DOCTOR & THE PATIENT

THE DISTINCTION BETWEEN CURE OF DISEASE AND RELIEF OF SYMPTOMS REMAINS AS VALID TODAY AS IN THE

PAST

NO PATIENT SHOULD LEAVE A MEDICAL CONULTATION FEELING THAT THEY WILL

“JUST HAVE TO LIVE WITH IT” , EVEN WHEN THE DISEASE IS INCURABLE

WHO IS MORE IMPORTANT?

PATIENT Patient is derived from Latin word

“patiens” It means sufferance or fobearance

DOCTOR Relieve suffering Homoeopathic perspective

The physicians high and only mission is to restore the sick to health as it is termed.(aph 1)

CASE TAKING Homoeopathic perspective Hutchinson’s method

HOMOEOPATHIC METHOD

It is a unique art of getting into conversation, observation and collecting information from patient as well as from bystanders to define the patient and diagnose the disease

ALLOPATHIC METHOD It is the process of recording the

complaints of the patients and to arrive at a diagnosis and to treat according to that.

HOMOEOPATHIC METHOD Described in Organon of Medicine by

Dr.Hahnemann in aph 83-104.

AIMS OF FIRST CONSULTATION Homoeopathy

IndividualisationDiagnosis

Hutchison’sDiagnosisNature of the

patients perception of the problem

REQUISITES FOR ELICITING THE PICTURE OF DISEASE Homoeopathy

Aph.83- Freedom from

prejudice Sound senses Attention in

observing Fidelity in tracing

the picture of the disease

Hutchison’s Knowledge of disease

& its patterns of presentation

Ability to interpret a patient’s symptoms & signs

Confidence in one’s ability to strike up a relationship with very different individuals

STEPS IN MAKING DIAGNOSIS Homoeopathy

Establish the symptoms of the patient by case taking to get a numerical totality

Interpret the numerical totality on the basis of generals , particulars to arrive at a conceptual image

Hutchison’s Establish the clinical

features by history & examination

Interpret the clinical database in terms of disordered function & potential causative pathologies , whether physical , mental , social or a combination of these

IMPORTANCE OF OBSERVATION

Homoeopathy In aph. 84 & 90Ascertains how

much was peculiar to the patient

Hutchison’sNature of the

problem will be immediately obvious

HOW TO TALK WITH THE PATIENT Introduce yourself & offer a greeting Observe the patient with care Avoid having patients full face in front of

you If patient sit to your left , at an ankle to

desk , the situation is less formal & clues such as agitated foot & hand movements are more evident

The seating arrangement also makes it clear that it is the patient who is the centre of attention , rather than any one present

HISTORY TAKING In aph 84 “the patient tells the history of

his sufferings , those about him tell what they heard him complaints of...”

In hutchison “give the patient the chance to begin with what they feel is most important to them, & avoid pre-judjment of issues or exclusion of what at first may seem less important

In aph 84 “ by keeping silence physician himself , he allows them to say , all they have to say and refrains from interrupting them , unless they wander of to other matters.....”

Hutchison encourage the patient atleast initially to tell their own story without interruption from spouse , carer , or any one else present. They can have their say later

DIRECT & INDIRECT QUESTIONS In aph 87 “physician obtains more

precise information respecting each particular detail , but without ever framing his questions so as to suggest the answers to the patient

In hutchison –indirect qns can be regarded as invitation for the patient to talk about the general area that the doctor indicates is of interest

HISTORY TAKING ACCORDING TO HUTCHINSONS

Age & address Marital status Social & occupational history History of previous illness Family history Presenting complaints History of present illness Treatment history

HISTORY TAKING ACCORDING TO HOMOEOPATHY

Age & address Presenting complaints History of presenting compaints Past illness Personal history Social history Life style Family history Generals mental Obstetrical history Menstrual history Provisional diagnosis Repertorisation Final selection of remedy

Hutchinson’sObserve your patientTrust your patient

Avoid suggesting symptoms until patient has finished.

Categorising the main symptomNote taking

Keep eye to eye contact & make notesDirect questions

If you notice an abnormality not mentioned by patient

Make sure that you & the patient are talking about the same thing

Hutchinson’sRelate the history to the patients

occupation , past history , & family historyNon verbal clues

Does patient catch his breath , change in breathing pattern etc

Vocabulary Use words that patient can understand

Social issues Relating complaints to a social or personal

conflict (somatisation disorder)

Hutchisons Exaggeration of symptomsDifficult patientsAngry patientsControlling the consultation

Always stop yourself from showing an angry reaction in response

Disress-try to solve the distress of he patient Tearfullness – relief that doctor has begun to

understand a problem that no one has listened to

Confusion-dementia , drug abuse , encephalopathy , focal brain disorder

Information through a third party is liable to distortion

SYMPTOM ANALYSIS Homoeopathy

Location Sensation Modality Associated symptoms concomitants

Hutchison Location Radiation Severity Timing & duration Character Aggrevation Relief Symptoms have a

anatomical or physiological basis

CHRONOLOGY Homoeopathy

HERING’S LAW OF CURE

LEVELS OF SUPPRESSION

MIASMATIC CHANGE

Hutchison Time course of

development Timing of onset

THEY TELL ABOUT THE NATURE OF PATHOLOGICAL PROCESS

PREVIOUS ILLNESS Homoeopathy

Miasmatic background

Herings law of cure

Hutchison Previous illness medication

SPECIAL QUESTIONS FOR WOMEN

Homoeopathy Aph 94 Pregnancy Sterility Sexual desire Miscarriage Menstruation leucorrhoea

Hutchisons Ocp Menstrual history Obstetrical history

OCCUPATIONAL HISTORY Homoeopathy

Aph 94 Those conditions

which tend to produce or maintain disesae

Hutchison Occupational disease

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