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Science and art of A Case Receiving – By DR. MANOJ Patel, M.D.( Hom. ) India.

Science and art of A Case Receiving

Master Hahnemann says homeopathy reaches beyond a surgeon’s scalpel. This statement is true for our interviews as well, each interview is like a surgery. To understand what is ailing in an individual we open up a case beyond the awareness of an individual, much deeper into his subconscious. This is done many a times without the physician’s awareness. This write-up is to make the physician aware about his responsibilities in building skills, attitude and knowledge required during different phases & steps of receiving the case. At the end of a successful interview the patient experiences the beginning of healing even before the administration of medication. Critical analysis of an interview is a powerful tool for healing of a Physician.

Key Words: Operation theatre, Psychosomatic disorders, individualization, physician, Case receiving, ICR (Institute of Clinical Research), training, Case taking, surgery, Knowledges, Skill, Attitude, Stuart Close, M.L.Dhawale

It is said, “A case well taken is a job half done”. Through my practice I have found that this is more easily said than done. In today’s practice, especially in a rapidly changing economy, we encounter innumerable stresses experienced by the patients in their lives and expressed through mental symptoms or psychosomatic disorders. Hence the study of the mind, the mental symptoms and the related dynamics assumes greater importance.

In Homoeopathy case taking is done for individualization through a study of the interior (inner being) of man and his dynamic disturbances which are expressed in the form of signs and symptoms. A number of contemporary Homoeopaths have come out with methods of case taking, recording as well as rubric interpretation focusing on the mind. New Materia Medicas are created with their unique perception about the genesis of human suffering and its expression in the form of signs& symptoms. We come across a number of prescriptions for the same individual and we feel lost as to what is right and what is wrong.

The study of the mind is complex.  Also the physician as a subject is evaluating another subject – the patient. This process brings up prejudices, which hamper perception of totality and in turn, the prescription. Hence, training of the physician becomes important. It becomes essential that ‘physician heal thy self in order to heal others‘.

Case receiving is the first step in the process of healing both the patient and the physician and deserves the highest importance. Dr. Hahnemann has classically described the philosophy/ technique of case taking in an aphoristic manner. Decoding of each aphorism gives an idea of his immense experience and insight in human suffering in all the three planes – mind, body and spirit. He also shows remarkable insight into the likely errors of the physician and has given clear cut guidelines in the form of ‘do’s and ‘don’ts. Other stalwarts Kent, Robert, Stuart Close, B. K. Sarkar & M. L. Dhawale have shared their experiences in respective literatures. Simultaneously in the field of modern medicine especially in psychiatry, numerous techniques have evolved for a better understanding of the human mind and behaviour.

At the Institute of Clinical Research we have integrated all approaches and evolved steps for case receiving and at every step taken care of training the physician. Case taking can be compared to surgery conducted in the ambiance of an operation theater, with the physician giving adequate time for the whole procedure, with pre-operative, operative & post-operative care of the self and the patient. To simplify I have created the model in the form of  Phases, steps & procedures along with the Knowledge Skills & Attitude expected from physician at each level..

Phase I: Preoperative: Screening and document evaluation,

Phase II: Operative: Interview proper

Phase III: post-operative: (Training of Observer within & without) & healing patient

 Phase I: Preoperative: Screening and document evaluation

Step 1: The first encounter where the patient and the relatives express their concerns and may come with previous treatment & investigation reports. Screening of the case allows us to assess the scope & limitation of Homoeopathy as well as the physician in the given case and whether the case needs any acute attendance.

Knowledges: Clinical (presenting complaint) including clinico-pathological, necessary ancillary measures, Homoeopathic.

Skills: Listening, observing, inquiring, examination & quick assessment: symptom processing skills for quick assessment of the chief complaint – symptoms, severity, course, stressors; skills of differential diagnoses and problem formulation.

Attitude of physician: Receptive, inquisitive, honest and full of concern and reassurance.

Step 2: Once you are sure of accepting the patient, here you orient the patient about the detailed information necessary for Homoeopathy and persuade the educated patient to write a detailed history.

KnowledgesAcute prescribing, scope & limitation of cure in the given chronic ailments.

Skills: Effective communication skills

Attitude: Caring and confident. Assurance of confidentiality

Step 3:

  1. Documenting the first encounter (screening) including verbal and non-verbal information from the patient and his relatives
  2. Adding to this information from any documents from the patient including investigations.
  3. Preparing for the actual interview by reading on the disease and planning strategies for making available the patient as a person, and the necessary handling skills
  4. Fix time for appointment where you have minimum disturbance and your attention is at its best.

 Knowledges:  General Knowledge of socio-political-economical-environment, Specific of modern medicine, Psychology,

Skill: Analytical for document evaluation (content, writing), that for utilizing faculty of Imagination, detective, Investigative, finally Integrating data & giving meaning to said as well unsaid information. Planning the interview

Attitude: like fictional detective Sherlock Holmes, Open minded planner but with a good sense of anticipation with readiness to handle obstruction

Phase II Operative:

Interview proper, Must be conducted in setup of complete privacy, comfortable seating environment, with proper time allotment for beginners at least 1 hour & 30 min,

Step 1 : Warm up: Put patient at ease, open the communication in a way that gives message of   acceptance of data or registration of previous communication, what you have understood in nutshell, what further you would like to know from patient.

