Week 9 - Case Taking and Case Analysis PDF

NMT100HOMEOPATHY C A S E TA K I N G A N D C A S E A N A LY S I S I N H O M E O PAT H Y LEARNING OUTCOME Compare and contrast acute and chronic diseases during case taking and case analysis. CASE TAKING THE ART OF RECEIVING A CASE APHORISMS 82 TO 104 In this section of the Organon, Hahnemann gives th...

NMT100HOMEOPATHY C A S E TA K I N G A N D C A S E A N A LY S I S I N H O M E O PAT H Y LEARNING OUTCOME Compare and contrast acute and chronic diseases during case taking and case analysis. CASE TAKING THE ART OF RECEIVING A CASE APHORISMS 82 TO 104 In this section of the Organon, Hahnemann gives the basic steps for the homeopathic interview He talks about acute and chronic diseases, but adds that his outline is only partly applicable to acute diseases WH EN C ASE TA KING S TARTS? In homeopathy, it is important to understand that casetaking starts right from the time the patient enters the clinic and continues until they exit the clinic. This is even more important in acute cases. IMPORTANT FACTORS IN CASE TAKING Observation skills Detailed history taking of the symptoms making sure to take "complete symptoms" Physical examination: it is very important, to touch and check local symptoms such as warmth, coldness, tenderness, perspiration etc Identifying any emergency, making sure that patient's safety is the priority and referring them to an emergency setting whenever necessary. OBSERVATION The most essential skill for a homeopath is being an unprejudiced observer! Be in observer mode to discover what is going on with the patient before taking the role of a homeopath in order to eliminate the bias. APHORISM 83 The interview must be conducted with professionalism, discretion (provide a safe environment), and using active listening The attitude of the physician matters a lot, and Hahnemann pointed out that… This individualizing examination of a case of disease… demands of the physician only: Impartiality Sound senses Attentive observation Faithfulness in recording the disease picture OBJECTIVE SYMPTOMS Appearance–what does the patient look like ( pale, flushed, posture, height and weight) Facial expressions– (fear, anger, surprise, confusion, embarrassment, sadness, etc.). Discoloration of any part during the episode Behavior –is the patient passive or aggressive, assertive or submissive, verbal or non-verbal, introverted or extroverted, reactions to environment, communications with other staff, receptionist, etc Reaction to conversation (prefers/ avoids/ nods/ snaps) O B J E CT IV E S Y M P T O M S , C O N T. Partial heat/ partial coldness/ partial sweat Position of amelioration (lying/ sitting/ carrying/ rocking in particular position) Gait –Different gaits are characterized by differences in limb movement patterns. NOTETAKING RECORDING DETAILS SUBJECTIVE INFORMATION Case taking starts with open ended questions such as : what brings you to homeopathy? SILENCE IS THE KEY! Let patient speak uninterrupted and start asking questions when the flow stops. Unless patient is going out of topic. When patient stops, still encourage them with open ended questions such as: What else? Tell me more….. APHORISM 85 NOTETAKING: Ask them to speak slowly, so that you can write down all the essential information Write verbatim what they say and what you see Separate the symptoms one per line, leave room to add details if they move on too early to the next thing THE INTERVIEW You can ask more direct questions only at the end, once the patient is not able to give you more information, or if some information is missing, or the patient needs some probing or examples or other motivations to give you more information. You may have some ideas of remedies that will pop up in your head while you listen. Write them down in the margin and return your attention to the patient. At the end, you can ask direct questions about these remedies (about their keynotes), to try to rule them out… SYMPTOM ANALYSIS Look for "characteristic" symptoms Make sure to get THE ‘COMPLETE’ SYMPTOM CHARACTERISTIC SYMPTOM Based on aphorism 153 characteristic symptoms are: the most striking, strange (odd), unusual (distinctive), peculiar (characteristic) signs and symptoms in the case are especially… the ones to which close attention should be given, because it is these… which must correspond to very similar symptoms in the symptom list of the medicine being sought The more a symptom reveals the core of an individual, its innate nature or identity, the more it is characteristic. CHAR ACTER IST