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Abstract

Have you ever tried to categorize patients coming to you? Here, an attempt is made to classify patients coming to our consultation room.

Introduction
Classification is the act of distributing things into different classes or categories on the basis of different features. This method makes study more systematic and easily memorable. In medical field too the classification is commonly applied to study various health related topics. Right from the beginning of our homoeopathic education we are quite familiar with the classification of diseases, health conditions, disease causing agents, remedies and medicinal sources. Dr J T Kent has wisely given the 12 observations we come across after giving the first prescription. Similarly, here too an attempt is made to classify various types of patients coming to a Homoeopath.

Here the patients are classified under three headings:

  1. Patients coming for the first time
  2. Visit of ongoing patients
  3. No medicine needed group

The classification under each heading is based upon certain facts such as purpose of their visit, health status, treatment history and outcome of the treatment.

1. Patients coming for the first time

First aid: Emergency cases will be brought to the nearby clinic for first aid. Airway Breathing and Circulation (ABC), the three preliminary steps of first aid have to be maintained and abnormal findings such as bleeding should be examined. Further details can be obtained from the victim or the bystanders. Indicated medicine should be given in suitable potency. In case of real emergency, patient should be referred to an appropriate center with a reference letter.

Coming for instant relief: Here the patient comes with an acute problem. He needs to go with his routine work without any break; hence immediate ease of symptoms is essential. This is truly challenging for us because if we do not give the most suitable drug in appropriate potency and dose, we will land up in failure.

One-sided disease: The patient comes with a particular problem without any other indication for a prescription. If he doesn’t get any result for that problem he may go for other mode of therapies. Even after repeated questioning we may not get the points with which we can select a drug homoeopathically. In such cases we should allow them to talk freely about their life, activities and various events they have come across. We may get some hidden points by this approach.

Coming with a difficult case: Here the patient comes with a chronic complaint with history of treatment from a number of doctors of various systems of medicine, without any sort of improvement. Remember, such distinguishing cases are really a challenge for us. If we handle these cases successfully it will be more beneficial than giving a full-page advertisement in a reputed newspaper. Most of the outstanding homoeopaths are made by such wonderful cures.

Palliative cases: These patients are affected with irreversible pathological changes and come to our clinic for a chance of survival. The mental and emotional spheres of such patients are usually collapsed after the diagnosis of cancer or such diseases. Homoeopathy has miraculously cured many of the so-called incurable diseases; hence such cases should be approached in a scientific way with cent percent confidence.

Non-trusting patients: These patients often ask, “Have you treated such cases before?” They also test our knowledge by asking some medical related queries. Many of such patients give some time for the doctor to study the case and prescribe later. Once we give the similimum in suitable potency and dose they automatically develop a positive attitude towards us.

Critics of homoeopathy: Often we get a few patients who are strong critics of homoeopathy. If our treatment does not give any result, they will surely be making propagandas against us. On the other hand, if we handle such cases successfully, they may become great supporters of homoeopathy. As we all know, many stalwarts of our system were once strong critics of homoeopathy.

Try homoeopathy: The patient has heard about homoeopathy, but not yet relied on homoeopathy for his ailments. Here he comes with his troubles to try our system. If you manage this case nicely he will become a good supporter of homoeopathy.

Planning to shift to homoeopathy: These patients are now taking allopathy for their ailments such as high BP, diabetes or thyroid disorders and now they want to shift to homoeopathy. Such cases are also challenging for us and have to be managed efficiently. We should know that the sudden withdrawal of some drugs could be dangerous so that care has to be taken while dealing with such cases.

Try the doctor: This patient already knows the efficacy of homoeopathy since he has already undergone homoeopathic treatment by some other homoeopath. Now he is searching for a good homoeopath like the one who treated him earlier. He will compare you with the other homoeopath. It is a real challenge for a particular doctor because if the patient doesn’t get a result he will go in search of another doctor.

Patients from nearby areas: When we start a clinic majority of patient come under this category. These patients come from the nearby areas because of the easy access to our clinic. Most of these cases are acute because for chronic complaints they can go to famous doctors even in a distant location. Once they feel the doctor is able, they consult us for their chronic complaints.

New patient sent by a cured case: This new patient is sent by one of our patients whose case was cured by us successfully. In many such cases, the confidence level of the new patient will be usually high because the person who has suggested our name might have given full guarantee.

Influence of media advertisement: This patient comes after seeing the advertisement we had given in the media. Here he comes with a lot of expectations, as he has fully believed the advertising words given.

Close relative: Here the patient is the close relative of the doctor. Case taking may be difficult in such situations. She/he may hide some symptoms that may be valuable for the selection of a drug. Beginners should always take care while treating close relatives because a failure may affect our confidence lever more seriously. Hence except in emergency cases, it is better to take the help of other doctors.

Other doctor comes as patient: Here the patient himself is a doctor. If the patient is a homoeopath he will be giving you a list of symptoms in the language of either materia medica or repertory. When you prescribe, better hide the name of the remedy we give, because he may refer materia medica and will come to a “conclusion” that the remedy given is not fully similar to his case. 

