By Dr Behnoosh Nooshi What are our main problems in case-taking? Most of our patients are unaware of their bodies and talk about their illnesses in vague and general words. When we ask them to explain in detail, very often they cannot because they have not thought about it before. They are used to saying “Doctor I have headache or back pain“ and with no other explanation because they assume that is enough for a diagnosis and prescription. They are used to this because in conventional medicine these general symptoms are sufficient for categorizing ‘diseases’ and prescribing drugs. Of course in conventional medicine too the history of illness and observation are both important but no interest is shown to many additional details as is in homeopathy. Even if there is any interest in detailed symptoms, the information would not assist in diagnosis or prescription. So in many cases modalities, concomitants and other details of illness are expressed vaguely other than in cases of patients who are by nature good observers who then give their symptoms in very clear and objective characteristics of pain or time etc. When patients are asked many questions to clear this vagueness, sometimes it creates a desire in some patients to choose to shorten the interview and free themselves free from an assumed trap! The sudden realization that they know so little of their bodily functions can be alarming to them We should consider the patient’s presenting symptom and focus on it. In asking questions around the presenting problem and in finding its modalities and concomitants etc the patient understands quickly that his problem is important to us. Then having got used to this idea of the detail of questioning, with a few words of explanation, that ‘I need to know the whole of you’, one is then able to do a head to toe check in detail and find other important and significant points. This procedure would help us get to the center of the case and give us the key for finding the correct remedy. During this process sometimes unwittingly the patient gives us interesting and useful mental and emotional symptoms. The other problem is to overcome the patient‘s DISBELIEF barrier. Most of them do not believe our numerous questions about details of their sleep, eating and sweating can relate really to their main problem. Although in some patients this inquisition leads them to explain many ‘unimportant’ details and expand the subject in such extent, which contorts it and deviate from main way. Some others are very impressionable and want to please and tend to say yes to any question. Others persist to have no other problems except the current one (which express it in general and vague words too) and so say no to any questions immediately. However, this may be a situation often referred to as a ‘one-sided’ case where the patient is only interested in removing the presenting symptom, be it only acne! We must therefore learn to ask open questions so that the patient cannot answer yes or no. But the greatest difficulty in case-taking is due to our own cognitive mistakes. We react to familiar things quickly and to avoid this we must be aware of this fault and not assume anything or simply as Hahnemann said, we must remain unprejudiced. Very often when patient says I have a burning pain in this point which ….we immediately think “Aha! It is this or that” and then unconsciously try to prove it and so tend to select proofs which are compatible with our unconscious decision. Sometimes just to hear a main keynote this tendency blooms involuntary. Most of these fast and easy choices don’t lead to cure of course. In fact these choices, which seem correct, are not necessarily true similimum. If one may use a tailoring metaphor, in place of producing a bespoke jacket for the patient, we try and fit him with a ‘ready-made’ one and in effect make our choice of remedy fit him. The best and most efficient point for a homeopath in case-taking after making an efficient and deep relationship with patient is patience and silence. For good case-taking a homeopath must be patient, listen precisely and not protrude in patient speech unnecessarily. With silence and patience and good listening many of above problems may be solved. It is advisable to reflect the main points of the case back to the patient before they leave. Especially if they are new to homoeopathy, they will be surprised at the detailed notes you have taken (especially about their presenting symptoms) and at this stage may start to give your more symptoms. Now, because these late symptoms come out in an uncontrolled manner, they will probably reveal more about the patient than the rest of symptoms noted before. I have experienced it frequently in my work whenever I listened to patient with conscious, precision and patience found much more important information than any other time. Even in unclear speech of confused patients (unless in very silent and reserved ones) there are worthful points that are lost if we intrude. In my experience the greatest enemy for my success always has been impatience, which is more harmful than other problems. Quick evaluation, estimation and finding the remedy is tempting but hurry is dangerous. And the last point is related to our character and mood. All we know when we are in a hurry or have little time or our mind is focused on other subject cannot be patient enough and lose many important and precise points through which we may find remedy easily but usually our success in such cases are low. Before finishing case-taking any guess must be set aside. Only after case-taking it is time for finding the remedy through case analysis and evaluations of rubrics. Procedure to make decisions to select the correct rubric and ignore others, is the finest step to find the correct remedy which needs further discussion. And here we face another problem. Some of our patients whose language is not English express themselves in words and phrases that are sometimes very difficult to translate to English. We as non-English homeopaths must pass two steps in case analysis - first to translate patient’s words to English and second to find the nearest rubric for it. But if we spoke in English only second step would be needed. So one of our difficulties relates to our proficiency in both our mother and English languages and in this translation and conversions errors are made. Finally we must appreciate great instructions of Hahnemann about case-taking in Organon which are proved more and more in experience cause are due to several years of worthy conscious work. |
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