we suffer the secondary consequences. We logically think of our bowel movements, urine, sweat, mucous, and tears as toxins that are abundant in an illness needing to be eliminated (so we eliminate them modern medicine has found a way to suppress these symptoms).

 

Thinking about the person as a whole meaning the emotional, mental, physical, and spiritual states, is a method used by many ancient cultures. Why have we strayed away from this thinking? Because "science" cannot do a double blind study? Because allopathic doctors have no time for all this soul searching (what can you accomplish in a 5 - 10 min. doctor visit)?

 

This is where homeopathy has made a small dent in the massive scheme of things. Homeopathy looks at disease from the point of the baby's conception, and before birth, and the patterns of inherited genetics. And not only at the present illness, but the complications prior to the onset or "cause" of the illness or imbalance.

 

The psychosomatic aspect forms a portrait of the illness or disease. By using the homeopathic materia medica, pieces of a huge puzzle start fitting together. This is why homeopaths spend 1-2 hours on the first visit with each patient. Not only is the illness of importance, but the temperament, likes and dislikes, cravings, dreams, habits, fears, peculiarities, childhood traumas, appetite, and of course, the objective observations such as body language, how the patient smells, their energy, and their "chi" or "prana" 

(vital force). "Disease" is a disturbance of this vital force -- an imbalance

. 

The body has always been able to heal itself by building up it's immune system and it's vital force. Herbs can detox the physical body and physical manipulations, meditation, yoga, and chiropractors can realign the energy flow that is blocked. Yet none come close to the healing powers of homeopathy, reaching into the depths of traumatic toxins not released for decades.

 

You might think that if homeopathy has such great force, what are the side-effects? As we all know in modern allopathic medicine, each prescription drug has pages of dangerous side-effects. From aspirin (which causes excessive bleeding) to drugs that induce sexual functions (causing heart attacks).

 

Homeopathy has no side effects. When it works, it awakens the imbalanced vibrational force through dynamic energy. So, when a person comes down with chronic stomach problems, or chronic headaches, and they have already been to several doctors, had tests after tests, x-rays, taken drugs to help the pain, yet still have no answers, there must be another avenue of escape. It is  obvious to a classical homeopath, after taking their case, that the illness is related to a psychosomatic history. These do not show up to an "allopath" on a physical level.

 

The phenomenon of the mind when it comes to disease (or illness) is baffling. A homeopath finds out soon enough that treatments with remedies eventually fail if only the physical ailments are addressed. One hundred people can have sinusitis and each person must be looked at as an individual that has a history of imbalance. So, each will need a completely different remedy.

 

It is the trademark personality (or constitution) that signals the homeopath the mental state and it's traumas, the disposition of the mind, and it's subconscious acts to the individuals state of being.

 

If you really look deep into each person, opening up their life like a book, turning each page one at a time, unfolding the layers of suppression, deception, and survival mechanisms then you will finally find a matching homeopathic remedy.

 

To not properly address these would mean no cure. Yes, a homeopath or allopath may "palliate" an illness or pain, but this never comes close to regressing the origin of imbalance. Psychosomatic illness is stored in memory. Even though the physical body externally might be perceived as balanced, beautiful, or put together, there is an ongoing festering volcano waiting to boil over inside the mind.

 

Allopathic mood altering drugs will suppress these urges from ever surfacing but they do not "cure" the imbalance and turmoil. 

 

1.  In some cases chemical toxins have caused this imbalance, such as vaccinations. Vaccines given to a child can cause extreme havoc to the brain (violent seizures, ADD, ADHD, hyperactivity, learning disorders, violence, chronic illnesses, immune

deficiencies, respiratory problems, and death). ( www.909shot.com for more info).

To give the child anti-seizure medication suppresses the convulsions, but does not address the cause of the convulsions. Homeopathy can remove these toxins permanently. When a child has ADHD, ADD, or hyperactivity, prozac and ritalin are prescribed. Thousands of children are turning into zombies and making the drug companies filthy rich. Does it help? NO! The cause is due to a "chemical toxin" like vaccines or aspartame (in nutra-sweet, equal, and  diet sodas). More info from www.dorway.com.

 

These toxins are extremely deadly yet the doctors and the FDA allow the use of them. Why? Think about it ... greed and money...billions of dollars are made from this vicious circle of chemical toxins. Brainwashing every parent into thinking that the safety standards are looking out for their child's welfare. 