Cases on Yoga, Reiki etc:  These patients are making use of drug-less methods for their ailments. Now, along with these techniques they need homoeopathy. Almost all people on Yoga or Reiki are having high vitality with no history of suppressions or ill effects of drugs; hence they give much better results along with homoeopathy.

Case referred by Allopaths: Nowadays many Allopaths refer cases, especially chronic cases to homoeopaths. Here the patients come with history of suppressed symptoms and drug symptoms along with detailed reports on clinical diagnosis and lab investigations. Most of such patients will trust us and will be ready to wait for a long time because allopathy could not cure them.

Coming after failure of allopathy: Here the patient comes after the failure of allopathy. Along with a history of suppression this patient has got a mixture of disease symptoms and symptoms as a result of drug reaction. Usually, we do not get any report on nosological diagnosis and management.

Case referred by other homoeopaths: Our colleague failed to cure the case and because of his sincerity he has referred the patient to us. Here we get the list of previous drugs and also some investigations. However we should take this case as a fresh one and prescribe on the basis of totality. Of course we can think about the high potency of the same drug he had given earlier.

Coming after failure of homoeopathy: Here the patient comes after the failure of homoeopathy from another doctor. Here we do not have the list of previous prescriptions given. Mostly this patient will be having a mixture of disease symptoms and symptoms produced by previous medication. But in practice the best way is to take the case in detail and give the most suitable remedy considering the totality that may include disease and drug symptoms.

Already taking homoeopathy: Here the patient is taking medicine from another homoeopath, now he also wants medicine from you for the same or the other complaints. This should never be entertained as the medicines can interact each other. Better advice the patient either to continue with that doctor or to take ours. 

Already taking Allopathy: These patients are taking Allopathy and also want homoeopathy so that they can continue both together. Nowadays we can see a number of patients adapting to different systems at the same time. Cases with conditions like diabetes, hypertension, thyroid dysfunctions, cancers etc usually come for integrated treatment.

Fear of injections, bitter tablets: These patients are having aversion to painful injections and bitter medicines, hence come for our treatment. Mostly children come under the above category.

Someone else comes for medicine: Here the direct interaction with the patient is not possible since he has sent another person for medicine. Here, mostly we will be getting common symptoms, but no generals, or any other individualizing symptoms. If the father comes for medicine for his child, we never get valuable information. Usually, the mother gives better information than the father. We should always ask the patient to come directly for a better result. If not possible for a direct visit, written details or phone calls can be of help. However, there is no better alternative than the direct interaction with the patient.

2.  Visit of ongoing patients

Patients on the way of cure: If we are too good in prescribing, majority of our patients come under this category. These patients are on the path of cure since we have administered the similimum in suitable potency and dose. Such patients get fewer episodes of complaints with great ease of all general complaints including mental symptoms. However, they are asked to visit on regular basis since their symptoms should be thoroughly observed to assess the direction of cure.

Relapse of complaints: This patient was under our treatment and was free from any sort of discomfort for a long time; and he was declared as cured. Now he is visiting us again with the relapse of same complaints he had earlier. This patient fully trusts both homoeopathy and the doctor because of the previous result with the treatment. Most of such patients ask the doctor “please give me a stronger dose of the same medicine you had given earlier”.

Acute exacerbation: Here the patient is already taking treatment for his chronic complaints. Now he has an acute complaint and comes for the treatment. If you feel the case self-limiting better give the second best medicine, otherwise give the indicated drug in suitable potency and dose.

No relief from the first prescription: This patient comes for the second prescription with dissatisfaction on his face. “Your medicine was not good enough doctor”, he says. Most of such patients even blame the doctor by saying that “your medicine aggravated the complaints”. Often, they do not mention the relieved symptoms till we ask them. Such cases can be managed successfully by giving the same remedy, same remedy in higher potency or a new drug on the basis of present totality or an intercurrent drug. 

Coming with new symptoms: Here the patient comes back after the appearance of some new symptoms. The new symptom may be due to the reappearance of the earlier symptoms, progress of pathology, proving of drug, indisposition, or even a coincidence. But whatever be the reason, most of the patients will say, “Your medicine has caused this problem”. A detailed inquiry will help to find out the cause for the new symptom and can be managed accordingly.

Coming for the “last attempt”: These patients are not happy with our treatment and enter the clinic with discontentment. They often ‘threaten’ the doctor by saying, “this is the last attempt, if no relief, I would go for allopathy. Such patients may double the tension of doctors, especially when the remedy given was well indicated (seemingly indicated in majority of cases). Most of such cases respond favorably by giving a higher potency or by giving an intercurrent and by removing all obstacles to cure.

Visiting the family doctor: Nowadays the concept of family doctor is a much-discussed subject. Due to various reasons there is a breach in the doctor patient relationship wherein patients are treated mechanically without any affection. Here comes the importance of a family doctor. Needless to say, a good homoeopath can be the best family doctor as we go much deep in to the life space investigation of individual patients.

Routinely visiting: These patients are habitually visiting our clinic with some vague symptoms. Older women with joint pains usually come under this category. They regularly take the medicine and come when the medicine gets over.

