Homoeopathy is a system of medicine which is based on a set of principles and its adherence to practice and research, it was Dr. Samuel Hahnemann who elaborated the concept of homoeopathy through various angles and directions and built the whole system of Homoeopathic medicine under the law ‘similia similibus curenter’.
(1) Some call it as customised medicine while some call it classical medicine, and also the tags which are put on homoeopathy as quacks, slowing acting, sugar pills, equivalent to placebo effect.
(2) Homoeopathy is widely being used in all part of world approximately 600 million
(3)Among them in India 100 million people depend on homoeopathy as health care treatment according to 2017 estimation
(4)Evidence based medicine is gaining popularity, and it’s considered to be the best standard for assessing the efficacy of any mode of treatment.
(5) But individualisation is key to homoeopathic prescription when it’s given as medicine to a patient’s every time principles of homoeopathy are validated i.e. law of similar
(6) Homoeopathy needs evidence to prove itself scientific as evidence based medicine, attempts are made by scientists to check its mechanism and plausibility through nanotechnology, quantum mechanics etc.,therefore for evidence based medicine in healthcare and research, case reports are being published in Indian journal of research in homoeopathy where physician proves a drug on patient and writes case reports with patients consent and assuring his/her privacy and confidentiality is maintained,
(7) however clinical research is of not that much use for homoeopathy as allopathy research takes place, because homoeopathy is based on inductive logic where in principles teach us and its application proves.
Homoeopathic Healthcare and Ethics
Homoeopathic healthcare starts when the patient enters the clinic, for homoeopaths it’s very important to get relevant information about patients’ mental symptoms, emotional symptoms, physical symptoms so as to prescribe accurate remedies for patients, because homoeopaths believe in a holistic way of treating individuals. The information needed by homeopathy to prescribe proper remedy based on knowledge of philosophy and principles of homoeopathy, knowledge of homoeopathic materia medica, knowledge of patients.
Knowledge of patients in healthcare is most important and its obtained by unique feature in homoeopathy that is ‘case taking’, it is also said that well case taken is half cure in homoeopathy because homeopathy as it enable the physician to select the proper remedy by making a good choice and also if needed of other treatment here homoeopathy principles are matched and validated.
Case taking also leads to a qualitative approach of homoeopathy in practice always when dealing with patients therefore quality is never compromised in homoeopathy. It is having following format of information and questionnaire
- Patient details/demography
- Chief complaints
- Present illness
Location – where is the location of the complaint
Causation – did something happen either physically, mentally or emotionally around the time the complaint started which may have caused it.
Modalities – what made the complaint better or worse. For example, this could be rest, open air, cold/heat/damp, motion, company, touch, time of day, pressure etc.
Sensation – taking the example of a headache again is the sensation of pain, thumping, bursting, a dull pain etc.
Time and duration – Time of day that pain occurs.
Duration – for how long they had the complaint
Concomitants – are there any other complaints that occur at same
- Past history – ask the patients whether he/she has suffered from any kind of illness, or underwent surgery and is on medication,
- Family history- medical history of mother and father, if not maternal paternal side so as to know whether its associated with present illness and miasms
- Personal history
Physical Generals
These questions often cover areas of the patient’s life which they may not have considered relevant but are important to the Homeopath to arrive at a totality of symptoms. Tolerance to temperature, humidity, weather changes, sun, wind, drafts, closed rooms etc. Tolerance to different seasons of the year.
Appetite, thirst, food cravings, food aversions and food aggravations.
Temperature – this would probably need to be observed. However, we need to know whether a patient is unusually affected by heat or cold.
- Mental illness which are relevant because homoeopathy also depends on psychology of patient
Mental & Emotional
Fears such as being alone, fear of animals, the dark, failure, crowds, death, robbers, heights, illness etc.
Emotional limitations – for example depression, apathy, lack of self-confidence, irritability etc., Quality of patient’s life in relationship to loved ones, family, friends and colleagues
Reactions to sympathy
Mental symptoms such as poor memory, inability to concentrate or comprehend, delusions, hallucinations, paranoia.
What makes a patient angry or sad such a question will be asked no yes or no question.
- Dreams and Sleep – Quality of sleep, quietness or restlessness of sleep, position of sleep, times of waking and reasons for waking, do they like to be covered up, do they like window to be open or shut etc.
In depth Case Taking
Homoeopathy treats a person as whole and not the disease so it is vital to get the characteristics of the person so that they can be treated Homoeopathically. So in depth case taking with patients helps us to get accurate information and intensity of the symptoms of patients
Accuracy
Physicians need to make sure that they understand what the patient is actually saying. For example, the patient may say he/she is afraid of crowds, however there could be different reasons for this. Is it because she has claustrophobia, dislikes being touched, worries something may happen to her etc. so it is very important to write down symptoms in the words of the patient so that it may help to check things with the patient later if necessary to understand exactly what is being said.