 

2.  With the other cases it is severe trauma as a child. Abuse, molestation, abandonment, and grief, keeping it all suppressed, secrets, deceit, denial...all of these kept inside, locked away for no one to see. The body does remember no matter what survival mechanism is used, causing extreme stress and turmoil within the emotional and mental states. Wait long enough, and you have the physical illness that mirrors these states.

 

A person can live in denial forever and get used to the situation, allowing the imbalance to grow into a multi-headed monster within, slowly affecting all their relationships, reacting with mistrust, jealousy, suspicions, depression, panic, fear, anger, irritability, violence, and suicide. Nothing makes sense but the "onset", the "cause" of the original problem. This is what classical homeopathy looks at: the psychosomatics behind all illness. Disease imparts blockades within the life force. Restricting the flow of life, living in a delusional state of "darkness". This darkness needs to become light, when you fill yourself with knowledge and the state of awareness, the delusions will vanish. This in turn will conquer the physical ailments of a particular disease. The chronic pains, cysts, hair loss, obesity, fatigue, nausea, dizziness, acne, and back pain  will disappear. 

 

There is no way to stop or destroy energy, you can only redirect it or block it. The energy "inside" vibrates like a matching homeopathic remedy. To cure by dynamics means to cure "pure consciousness".

 

Homeopathy is based on "nature's law of cure". For a classical homeopath to take a case, it is not merely the asking of several questions that matters, it is the observations, to feel what the patient feels, to become that person, to step into their shoes and to find the "disposition" of the patient.  


Communication skills in case-taking

 - Dr. Ajit Kulkarni

 

(This lecture given by the author before Homoeopathic Research Institute, Satara has been transcribed by his students).                        


 “In every art there are few principles and many techniques.”

                                                                                - Dale Carnegie

Introduction        

 Today I am going to talk on a fundamental subject of communicating with our patients. Our syllabus at undergraduate (BHMS) level or at Post – graduate (M.D.) level doesn’t contain the subject of communication although we get very few points on case taking. Case – taking in homoeopathy is a multi-dimensional complex process, which demands the full exploration of a human being. It is not merely gathering of some symptoms through a certain frame of questions. To be frank with you when I began homoeopathic practice, I was unaware of the depth of case – taking and communication skills. My entire interview was based on questions alone and I was bombarding my patients with innumerable, stereotyped, successive spells like Rawalpindi Express of Shoab Akthar. I was concentrating not on length and accuracy but on speed. This resulted in many fours and sixes as there were many ‘Sachins’ in my patients. I lost many matches and yet I was confused: why I lost? Why were there drop-outs?

 

I started looking seriously and I found that communicating with patients has a heavy bearing upon physician – patient interaction. Now I realize that communication is a critical component of all medical interaction, it is not “just talking” and that communication is the keystone of the doctor-patient relationship.

 

 

 

Communication: Meaning

The term communication is grossly overworked. Everything from billboards, encyclopedias, to television, to holding hands is communication. However, exchange of words only doesn’t constitute ‘communication.’ The word ‘communication’ originates form Latin term “communicare” or “communico” meaning TO SHARE. When a patient communicates his grievances, his complaints, his painful experiences from his life, he is actually SHARING with the physician. SHARING involves a deeper process of human interaction, of human relation.

 

Webster dictionary defines communication as “the interchange of thoughts or opinions.” Interchange: to inform, tell, express, or show in order to get a reaction or a response. It also means to listen, understand, weigh or evaluate.     

 

Charles Estes defines communication “------ the reception, digestion, and transmission of meanings, attitudes and feelings through words, gestures and symbols.”      

 

Communication has a basic attribute of enlargement of feelings, facts, attitudes and ideas.    So when a physician starts interrogating a patient, a patient is unearthed, unfolded and then he appears to him as a living vibrating individual whose facts are known, whose inner feelings are brought onto the surface, his attitudes and inclinations are understood and his ideas are known.     

 

Communication is not a momentary event; in fact it is a momentary intensification of a continuing, cumulative process that starts even before actual communication takes place and continues even after it has occurred.        

 

Communication is not merely transmission of meaning from one person to another through symbols. It involves the pathway

 

Source ---- Sender -----Sent------Received ------Receiver-----Result      

 

“The success of communication is measured in terms of not only the effective transmission of the message but also the achievement of intended result.” This sentence indeed gives the crux. Only concentrating on sending the message, a physician shouldn’t get relaxed; he must concentrate also on what is the net result of communication. This net result is the feedback which every patient gives to a physician.

 

Key – communication skills

There are two critical skills - Active listening and Feedback.