Trusting patients: These patients fully trust both homoeopathy and the doctor. He will not go to another doctor even if we are out of station for a long time. He will wait patiently till we come back. Such patients will not leave us in spite of referring them to another doctor in case of some emergency conditions. They patiently wait for a long time for a complete cure.

Coming back again: Earlier this patient had taken medicines from us, but had to consult another doctor because of aggravation or no special relief. Now he enters our clinic with some timidity and starts talking by giving some silly excuses for his discontinuance. Some tricky patients even praise the doctor by saying, “your medicine was far better than the other doctors’”.

Rotating patient: The main habit of these patients is to move from one doctor to another or from one system to another. This is called Doctor Shopping. Even if they get much relief, they go to the other doctor within a few days. Such patients criticize the other doctor or even cause feud among doctors. This group also includes patients who have yielding disposition to others’ misguidance. Initially they will be feeling better by our medicine but go on changing doctors as a result of “guidance” from relatives, friends or neighbors. Since such patients get treated by a number of doctors with different types of drugs, such cases usually land up in failure. Needles to say, women are the main victims. 

3. No medicine needed group

Routine checkup: Nowadays, due to the increased awareness on all types of preventable diseases and life style related problems, there is a rise in the number of healthy people visiting the doctor for routine health checkups.

To ask about a particular treatment: This patient is going for a particular mode of treatment and has come to us for our advice. Patients, before going for treatments such as surgery, chemotherapy or radiotherapy usually come to us for opinion. We should be very careful in giving our remarks in such cases. Before we give an opinion, we should do an overall assessment of the condition of the patient. The limitations and possibilities of our mode of therapy should be considered. The positive and negative outcomes of the different modes of treatments should be told clearly. If necessary, we should also refer for a second opinion.

Coming to clear medical doubts: Apart from treating we doctors are having major role in educating the public on various health related issues. Though Internet provides a lot of information at the click of a mouse, many people come to us for clearing their health related queries.

Coming to tell your medicine was not good enough: This patient had taken treatment from us. But it couldn’t help him; he had to consult another doctor for relief. Now he doesn’t need any treatment but has come to inform that our medicine didn’t work. Though it is disappointing, especially for a beginner, such information is essential for record keeping, learning from our mistakes and to find out what was the obstacle to cure. It should be kept in the mind that if the patient doesn’t come back after the prescription, it need not always mean that he is cured. Hence always tell the patient to inform the result of treatment.

Thanksgiving: Patients when not satisfied with the previous dose will call us even at midnight, but when they get cured many of them may not inform, which forces us to write “patient might have got cured” in the case paper. I have seen patients offering thanks when they meet me unexpectedly at railway stations or markets, for the wonderful result they got from the previous prescription, of course, with a strong apology for not informing the matter. In todays busy life wherein people struggle for managing time, such mistakes are pardonable. However, some people visit our clinic to express their gratitude for a wonderful cure and a few of them come with sweets or gifts as token for their appreciation.

The list of our visitors never end here as we face a number of patients, medical reps, insurance agents, sales reps etc. in our day-to-day practice.

Dr Muhammed Rafeeque
Family Homoeopathic Clinic
Kerala
FamilyHomoeopathy.com




Views: 347

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Comment by Dr Muhammed Rafeeque on January 17, 2011 at 1:25am

Thanks for the comments.

 

Usually homeopaths and homeopathic students come with some rubrics given in the repertory!

Comment by Dr. Bruce Arnold on January 16, 2011 at 5:28pm
Dr. Rafeeque, thanks for sharing this encyclopedic list with us. Every bit that I can learn about what makes a patient tick is going to make me a better prescriber. Although they may not come with rubrics attached, these categories are invaluable bits of information. Motivation is an important indicator of mental state.
Comment by dr.sadathsait on January 15, 2011 at 9:26am
dr.rafeeque.This is amazing.we all go through this.we dont put edfforts to classify something likethis.great work.keep it up
Comment by Dr Ravindra Saraswat on January 14, 2011 at 11:43pm
Thanks a lot.
Comment by Dr Muhammed Rafeeque on January 14, 2011 at 11:36pm

Thanks for the comments.

@Dr Ravindra- Just one visit is enough to classify most of them. Of course, many visits are required to identify rotating patients (those who are addict in doctor-shopping).

Comment by Dr Ravindra Saraswat on January 14, 2011 at 11:17pm
Dr Rafeeque,
After how many visit you put them according to your classification?
Comment by Debby Bruck on January 14, 2011 at 1:12pm
I will come back to reread tomorrow. I have obligations today. Looks very interesting.
Comment by Dr. Wequar Ali Khan on January 14, 2011 at 8:54am

Dr Rafeeque,a very timely and thought provoking post.Yes as homeopathic doctor we will have to search the psyche of our patient.and the buzz word is "patience";

The types of patient you have mentioned is really true,and we can not overlook the "hypochondriac" the type who is always coming with some health issues.

It is worth studying these types,and in many cases they tend to be psychosomatic patient;

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