Case-taking vs Data-collection

Dear friends,

What initiated me to post this small write-up is a discussion between some of our friends in HWC.

Every individual is different in several ways; hence, the way of case taking may not be same for different doctors. However, there are certain methods to take the case. As per the type of case, situation, and several other factors, the method adopted may be different.

Here are some methods:

Blank paper method: Here the case is taken with a blank paper and a blank mind. Here the doctor listens to the patient, without distracting him. No leading questions are asked. Here the patient is the driver, he can go anywhere, even out of topic. Whenever the patient stops at a junction, the doctor can give some stimulation to make him speak more (by asking - then, how, why, when, etc.). Here, we get the real picture of the case with his expressions. However, this method is time consuming, but practiced by many classical homeopaths. This is not practical for a busy practitioner who gets only a few minutes for each patient. This method is also not practical for a person whose consultation charges are less, because charging just 50 Rupees for two hours is obviously not practical!

Case sheet method: Here the case taking is done with the help of a definite format, in which, name, age, sex, occupation, address, chief complaints, details of chief complaints, histories, etc. are noted down. Here the physician is the driver. He can decide the questions and topics. However, the patient may get the freedom to go to the details in each subject.

Combined method: Here the doctor asks some questions to get a picture of the case. The specific questions help for disease diagnosis and to get the complete symptoms and other generals. Later, the patient gets time to speak, and can go out of topic. Some practitioners give appointment on a particular day for a detailed cases taking. This is useful for busy practitioners getting many acute cases, because a detailed case taking is not practical when many acute cases are waiting outside the consultation room. So, giving appointment for a particular date is more practical.

Team approach: Initially, a team of junior doctors collects the data (as per the format) and then the patient is send to the main physician. Here the patient is allowed to talk slowly and he can go “out of topic”.

Diary method: This I learned from Dr Kasim Chimthanawala. Here, when the patient comes for the first consultation, he is mentally prepared to be a homeopathic patient, because majority of patients are allopathic minded patients. Hence, they should be mentally prepared before starting the treatment. He is asked to write down his feeling and complaints in a diary on regular basis. It is almost like drug proving. When the patient comes for each consultation, the doctor gets the real picture of the patient. This works for the nervous patients who forget every thing in the doctor's cabin. Mentally, the patient feels better for keeping a good communication with the doctor through his diary. We know that even “silly things” may be useful for drug selection; hence diary method is very useful in practice.

Busy practitioners' method: This is done by many homeopaths, especially the busy practitioners. Here the remedy selection is done quickly by asking some questions. The patient may not get freedom to talk for a long time. Those who practice this method use keynote prescription, favorite remedy, past experience, clinical tips, climatic remedy, shortcut methods, specifics, combinations, etc.

Prejudiced method: We should never follow this method. Here the physician comes to a remedy immediately when the patient tells his complaints, and the physician keeps on asking some leading questions from the materia medica of the drug he wants to prescribe. Example: When a girl comes with headache, the prejudiced doctor will ask, “Do you have craving for salt?” Some doctors even force the patient to node her head so that he can prescribe Natrum mur with surety!

Many doctors do not allow the patient to go out of topic, but the truth is, patient going “out-of-topic” can be useful to dig-out the hidden symptoms, and can help for the selection of a suitable remedy. When he goes out of topic, we may get some hints by which we will come to know the patient as a person. A busy practitioner may not get more time to spend with each patient; hence, he can give appointment to selected patients for a detailed case taking. He can also take the help of some junior doctors for data collection and clinical examination, and the detailed case taking can be done later.

The list of methods never ends here. You may add more...

Wish you a happy Diwali (The festival of lights)

Dr Muhammed Rafeeque

Tags: case-taking, case-taking-methods

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Comment by Dr Ravindra Saraswat on November 3, 2010 at 1:33pm: Dr. M. Rafeeque,
Very nice approach for case taking. as you say every individual has his own way for case taking, in my opinion busy practitioner's method should be populer in India because here a homoeopath see so many patients a day.

Comment by DR. Sushil Bahl on November 3, 2010 at 11:56pm: Dr Rafeeque,
Personally I prefer blank paper method.No leading question is asked.And after the completion of case taking , I look for the desired symptoms as per the intensity and peculiarities, and mostly for the generals, physical or mental.For each case I make a provisional diagnosis and eliminate the common symptoms.Therapeutic diagnosis follows after repertorisation of the case.

Comment by Dr Muhammed Rafeeque on November 4, 2010 at 2:14am: Thank you Dr Ravindra and Dr Sushil for your comments.

