CASE TAKING
– Dr.J H Clarke
The first step towards making a good prescription is a well-taken case. The
homeopathist takes his cases with much care than do others ; for he has a double
diagnosis to make – the diagnosis of the disease and the diagnosis of the
remedy. The directions given by Hahnemann himself in the Organon
should be carefully studied, and the spirit of them followed. The patient should
be allowed to tell his own story just what he feels, and the particular
symptoms he is most anxious to be rid of.
I once had a compliment paid to me by a patient in Hahnemann ward when I was
a resident physician in the hospital. It was paid indirectly and was all the
more valuable for that. It was contained in a remark made to another patient and
overheard by one of the nurses. The speaker was telling his neighbour why he
approved of my methods. It was not because I cured him, for he had not been in
hospital long enough for that; it was because, as the put it, “He lets
you have your say“.
This, as I take it is the foundation on which a true picture of a case has to
be constructed in the doctor’s mind – he patient’s own uninterrupted story
of that which he experiences. It is very far from being the whole of the
picture, for if the doctor cannot see much more than the patient can tell him,
he is not much of a doctor. But the patient’s story provides not only the
foundation, but also the outline which the imagination of the physician must
fill in. It is on this power of correctly filling in the lines and the colours
of a case that success in the art of the physician largely depends. When the
patient has finished his story then comes the physician’s turn. By his
questions he elicits the particulars of the patient’s past history, his family
history, and the cause of his trouble if ascertainable, and he completes the
picture by such items as he is able to obtain by physical examination.
Having elicited the evidence, subjective, objective and inferential, the next
question is – how is he to preserve the record ? In this matter, every
practioner is a law to himself. Some have copious and accurate memories and are
able to hold the picture complete in all it’s details in their own minds. I am
not one of them. For me, it is a necessity to get all the chief points on
written record, so that, without burdening my memory, I can quickly restore the
mental picture at nay future time, by a reference to my notes.
In my own practice I have found of great service in taking cases in detached
printed forms such as here I append. The headings of the Hahnemannian Schema are
spaced out , and under each I put the symptoms as told to me by the patient, or
as ascertained in the examination. As the Schema form is the only form in which
a comprehensive knowledge of a remedy can be retained in the memory, so it is
most useful to get the facts and symptoms of a patient’s case likewise into
Schema form for purposes of comparison. The points of resemblance at once occur
to the practitioner who has his knowledge in orderly shape. For it is of vital
importance to have our knowledge in vital form ; otherwise the unorganised part
of it only hampers us in the use of the little we have made our own. And we
cannot rightly claim to possess any knowledge that we have not incorporated into
our mental organism.
For recording the subsequent progress of a case, I have blank papers of the
same size as the printed forms. I have them made of the thinnest notepaper, so
that they occupy very little space in my pocketbook. Any stationer can supply
both the printed forms and the blank papers.
It is simply for the convenience of reference that I use this form to enter
the symptoms in. I do not elicit them in that shape – I take them in the natural
order as they come. The scheme is the index of the case, but the body of the
case is the picture in your own imagination. For the continuation of the case,
blank slips are used into which the initial slip fits, and these can be added on
to indefinitely. In my desk are drawers which hold these slips, and these are
arranged in alphabetical order. The following indicate what I mean.
Complaint and History
Generalities
Mind
Head
Eyes
Ears
Nose
Face
Mouth
Throat
Appetite,Eating
Stomach
Abdomen
Bowels
Kidneys, Urine
Generative
Respiratory
Chest
Heart
Neck,Back
Extremities
Skin
Fever
Sleep
Temperature
Time
Motion, Touch, etc
For the cases taken at the bedside I adopt the same plan. At first I used to
memorise and write the cases up later at home. But I found that too troublesome
and too great a strain on my memory. I always like to save myself trouble, as
most of my friends know, and by dotting down the items at the bedside in the
records which I carry in my pocket I save both trouble and time. Thus far the
mechanical part of the process.
Having got your case taken and entered, what are you going to do with it ?
“Cure it”, you say. Certainly !! But there is something more to be
done before you can get to work on that. The case must be digested in your own
mind. If you can put a satisfactory label on it, by all means do so. But that is
not sufficient by itself.
Every new case we take on is a new world we enter ; and for the time being we
must identify ourselves with it, if we are to alter it for the better.
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