What initiated me to post this small write-up is a discussion between some of our friends in HWC.
Every individual is different in several ways; hence, the way of case taking may not be same for different doctors. However, there are certain methods to take the case. As per the type of case, situation, and several other factors, the method adopted may be different.
Here are some methods:
Blank paper method: Here the case is taken with a blank paper and a blank mind. Here the doctor listens to the patient, without distracting him. No leading questions are asked. Here the patient is the driver, he can go anywhere, even out of topic. Whenever the patient stops at a junction, the doctor can give some stimulation to make him speak more (by asking - then, how, why, when, etc.). Here, we get the real picture of the case with his expressions. However, this method is time consuming, but practiced by many classical homeopaths. This is not practical for a busy practitioner who gets only a few minutes for each patient. This method is also not practical for a person whose consultation charges are less, because charging just 50 Rupees for two hours is obviously not practical!
Case sheet method: Here the case taking is done with the help of a definite format, in which, name, age, sex, occupation, address, chief complaints, details of chief complaints, histories, etc. are noted down. Here the physician is the driver. He can decide the questions and topics. However, the patient may get the freedom to go to the details in each subject.
Combined method: Here the doctor asks some questions to get a picture of the case. The specific questions help for disease diagnosis and to get the complete symptoms and other generals. Later, the patient gets time to speak, and can go out of topic. Some practitioners give appointment on a particular day for a detailed cases taking. This is useful for busy practitioners getting many acute cases, because a detailed case taking is not practical when many acute cases are waiting outside the consultation room. So, giving appointment for a particular date is more practical.
Team approach: Initially, a team of junior doctors collects the data (as per the format) and then the patient is send to the main physician. Here the patient is allowed to talk slowly and he can go “out of topic”.
Diary method: This I learned from Dr Kasim Chimthanawala. Here, when the patient comes for the first consultation, he is mentally prepared to be a homeopathic patient, because majority of patients are allopathic minded patients. Hence, they should be mentally prepared before starting the treatment. He is asked to write down his feeling and complaints in a diary on regular basis. It is almost like drug proving. When the patient comes for each consultation, the doctor gets the real picture of the patient. This works for the nervous patients who forget every thing in the doctor's cabin. Mentally, the patient feels better for keeping a good communication with the doctor through his diary. We know that even “silly things” may be useful for drug selection; hence diary method is very useful in practice.
Busy practitioners' method: This is done by many homeopaths, especially the busy practitioners. Here the remedy selection is done quickly by asking some questions. The patient may not get freedom to talk for a long time. Those who practice this method use keynote prescription, favorite remedy, past experience, clinical tips, climatic remedy, shortcut methods, specifics, combinations, etc.
Prejudiced method: We should never follow this method. Here the physician comes to a remedy immediately when the patient tells his complaints, and the physician keeps on asking some leading questions from the materia medica of the drug he wants to prescribe. Example: When a girl comes with headache, the prejudiced doctor will ask, “Do you have craving for salt?” Some doctors even force the patient to node her head so that he can prescribe Natrum mur with surety!
Many doctors do not allow the patient to go out of topic, but the truth is, patient going “out-of-topic” can be useful to dig-out the hidden symptoms, and can help for the selection of a suitable remedy. When he goes out of topic, we may get some hints by which we will come to know the patient as a person. A busy practitioner may not get more time to spend with each patient; hence, he can give appointment to selected patients for a detailed case taking. He can also take the help of some junior doctors for data collection and clinical examination, and the detailed case taking can be done later.
The list of methods never ends here. You may add more...
Wish you a happy Diwali (The festival of lights)
Dr Muhammed Rafeeque