Lecture 9 Flashcards
What does Hahnemann give in aphorism 82-104?
gives the basic steps for the
homeopathic interview
When does case-taking start and stop in homeopathy?
first moment pt contacts you till they exit the clinic
What are 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
Why is it important to be in observer mode not naturopath mode?
eliminate the bias
What does aphorism 83 say?
The interview must be conducted with professionalism, discretion (provide a safe environment), and using active listening
This individualizing examination of a case of disease… demands of the physician only:
- impartiality
- sound senses
- attentive observation
- faithfulness in recording the disease picture
What are 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)
- 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.
What does case taking start with?
open ended questions
T/F: ONLY ask questions when the flow stops
True
What is Aphorism 85 based on?
notetaking
What are important things to consider about 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
When can you ask more direct questions?
only at the end
What do look for during symptom analysis?
characteristic symptoms
What are characteristic symptoms based on aphorism 153?
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
What increases the value of a characteristic symptom?
- The more a symptom reveals the core of an individual, its innate nature or identity, the more it is characteristic
- 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
T/F: You don’t have to get the complete symptom
FALSE
What is the “SMILE” symptoms nemonic?
Sensations, Modalities, Intensity, Location (precise location or tissue involved), and Etiology
How are symptoms ranked?
- intensity
- how deeply they reach into the organism
- mental and emotional
When is the state of the pt observed?
After observing and ascertaining the diagnosis and cause of disease
T/F: that there can be both subjective as well as objective changes displayed by the patient in an acute state
True
What do acute diseases tend to have with reference to their symptoms?
severe, more intense and clear symptoms than chronic diseases
What do you 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
T/F: In a chronic case go as far back as possible
True
When is the chronic case most clear?
at the end of an acute state when it has subsided
What does the prescription of a chronic case consist of?
totality of symptom picture, not one symptom alone
What are chronic case questions?
- Since when?
- What is the experience?
- Where (location)?
- When (modalities)?
- With what? (concomitants)
- Identify the shift in state if applicable
What does a person’s attitude towards their illness give us?
its a representative of their general emotional state
How do you review the system? Why?
head to toe to make sure you have covered all the symptoms including old symptoms
What does exploring more about the pt state?
- interests and hobbies
- people choose personal activities as an outlet for the uncompensated state
- things pt can’t tolerate
- what we accept or don’t accept (tolerate) is OK
- what life has this pt created?
What are common challenges in case taking?
- patient can’t describe symptom
- patient is resisting, or restricting their responses
- patient changes topic
What do you do before leaving the case?
- review record
- did you forget any details?
What do you do if a patient can’t describe the symptom?
suggest to use images, metaphors, sensations, experiences that come to mind based on the symptoms
What do you do if the patient is resisting or restricting their response?
- reassure they are correct
- they should not judge or censor their response
- should just be spontaneous
- ask them about: dreams, childhood, hobbies
- ask what else? to encourage elaboration
What to do if the pt changes topic?
- gently bring the pt back to the topic you are asking about
- be calmly persistent
- if resistance, just drop it and move on