Precision
For example, with pain physicians need to know exactly where it is in the head, legs etc. so location is proper, also is the pain shooting up or is it just in one place. In addition, it is usually much better to get a patient to point specifically to where the pain is rather than using anatomical names which may not be familiar to the patient. In other words, assumptions are to be avoided.
Objectivity
Good case taking is to ensure physicians remain the unprejudiced observer in other words prejudge about the patients. Therefore, physicians need to understand what is normal and what is not normal – to do this, physicians need to have a good knowledge of their selves and culture and environment that they live in. For the homoeopath, finding out the characteristics of the case is critical and he should be very keen in observing the things to select the right remedy and characteristics.
Observations
Observations such as physical appearance, eye contact, dress, body language, energy level, attitude etc. are very helpful in building up the total symptom picture. For example, a fat, fair and flabby person would be a pointer to the Calcarea Carbonica (remedy) This is clearly a major generalisation but all the same they are useful in selecting the right remedy.
In addition, identifying what psychological type a patient is will also help in remedy selection. In other words, are they extrovert or introvert, are they intellectual thinkers or are they more oriented towards feelings.
All symptoms should be measured by accuracy for Example, if the patient says they have depression it is important to find out what the patient actually means by this – it could be suicidal desire, suicidal thoughts, anxiety etc.
Also it is important for the Homeopath to ensure what the symptoms actually mean to the patient. When a generalised symptom is mentioned by a patient the homeopath should ask such questions which show how the symptom manifests itself in life of patient – for example: If a husband says she feels unsupported by his wife the homeopath needs to establish how this issue happens itself for patient – does it mean he feels angry, abandoned, rejected, sad, confused, anxious. The remedy selected will depend on the response.
There is a fair amount of information that needs to be taken from the patient. The purpose is to get a totality of symptoms which expresses the disturbances in vital force and so leads the Homeopathic physician to act upon it by prescribing the accurate remedy.
Obstacles to good case taking
How will they achieve the whole portrait of the patient in one setting? The past history and personal history will patients feel comfortable to say during their first visit?
- Same as in -depth interview in research till we get a saturated answer, homoeopathic physician also tries to obtain answer till he gets what is peculiar-queer-rare-characteristic symptom (PQRS) the physician also may take minutes to hours to chronic case taking.
- When taking the case, it is also very important for the Homeopathic physician to be aware of difficulties they may face getting the information they need.
Patient’s wrong picture:
People are born with certain constitutions – for example slim, attractive, extrovert types. Identifying this for the Homeopathic physician is an important factor in selecting the correct remedy. (However, for example a major emotional upset has happened to change the behaviour of that person from being extrovert, trusting etc. to being unsocial and less friendly one of the remedies that person really needs could easily be missed by the Homeopathic physician) This happens because person has showed that kind of portrait which was not true but the effect of prevailing condition. It also happens that the symptoms the Homeopathic physician most needs to treat are the very ones the patient least wants to discuss.
Withdrawn Patients:
These patients either withhold symptoms or describe them with far less intensity than is the reality. They may also feel the interviewer is not interested in their problems and thereby mislead the Homeopathic physician into prescribing the wrong remedy. In this situation observations of the patient such as restlessness, excessive irritability, time taken to answer questions, blushing, perspiration etc. are possibly the only way of accurately getting the information needed.
Hypochondriacs:
These people exaggerate their symptoms so it becomes difficult to see the actual symptoms, they often want to impress the physician with how sick they think they are. In this situation the physician needs to keep a strong perspective on what is going on so that they can focus on the real issues for their condition
Intellectual patients:
These patients don’t tell about their symptoms more or do not feel like explaining more because they feel it’s not important to tell them to a physician, i.e. the most individual or characteristic. but it’s physician duty to be a keen interviewer and ask questions in that manner to get an answer for it. In these situations, the Homeopathic physician can end up with many symptoms but all are linked by the patient for one reason or another and it becomes difficult to assess which are prescribing symptoms. In other words, intellectuals tend to focus on exciting causes for their problems whereas this happens to confuse physicians so this needs to focus on susceptibility to those causes.
Conclusion
In homoeopathy, taking a case is far more than just listening to it and it’s also asking the right questions at the right time to find out why people are suffering both mentally and physically.
Finally, in homoeopathy physician tends to be the best prover than the patient himself as stated by Dr Samuel Hahnemann in his aphorism of organon of medicine.
Homoeopathic physicians trust that the organism knows how to cure itself and is already in the process of doing so but sometimes due to some disturbance in vital force it tends to need external strength in the form of remedies to achieve cure. By ensuring that physician helps the process by giving the right remedy in the right potency is by good case taking.
References:
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9. The Science of Homoeopathy | Homeopathy Resource by Homeobook.com [Internet]. [cited 2021 Apr 12]. Available from: https://www.homeobook.com/the-science-of-homoeopathy/
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Author
Dr Pooja P Mudhol
Guide: Dr Girish Navada UK
Department of Psychiatry – FMHMC