 

Listening

I give pivotal importance to listening. A homoeopathic physician who sits on a chair with holistic philosophy in the mind, who has to deal with the patient from totalistic viewpoint, who has to keep his awareness fully to focus on emotions, on every body movement, gestures, postures, speech modulations etc., has to be a good listener. It is said that knowledge - seeker has to be a good listener. The process of case taking is a knowledge-seeking process. Ultimately it is the patient who gives knowledge to a homoeopathic physician.

 

Major difference between ‘hearing’ and ‘listening’ must be understood. Hearing alone is not listening. Hearing means merely picking up sound vibrations while listening means making sense out of what we hear. Hearing is related with ‘ear’ functioning while listening is related with ‘ears, brain and mind’.

 

“Active listening is an important way to bring about changes in people. Despite the popular notion that listening is a passive approach, clinical and research evidence clearly shows that sensitive listening is a most effective agent for individual personality change and group development”( Rogers and Farson).

 

To be an active listener, following skills will help a homoeopathic physician.

 

X         Make eye contact

 

X         Exhibit affirmative head nods & appropriate facial expressions.

 

X         Avoid distracting actions or gestures

 

X         Ask questions

 

X         Paraphrase

 

X         Avoid interrupting the patient

 

X         Don’t over talk

 

X         Make smooth transactions

 

The Second critical skill is Feedback. The process of interview evokes innumerable responses from a patient. Some responses may not be likened but a physician has to keep his mind balanced. A physician must remember, “Positive feedback is more readily and accurately perceived than negative feedback.”

 

Skills for feedback

i)                    Focus on specific behavior

 

ii)                  Keep feedback impersonal

 

iii)                 Keep feedback goal-oriented

 

iv)                Make feedback well-timed

 

v)                 Ensure feedback positive

 

vi)                Direct forward behavior

 

 The word feedback relates to the reflection of a patient. When the interview is continued, the dynamic interaction occurs. Varied responses are evoked by both the patient and the physician. The feedback is of 6 points.

 

1. Focus on specific behaviour

 

There are 3 questions, why, how and when? Let us take an example.

 

A flatterer is sitting before you as a patient. He is pleasing you. “How wonderful! Doctor you are great, what a nice interview”. These are the statements of a patient. What doctor should do about this? Instead of engaging himself in appeasement of his own ego from the emotional overtone, the physician should focus on the specific behaviour that is flattery!

 

2. Keep feedback impersonal:-

 

A physician is one who has to keep balance between his subjectivity, his emotionality, and his professionalism. He must be able to look at the patient as he is. It is here that Hahnemann expects from him the state of being unprejudiced. In the above example of flattery, a physician should not feel himself great and excited. He must look at it impersonally. It’s like not getting carried away. Keeping the feedback impersonal is reflective of maturity on the part of a physician. Finally his goal in practice is to treat the patient as a person and this goal must not be forgotten.

 

Let us take another example: Interview begins and patient starts abusing the medical profession, “You all are blood suckers”. The physician should not take this statement in the personal context. He should understand that a patient has strong antipathic notions against the medical profession. The hostile attitude of a patient should make a physician to find out his disposition. He should find out why a patient is hatred. The phenomenon of development of this hatred feeling may itself unlock a case. For the selection of a similimum, it is extremely important to find the inner personality characters.

 

3. Keep feedback goal oriented:-

 

The goal of the interview is to seek A2 : that is Accurate and Adequate data. The goal is to understand the patient as he is. For example, in the flattery example the goal is to know the dimensions of flattery i.e. why he developed this disposition? What are the consequences of this as far as his family and social interactions are concerned? There should be pertinacity in achieving the goals. For a physician who has trained himself in making the vision of totality clear, this becomes easier as goals are known.

 

4. Make Feedback well-timed:-

 

A patient takes an appointment and is very punctual, but anyhow he has to sit for a long time. A patient expresses his resentment. Now the physician should take this feedback into consideration and should honor the punctuality of a patient in the subsequent follow-ups.

 

5. Ensure Feedback Positive:-

 

Once the goal is fixed and it is understood that the feedback should not be perceived in a personal way, it is possible to ensure the feedback positive. In positive feedback the physician acts more as a learner, as a care-taker and as a trustworthy human being.

