Abstract
The entire homoeopathic methodology, the whole monumental and magical action of healing the sick comes down to two things: obtaining from the patient the clearest, most complete knowledge of his condition, and knowing how to use that knowledge properly.1 While interacting with the patient not only we need to hear them patiently but a keen observation is equally important. Their physical make-up, the way they walk-in and greet, the way they sit, talk, and interact, all are part of case taking. This article emphasizes that case taking is not about a question-and-answer session but to observe as well and its importance in diagnosis, prognosis, symptom evaluation and remedy finding. We need to be an unprejudiced observer, a detective, a philosopher and a psychiatrist in order to be a good homoeopathic physician.
Keywords
Physical examination, case taking, behavioral patterns, physical make-up, gait and gestures, unprejudiced observer, individualization, mental health, Hawthorne effect.
Introduction
Detective Eye
A detective is an investigator, whose main role is to gather information and evidence to solve and uncover the truth in a situation. The term “detective eye” often describes a person’s keen observational abilities and meticulous attention to detail, which enable them to spot things that others might overlook. The one who is observant, intuitive, and skilled at picking up on hidden messages or subtle clues. A physician is an undercover detective whose role is crucial in finding the diagnosis, assessing the prognosis, and the cure for the patient. Not just from the physical point of view but mentally, socially and most importantly psychologically.
Physician’s Role As The Paramount Observer
In 410 BC, the father of medicine, Hippocrates, developed a critical approach to medicine based on observation and experience. Hippocrates stated: “Leave nothing to chance, overlook nothing: combine contradictory observations and allow enough time … A great part, I believe, of the art is to be able to observe.”2
In aphorism 3, Dr. Hahnemann states that in order to become a true practitioner of the healing art, a physician needs to clearly perceive what is to be cured in diseases and what is curative in medicine. And in order to perceive we need to have a good observation skill which must be devoid of any prejudices as stated in aphorism 6, where Dr. Hahnemann advises to take note of perceptible signs by means of the senses which form the true and only conceivable portrait of the disease. In aphorism 84, Dr. Hahnemann advocates that while the patient details the history of his sufferings, the physician should see, hear, and remarks by his other senses what there is of an altered or unusual character about him.3
Case Taking In Homoeopathy
The main objective of case taking in homeopathy is to uncover the totality of symptoms experienced by the patient. This involves not only the chief complaint but also the modalities, concomitant symptoms, and the patient’s general state of health.
Effective case taking in homeopathy goes beyond clinical interrogation. Sometimes it is more like a psychological counselling of the patient where they are encouraged to openly share their concerns, fears, and life experiences, fostering a deeper understanding of their health journey. To find out the miasma of their illness, diathesis and susceptibility, indispositions, maintaining an exciting cause we go far beyond a mere question and answer session. We show empathy, concern and a true intention to treat not just their disease but them as a whole, we treat the sick so that their health is restored. In today’s era a lot of patients sometimes struggle to find the right person to whom they can share all their concerns. Their turmoil which clinically seems insignificant, deep in their heart, they know, are indeed the real cause of their trouble but do not find the courage to speak openly about it. But case taking in homoeopathy is so beautifully designed in order to find the individualisation that many times a patient feels relieved just by giving the case. Somehow, they feel satisfied because we listen to them patiently about their troubles that they have buried deep in their hearts and felt so heavy all this time that since they started speaking about it, they start to feel light and feel a lot better than before. No wonder Elizabeth Wright once said, “A Well taken Case is Half Cured”. Rather than merely suppressing symptoms, homeopathy aims to address the root causes of illness and encourage long-term healing and resilience. This approach not only alleviates immediate discomfort but also promotes overall health and well-being.
Principles of Observation and Symptomatology
Physician’s observation
In aphorism 83, Dr. Hahnemann provided general directions for individualizing examination of a case of disease in which the practitioner should bear in mind that each individual case demands nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease.
The moment a patient enters the consultation room we can check the way they walk in, their gait, physical makeup, the way they are dressed, how they greet and sit. Notice their physical make-up e.g., whether the patient is thin or fat, tall or short, fair or dusky, dressed formally or casually, wearing too warmly or too less etc . We should also note the expression on their face whether they look anxious, depressed, sad, hopeless or in pain etc. It may look insignificant from a diagnostic point of view but plays a vital role in individualization and remedy selection. Dr. Kent gives significant value to the physical general of the patient in symptom evaluation.
Gait plays a very crucial role in diagnosing patients with locomotor and neurological abnormalities. Also, a depressed patient is often found to have a stooped shoulder. An anxious patient on the other hand usually sits upright with head erect often at the edge of the chair with hands gripping the sides and is restless.