Knowledge: Human relationship

Skill: Initiator of communication,

Attitude: Become an ally with understanding gesture

Step 2: Active Receiving: Physician is unaware of what is patient’s internal suffering, his signs & symptoms, deeper feelings.  Patient narrates his story of suffering physical, mental, social, work, family & experiences of his inner being.

Knowledge: General Knowledge of socio-political-economical-environment & specific homeopathic case taking

Skills: Empathize with suffering, become a compassionate listener, direct if patient is off the track, role playing in some cases to facilitate communication.

Attitude: Nonjudgmental, sensitivity with openness for all possibilities, encouraging for communicating deeper feeling & experiences.

Step 3: Inquiring  & Concluding: The most important part where we incorporate what we have received and direct the patient to share all that is essential to complete data for the  diagnosis of disease, patient as a person, and his  miasma,

Knowledge: Biological & psychological Concept of man in health & disease, Apho#3 [1]

Skills: Guiding, Inquiring, Questioning, Confronting, Blocking,

Attitude: Take leadership, motivate for further sharing, show expertise, interest and thoroughness

Step 4: Traveling on path unknown:  At this unique junction the patient knows what he is suffering but wants to explore the reason why, and expects frequently ignorant physician to answer.

Knowledge: Life & living, spiritual concept of man in health & diseases.

Skill: Getting the patient to participate actively in his health-careExploring beyond material cause, sharing conclusions, one’s experience & philosophy.

Attitude: ‘Physician heal thy self in order to heal others ‘where physician whose observer within is active who believes heal thy self is essential for healing others.

Phase III post-operative (Training of Observer within & without) & healing patient.

If physician is blessed with external observer then he must keep track of interview in the form of transactional record or if physician is all alone must record it on Dictaphone or Video, this become vital part of  this phase. Evaluation of this document is the key to the training of the Physician as unprejudiced observer.

Step 1: Completing Documentation: with help of transaction recording: The sharing by the patient needs to be documented in his own words and the essentials need to be highlighted.

Knowledge: Recording system for putting right information in the right place to ease analysis & synthesis.

Skills: Of primary analysis & language of recording system

Attitude: Like unbiased reporter to create document of doctor-patient encounter

Step 2: Reflecting on deficiency of data, analyze transactional recording find out Mal Observation -improper & Non Observation with the help of observer (Man or machine).

Knowledge: All knowledges required for Homoeopathic perceiving. Psychology

Skills: Analytical (self-analysis)

Attitude: Steadfast, dispassionate

Step 3:  Follow up with patient & taking his participation in healing: sharing the concerns of the patient and helping him to solve his problem (make him doctor of his circumstance)

Knowledge: specific of the patient’s problems & possible resolutions, role of Homoeopathy & ancillary support

Skill:  Effective communication

Attitude: compassionate healer with lots of patience.

Now you can comfortably say “A case well taken is a job half done”.

I would like to conclude this by the finest remark by Stuart Close:                                                                        ‘ … an  examination  should be made not  only  for  its  great practical  and  scientific  value,  but  for  its   psychological influence  upon  patients. Patients will be much more likely to remain permanently with the physician and his hold upon them will be much stronger if he has through and comprehensive histories of their cases in his files and impresses that fact upon them.  It gives them confidence in his professional ability and skill.   Patients  like to feel their physician, “knows all about  them;” that  he  is  not only interested in  them  and  their  families, personally  and professionally, but that he takes pains to  learn and keep in touch with all their individual peculiarities.  There is  no  surer  way  to  build  up  a  permanent,  lucrative   and substantial  practice  than by doing this work. It  goes  without saying  that  the  fee  for such  a  first  examination  must  be commensurate with the time and skill employed and that it will be paid  without grumbling, for every intelligent patient  will  see that he is getting good service and good value for his money.   Printed  blanks,  systematically covering  the  point  outlined, modified  according to individual judgment and need will  greatly facilitate  the  process of good history  and case  taking.’  [2]

Bibliography

[1] Hahnemann, s Organon of medicine 6th. edition translated in English by William Boericke pub Published by Boericke & Tafel 1922, Philadelphia

[2] Stuart close The genius of homeopathy published B. Jain Publishers New Delhi, India 1982

 [3] Editor Anand Kapse I.C.R.Operation manual:  The art and science of standardized homeopathic practice education & training Published by Dr. M.L.Dhawale Memorial Trust, Mumbai, India

Dr. Manoj Patel, M. D. (Hom.),

Prof.  & HOD Psychiatry,

Dr. M. L. Dhawale Memorial Homoeopathic P.G. Institute

Director Community Health Services, Dr. M. L. Dhawale Organization

Communication address: Shatrunjay , MG road, Vile Parle (East) Mumbai 400057

Email: drpatelmanoj@gmail.com

 

                                                                                                                   

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