 

Example: Mother-in-law and daughter-in-law are at cross with each other. New daughter-in-law behaves arrogantly and in the interview mother-in-law expresses the agony and goes to the extreme to knock out DIL out of the house. The physician advises her not to take an extreme stand. MIL sarcastically expresses, “It is better for you to give an advice by just sitting on a chair”. The physician should take this statement lightly. He should try to understand the dynamic relations, try to explore the personality profile and in the subsequent follow-ups should make a statement in a laughing tone, “I am just giving you an advice by sitting on a chair.” Ensuring the feedback positive helps to develop favourable attitude.

 

6. Direct forward behaviour:

 

The physician must be greedy in eliciting the data. A patient often becomes disorganized, wanders here and there, doesn’t stick to any specific issue and doesn’t narrate the totality. It is here that direct forward behaviour has to be followed.

 

The reflective technique of communication often is very useful in forwarding the interview in a right manner.

 

Communication skills are not innate or fixed. They can be learned or improved and consequently the physician can improve the health outcomes.

 

Adherence

Every physician has insecurity in his mind. Whether my patient will stick up to me or will he leave? Insecurity hovers. Anxiety state develops. And the reaction develops “today’s patients do not adhere.” Remember that “poor adherence can be attributed to patient characteristics” is a myth. In fact no consistent relationship has been shown between adherence and

v      Age

v      Gender

 

v      Social / economic status

 

v      Marital status

 

v      Personality traits (introverted, gregarious etc.)

 

Then what does affect adherence?

 

v      The patients’ perception of the seriousness of the disease

 

v      The patients perception of the efficacy of the treatment

 

v      The duration of the treatment and illness

v      The complexity of the regimen

 

v      The relationship with a physician

 

Skills for improving Adherence

 

v      Demonstrate compassion

 

v      Communicate:

 

Ø       Personal concern for the patient

 

Ø       Personal interest with patient’s well being

 

Ø       Activate patient’s motivation

 

Ø       Share responsibility with the patient

 

Ø       Discuss the patient’s beliefs

 

 

Barriers to communication

When I started practice I was not aware of ‘barriers’ to communication. I found that there are some patients to whom I was unable to communicate. In some patients I was right at selection of remedy or at repetition, but not knowing how to handle the patients through positive communication. Subsequently I understood that good communication skills are required not only in the first interview but also in follow-ups. The dropouts in my practice taught me to see the barriers, which are collectively termed, as Noise.

These are as follows:

 

 

Ø       Absence of a common frame of reference.

Ø       Badly encoded messages.

 

Ø       Disturbance in transmission channel.

 

Ø       Poor retention (esp. in face to face communication).

 

Ø       Inattention by the receiver.

 

Ø       Premature evaluation of the message.

 

Ø       Unclarified assumptions.

 

Ø       Mistrust between sender and receiver.

 

Ø       Different perceptions of reality

 

Ø       Semantic difficulties.

 

Ø       Vagueness about the objectives to be achieved.

 

Ø       Misinterpretation of the message.

 

Ø       Clash of attitudinal nuances of the sender and receiver.

 

Ø       Psycho - physical factors.

 

Ø       Selection of wrong variety of language.

 

 

 

Now I focus on the factors, which produce the Noise, and I see that the communication is

 

barrier-free and smooth.

 

 

 

Homoeopathic interview: qualities desired

Ø       Well-defined ego and not to be over involved

 

Ø       Healthy attitude towards patient

 

Ø       Empathy, sensitivity and sensibility

 

Ø       Sufficient intelligence to understand and co-ordinate in a coherent way

 

Ø       Interview skills for warm and effective communication both verbal and non-verbal

 

Ø       Maintaining professionalism, open and trusting way

 

Ø       Ability to create supportive climate in interview to be able to make patients express their true feelings and honest opinions without fear of rejection or censure

 

Ø       Knowledge of related subjects: clinical, para-clinical, homoeopathic, social, psychology etc.

 

Ø       A calm, quiet, balanced mind and yet alert

 

Ø       Jovial, charming, cheerful communication

 

Ø       Awareness and observational eye

 

Ø       Precision of mind

 

Ø       Asking the right question(s) at right time

 

Ø       Appropriate use of memory box

 

 

 

Now  if  you  think  that  you  know  the  basics  of  communication,  you  know  key

 

communication skills and now you are in a position to take an interview, you may face a lot of difficulties; for, you must know communication techniques.

 

These are as follows-

 

1.      Facilitation - Verbal or non-verbal communication that encourages the patient to elaborate.

 

2.      Open-ended Questions - Requests stated in general terms for non-specific information.

 

3.      Direct Questions - Are those that ask patient for specific information. There should not be leading questions; they should give a graded response than yes or no.