As a physician, we can observe the respiration pattern, sighing, wheezing, hoarseness in voice, rattles while coughing, peculiar eruptions on skin, odour of the body and breath, shiny or dull looking face, premature greying of hair, wrinkles of face, bony outgrowth, oedema, etc. We auscultate the chest, palpate the abdomen, and through various clinical examinations we diagnose the problem. We can also observe their energy while they speak of their symptoms, which helps in elucidating the intensity of the problem as they tend to emphasise more on the problems which are generally intensified at present. A thorough clinical examination not only helps in individualizing the case but also provides a satisfaction to the patient that they have been examined properly and taken good care of, which in turn, alleviates their mental anxiety which they might have before the consultation. Through thorough case taking with keen observation, we also build trust of the patient which plays a key role in treating the case. Without a doctor-patient trust build-up seldom a cure can take place, because in that case a patient will not show their true nature and we may fall in the trap of Hawthorne effect which describes the phenomenon where individuals modify or improve their behavior when they are aware of being observed or participating in a study.
Mental and emotional aspect of observation
Emotional and mental well-being significantly impacts physical health. Negative emotions and mental health conditions can weaken the immune system, increase the risk of chronic diseases, and contribute to unhealthy behaviours.4 Stress, anxiety, and depression can suppress the immune system, making individuals more susceptible to infections and illnesses. Mental health issues can manifest as physical symptoms like headaches, fatigue, digestive problems, and muscle tension.5 Vice versa physical health may impact mental health as well, e.g., psoriasis is associated with acute stress and depression.6
Many stalwarts advocated for exploring the patient’s emotional state, temperament, fears, dreams, and overall mental outlook as part of the case taking process. In foot note of aphorism 90, Dr. Hahnemann emphasises to observe “how the patient behaved during the visit- whether he was morose, quarrelsome, hasty, lachrymose, anxious, despairing or sad, or hopeful, calm etc. Whether he was in a drowsy state or in any way dull of comprehension; whether he spoke hoarsely or in low tone or incoherently, or how otherwise did he talk?” many physical aspects were also mentioned that should be observed by the physician and should be ascertained how much of that was peculiar to the patient in his healthy state.
Dynamic Observation
In aphorism 72, Dr. Hahnemann explains that the disease to which man is liable are either abnormally deranged vital force, or they are diseased of such a character that, with small, often imperceptible beginnings, dynamically derange the living organism, each in its own peculiar manner, and cause it gradually to deviate from the healthy condition.3
Kent and Boger emphasized the dynamic nature of symptoms and the need for ongoing observation and reassessment during treatment. This allows for adjustments in the choice of remedy as the patient’s condition evolves. Hering believed in identifying the most characteristic and striking symptoms that define the patient’s condition. He encompasses a thorough and systematic approach to understanding the patient’s symptoms, mental and emotional state, and overall health history. 7
Discussion
A thorough clinical examination helps in finding the diagnosis as well as peculiar signs of the disease which undeniably is important from a modern point of view where the patient demands to know what disease they are suffering from. This also provides them with an insight that the physician is well known and will be able to cure them. From a homoeopathic point of view, a homoeopathic physician can ascertain the peculiarity of the disease in the patient. Observing the patient through “detective eye” helps the physician understand the individuality of the case, the uncommon, peculiar symptoms that belong to the patient as a whole and helps in symptom evaluation and remedy finding.
Conclusion
The observation of the physician during case taking plays a pivotal role in individualization and selection of the remedy. The way they look and observe the patient is equally important as it affects the patient directly. Sometimes they tend to hide and give false statements as the effect of Hawthorne phenomenon but once a physician develops an interacting skill that not only provide a sense of security to the patient but ensures that they are treated individually, they open up. The art of case taking where we take deeper dive in their physical, emotional and mental well being in an orderly manner and observe calmly and subtly but with precision and detailing just like a detective who doesn’t let people discover that they are observed and make them feel safe enough to share their deepest concern, their emotions that they have buried deep, their thoughts that might have triggered the dynamic derangement and through an unprejudiced observation via all senses, we individualize each case and help in restoring the sick to health.
Reference
1. Schmidt, P. (2003). The art of case taking. B. Jain Publishers.
2. Principles of Observation Medicine, Ross, Michael A. et al. Emergency Medicine Clinics, Volume 19, Issue 1, 1 – 17
3. Hahnemann, S. (2005). Organon of Medicine. B. Jain Publishers.
4. Ohrnberger, J., Fichera, E., & Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Social Science & Medicine, 195, 42–49. https://doi.org/10.1016/j.socscimed.2017.11.008
5. Physical health and mental health. (n.d.). Mental Health Foundation. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/physical-health-and-mental-health#
6. Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes. 2006 Jun 6;4:35. doi: 10.1186/1477-7525-4-35. PMID: 16756666; PMCID: PMC1501000.
7. Rongmei, K. D., Hawaibam, P., & Bhagat Singh, L. (2024). Case taking in homoeopathy. In Devs Homoeopathic Medical College and Hospital, Kaloji Narayana Rao University of Health Sciences Warangal, Jawaharlal Homoeopathic Medical College, & Parul University, An Online Peer Reviewed / Refereed Journal (Vol. 2, Issue 8, p. 426). https://theacademic.in/wp-content/uploads/2024/09/47.pdf