IC S YM P TO M The more intense a symptom, the more it tends to increase its characteristic value. If two symptoms are equal in characteristic value, the more recent symptom has more value than the first one. COMPLETE SYMPTOM Make sure to get THE ‘COMPLETE’ SYMPTOM Obtain at least the S-M-I-L-E of the symptom: the Sensations, Modalities, Intensity, Location (precise location or tissue involved), and Etiology (if applicable) Let's Complete the chart together Etiology Location Sensation Modalities Concomita nts A 16-year-old male suffers from chronic headaches, feeling the pain in forehead, the pain is throbbing/pulsating, any slight movement makes the pain worse, he is so sensitive to light and noise. He becomes irritable during the headache and wants to be left alone in a dark quite room. His thirst usually increased significantly during the headache. He had a head injury 2 years ago and having the headaches since. Mother feels that dehydration also triggers the headaches. when he exercises in hot days, he usually gets the headache. 21 RANKING SYMPTOMS Symptoms may be ranked as to intensity how deeply do they reach into the organism Mental and emotional are considered more important, according to their peculiarity STATE OF THE PATIENT After observing and ascertaining the diagnosis and cause of disease, the state of the patient (the changes seen in the patient physically and mentally since being unwell) is examined. It is important to note that there can be both subjective as well as objective changes displayed by the patient in an acute state. ACUTE CASES Keep in mind that acute diseases tend to have severe, more intense and clear symptoms than chronic diseases do. In an acute case limit inquiry to the acute state only, do not dip into what has been the chronic state. Record changes that happened due to acute state. CHRONIC CASES In a chronic case go back as far as possible Your prescription is for the totality of the symptom picture, not one symptom alone The chronic case is often most clear at the end of an acute state when it has subsided CHRONIC CASE QUESTIONS Since when? What is the experience? Where (location)? When (modalities)? With what? (concomitants) Identify the shift in state if applicable. HOW DOES ILLNESS AFFECTS THEM A person’s attitude towards their illness is representative of their general emotional state. e.g. “I need support”; OR ”I’m so unlucky”. MORE QUESTIONS How does this (symptom, situation, etc ) affect you or your life? How does this make you feel? (useful in detecting themes and sensations) METAPHOR OR SIMILE WORDS Feeling as if: e.g...someone is standing on my chest. e.g…. the ice is cracking and smashing into pieces EXPLORING MORE Interests and hobbies people choose personal activities as an outlet for their uncompensated state Things the patient can’t tolerate or understand What we accept or don’t accept (tolerate) is due to our conditions for feeling OK What sort of life has the patient created? REVIEW OF THE SYSTEM Review systems head to toe to make sure you have covered all the symptoms including old symptoms COMMON CHALLENGES IN CASE TAKING PATIENT CAN’T DESCRIBE THE SYMPTOM: Ask the patient to describe a specific situation in their past when the symptom or feeling occurred What were the emotions, thoughts, body sensations in that specific moment? Suggest that the patient use any words, images, metaphors or descriptions that come to mind Sensations are experiences that are perceived through the 5 senses PAT I E N T I S R E S I S T I N G , O R R E S T R I C T I N G T H E I R RESPONSES Reassure the patient that whatever they say is correct that they should not judge or censor their responses they should just be spontaneous Ask them about: dreams, what they were like in childhood, hobbies….. these give clues to the patient’s “uncompensated” nature and feelings Ask, “What else?…” at the end of statements to encourage elaboration PATIENT CHANGES TOPIC Gently bring the patient back to the topic you are asking about. Be calmly persistent; rephrase the question so it’s clear as to what you’re asking. If there is resistance because it’s a sensitive topic, just drop it and move to something else FINAL CONFIRMATIONS Before leaving the case Review the record Did you forget any details? If so, go back and complete the case record some references Reliable authors on the subject RESOURSES Dhanipkar G. How to Approach Acute Cases in Practice, Clinical Experience and Approaches in Pediatric Acutes; HPATHY.COM (2013) FEEL FREE TO P OST YOU R Q U ESTIONS ON MOODLE.