 

4.      Support - Indicates physician’s interest and concern and his willingness to help the patient.

 

5.      Empathy - Communication that expresses understanding of and sympathy for the patient’s feelings.

 

6.      Silence – Expresses a range of responses from total disinterest to active concern. It gives the patient a chance to explore and express deeper.

 

7.       Reflection – A response from the physician that repeats, mirrors or echoes a portion of what the patient has just said; useful in eliciting both facts and feelings.

 

8.      Clarification – A response that asks the patient for further information and explanation for the sake of clarity.

 

9.      Confrontation – A technique that brings the patient face to face with the patient. Should be used with caution.

 

10.   Hypothetical – If patient is not coming out with hard facts, this technique may help

 

       in selected cases.

 

11.   Summation – Reviews the information that has been given by the patient.

 

12.   Interpretation – Formulation by the physician of data, events or thoughts into terms

 

       that make the patient aware of their inter-relationship.

 

I briefly outline some of the qualities needed on the part of a physician for homoeopathic

 

interview.

 

 

 

Some questions discussed in the lecture

 

1. Absence of Common frame of reference

 

The frame of reference relates to the environmental setting in which the interview take place. The concept is that the environment must be congenial for the free ventilation of patient’s narration. The patient should feel that the environment in the clinic is favourable and there are no obstacles.

 

Example: The sitting posture between a patient and a physician must be face to face. If a physician is looking at north-west and a patient at south-west, it is not a congenial frame of reference. Strong smell coming from slums can be an irritating experience for both a patient and a physician. The word common represents at least the prescribed notions of the expected environmental settings.

 

2. Badly encoded messages:-

 

It is the fundamental right of a patient to get all the message of a physician in clear terms. Many physicians have the habit of talking in a rapid way or they talk as if muttering with themselves. The coding of message must be in the format which is digestible by a patient.

 

3. Disturbances in transmission channel:-

 

This relates to the interferences that are from various sources. Frequent ringing tones, vehicles on the road, T.V. or radio in the clinic making big sounds, receptionist interrupting, the students asking questions in between etc.etc.

 

3. Semantic Difficulties:-

 

The language is the prized possession of a human being, but it is the complex way of communication. Each word has many meanings and both – the patient and the physician must have at least working knowledge of the meaning of words.

 

Example: A patient from Tamilnadu speaks in Tamil language with a Maharashtrian physician who doesn’t know tamil. This will be the semantic difficulty.

 

Sir, in communication techniques, what do your mean by “OPEN ENDED QUESTION?” (Requests stated in general term for non-specific information). Example?

 

Answer: Open ended questions give a wide platform to talk with free association.

 

Example: A patient is telling about pain in abdomen and open ended question is “Tell me more about your pain?”

 

A patient is narrating grief incidence but in a brief way then O-E-Q is- “Tell me more about your grief”.

 

The benefit of O-E-Q is that there is no bombardment of questions and a physician does not restrict a patient in the golden cage of questions. The ventilation of patient’s thoughts and emotions occur spontaneously, freely and adequately.

 

Hypothetical: In order to explore the true portrait of the patient’s mental state, an imaginary situation is produced by a physician. e.g. In order to understand what exactly happens when a patient develops anticipatory anxiety, physician puts up the scenario before the patient, like a patient undergoing an air-travel for the first time or a patient is caught in an accident etc.

 

Summation: It’s like summing up in a concise way and again asking the patient to comment. Summation is useful for facilitation and classification.

 

The major barrier to communication is the self-concept. We know that whatever concept an individual has of himself, he clings to, shutting out data that are not congruent with it.

 

One more major barrier to clear, undistorted communications results from the role relationships, or status differences, of individuals involved in inter-personal communication.

 

Credibility of the source also affects communication. Generally speaking, individuals of high status are accorded greater credibility. We tend to believe people who we define as “experts.”

 

No communication is free from emotions, either on the part of the sender or the receiver. Emotions form part of the “modifiers” system that screens transmissions and inputs.

 

I briefly outline some of the qualities needed on the part of a physician for homoeopathic interview.I have applied all these techniques and knowledge in my interview chamber and I have found them extremely beneficial. I request you, the readers, to apply these techniques and send me your feedback.

 

My friends, remember that to explore the human being is not an easy task. One has to change his personality, look within himself, banish his prejudices, wrong notions or beliefs and go ahead with vigour. Amen!

 

Dr.Ajit Kulkarni

MD(Hom)

e-mail: dr_ajitkulkarni@rediffmail.com