Case Receiving: Desired Qualities of a Physician
Homeopathic Journal :: Volume: 2, Issue: 1, Nov 2008 (General Theme) - from Homeorizon.com
Author : Dr. Anoop Kumar Srivastava, BHMS (Gold Medalist), MD(Hom), Director www.homeorizon.com, Consultant, Homeopathic Hospital, Government of U.P. (India)
Article Updated: Oct 18, 2009
Individualization forms one of the most important pillars, on which stands the portal of Homeopathy. A physician cannot think of prescribing unless he has learned the art of deducing uncommon from the common mass. This can only be attained when he judiciously receives the whole case and henceforth moves towards extracting of characteristics from it. Receiving of Case, as it may seem to a layman is not an easy task. It is acquired through years of persistent labor and experience.
So, can just obtaining the knowledge, reading books make one adept in this art? It is not so, it requires qualities of mind and soul which makes one an expert in this art.
"The individualizing examination of a case of disease, for which I shall only give in this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demands of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease."
In this aphorism Hahnemann has given the motive, requisites and method of case taking. The sole motive of case taking is "formulating the image of the sick" through the bringing out the individualizing features of the case.
Now we see for case taking:
Purpose = formulating the image of the sick
Methodology = bringing out the individualizing features of the sick
Requirements = Freedom from prejudice and Sound senses
Attentive Observing mind
Fidelity in tracing the picture of the disease
In the above aphorism (83), Hahnemann asserts the desired qualifications in a physician. He is so particular about these as he believed that only a proper physician (who has all the requisites) would be able to imbibe and practice his directions in dealing with different cases, in different ways according to the circumstances, which he plans to explain in the later Aphorisms (84-99).
Freedom from prejudice Hahnemann had already discussed about the qualities of a physician and about his knowledge in previous aphorisms e.g. aph.6 and 3. As per the quality is concerned he said that the physician should be unprejudiced and as per the knowledge he said that the physician should have detailed knowledge about what is to be cured in the disease and what is curable in medicine i.e. he should have the knowledge of the disease process and the knowledge of the medicine.
Now why he again refers to the word "freedom from prejudiced" before explaining the case receiving guidelines? This is so because he wants to remind us that every physician has to know with their sound senses that which aphorism will be applicable to the given case and which aphorism will not be applicable, without being prejudiced. It is essential to testify through all aphorisms and ascertain that to which aphorism the case belongs. This can be understand by the following examples-
A person often exaggerates his symptoms to draw the attention of the physician; this does not mean that we take the Rubric crying pain with or pain agonizing. We should have the freedom of mind and use our sound senses to discriminate whether the patient's agony is due to pain or only he is doing it to impress the physician and should be listed under Hypochondriac patient mentioned in Aph. 98.
Now the guideline and the plan of treatment to deal with this kind of cases will be different if we do not have the freedom of mind and we can select the rubric crying pain with which actually does not belong to the patient and can lead to the wrong section of medicine.
So Hahnemann teaches us to be free from prejudice and have sound senses to use his guidelines whenever needed.
Attentive Observing mind:
To observe means to look without judgement, to witness without analysis.
Attentive means giving close and thoughtful attention.
Necessity of attentive observing mind is explained by the Hahnemann in Aphorism 84 as he describes "The patient details the history of his sufferings; those about him tell what they heard him complain of, how he has behaved and what they have noticed in him; the physician sees, hears, and remarks by his other senses ..."
This means that all our senses, including our awareness and observation and the inner senses have to be concentrated towards patient at the time of case receiving. We have to be completely observant; we need to focus our senses, attention and observation towards patient.
Fidelity in tracing the picture of the disease: Fidelity means faithfulness. Here Hahnemann wants the physician to be faithful in drawing the picture of the sick. One must pay faithful attention on the symptoms narrated by the patient, the behavior of the patient and the observations made by the attendants and physician himself. After this he should use his common senses to arrange the data given by the patient and process it to decide the further plan of treatment.
I was once called to attend an unconscious patient. I saw a newly married lady of 24 lying down on the floor of the kitchen with some flour sticking on her hand. On examination I found nothing abnormal with her, Pulse, B.P., Temp all ware normal. The patient regained her consciousness during the course of examination.
On enquiring, she told me that doctor I don't know what happened, but suddenly I felt that I am sinking and I fell on the ground.
I just asked her whether she gets injured every time she falls?
She replied no not at all.
It was really strange for me that a person fell on the floor suddenly and she did not receive any injury (use of attentive mind and observation).
I further enquired that did she ever have this kind of symptom?
Her husband replied that yes this was the third attack. The first was 15 days back and the second was just 7 days after the first now this is the third and just 7 days after the second. (Is it periodic i.e. at every 7 days?).
I asked what had happened in these 2 earlier episodes. Again her husband replied that we consulted a gynecologist and a neurologist for the attacks. All the scanning reports and investigations were normal.
On questioning that when she got such attacks, it was told that the first attack came when the lady first entered in the kitchen and then she was advised to take rest. The second episode come again when she entered in the kitchen after the rest and now this is the third.
I asked the couple to visit my clinic (as I found that being newly-wed, the lady was not at ease to answer my questions at her place) and interrogated both of them individually and the story was clear.
Just 1 month after her marriage her mother in law arranged the function in which the patient had to cook food for the first time in her husband's house. She was asked to cook dinner for 26 members of the family and that too varieties of dishes.
Patient had never prepared food for such a large family. In her parents house she hardly prepared food for 5-6 members.
She felt nervous and assumed that if she did this; she would have to do this for the rest of her life. She felt miserable, a sinking feeling enveloped her and before she could sit she fell on the ground. She was taken to the doctor and all was peace but the situation repeated itself the next time she was asked to cook.
Now studying her whole case I found her illness does not come in the domain of medicines. She needed a psychological counseling and assurance. I just gave her the placebo and explained the condition to her attendants that they have to provide her friendly environment. They supported her and now she is a responsible mother of 2 kids with a happy family life.
In this case I was observant and so found out the strange, peculiarity of the case. Next the repetition of the episode on the same event and at same place is quite related with some painful stress at the place. Using my sound senses I found the root of the sickness and restored her health without even prescribing medicine. It was with perfect Fidelity that I traced the picture of the disease. Of course I was unprejudiced other wise there were so many mental conditions in the story for which I could have prescribed the medicine and harm the case unnecessarily.
So finally we come to the conclusion that it is only when these qualities are present in a physician can he effectively deal the case and establish cure.