Yes, busy practitioner's method is very common.
But, i feel the combined method is best. If we have some junior doctors, we can utilize the team approach. The diary writing can also be utilized.

Comment by Dr. Prabhat Kumar Dasgupta on November 4, 2010 at 10:16am: Busy practitioners' method is common along with 1-constitution or 2-modalities or 3-Mental based selection.
I prefer the best way to select similimum is Case sheet method..
One interesting thing i want to add here that once one of my friend said that " Kabhi-kabhi Pt. ko bahala, fusla kar bhi medicine ke kareeb lana parta hai"... Dr.Sarswat also remember this..

Comment by Elena Zagrebelnaya on November 4, 2010 at 8:36pm: I think this is a very good summing up of the way case-taking can be done! Thank you very much! I'm doing my case-taking with supervision right now - and I would say that for the lack of practice I can only go with what you call Blank Paper method, which really takes a lot of time when I start the interview with asking the people about their history and personal details first - and asking what troubles them right now makes it much more to the point, so the order in which you ask things may be a good way to make the "way" to remedy selection shorter - for beginners like me, that is.

Comment by Dr Muhammed Rafeeque on November 5, 2010 at 12:45am: Thanks to Dr P K D and Dr Elena for the comments.

Initially, I used to listen to the patient and do the rubric selection at the same time. But, later I changed that due to the habitual selection of some common rubrics with many drugs. Once a patient also told me that he is not feeling comfortable when I go to the computer in between. Thereafter, I changed my style.

Busy patients prefer the shortcut methods, whereas those who are very serious about their health usually prefer the blank paper method. I have seen many patients forcing me to give the medicine within a few minutes. They are not ready to wait for a few mintutes. A few among them ask, "give me the previous drug". The situation is more worse when the father comes for medicines. He wont be able to give the general and peculiar symptoms of his kids, he can onlt give the common symptoms. In this busy world, we will have to adjust with all types of patients. I feel, to some extent, our patients are also responsible for our wrong methods of practice!

Comment by Dr Ravindra Saraswat on November 5, 2010 at 2:44pm: Dr. Rafeegue.You have seen many patients forcing you to give the medicine within a few minutes. They are not ready to wait for a few mintutes. A few among them ask, "give me the previous drug". The situation is more worse when the father comes for medicines. He wont be able to give the general and peculiar symptoms of his kids, he can onlt give the common symptoms. In this busy world, we will have to adjust with all types of patients. I feel, to some extent, our patients are also responsible for our wrong methods of practice!
As you say, Many time we all busy homoeopaths also face this type of situation in daily routine practice, but diffrence is that Sir, you accept the truth & also have courage to share these all prectcal things on this community. This type of discussions may be helpful in our practice & also give the confidence-------

Comment by Elena Zagrebelnaya on November 5, 2010 at 8:14pm: Dear Dr. Rafeeque, I recall a story about a doctor who was asking a patient a lot of questions, and the patient got impatient and asked the doctor: "Why do you have to ask so many questions? Give me something to make me feel better quickly!" And the doctor answered that if the patient did not like to answer questions (or being asked questions) he should go and see a vet instead - vets do not ask their patient any questions! Maybe someone could remind me where this story comes from... But the things is - I totally agree with you that patients should really be patient and cooperate with the doctor - in case of homeopathy more than in any other holistic medicine, - otherwise they just prevent the doctor from finding them a good remedy... and get better. Maybe it makes sense to explain this to patients in some sort of pamphlets that they could read while waiting in the waiting room? In case of busy practitioners, that is. A sort of a pamphlet like - what the homeopath needs to know, in general, like "location, sensation, modalities" of a symptom and similar such things, as well as the general idea that homeopath needs to know all that is characteristic to the patient, what differs them from other patients, and only then he can make a successful prescription, otherwise the remedy will only be superficial and is not going to help much.

Comment by Dr.U.K.Srivastava on November 5, 2010 at 11:08pm: Dear Dr.,
Indeed a very nice information on case taking. The combined method is the best. In case taking the homeopath should have a good knowledge of Materia Medica. At least 30 medicines with comparisons are needed. Observation is the main part of case taking and in about 10% cases we can prescribe Homeopathic remedy on the basis of observation only.
For observation skill Practical Homeopathy authored by Dr Vinton McCabe is exellent.

Comment by Dr Muhammed Rafeeque on November 6, 2010 at 12:13am: Thanks to Dr R S, Dr E Z and UKS for sharing your knowledge.

Dr Vinton McCabe is the member of HWC. http://www.homeopathyworldcommunity.com/profile/VintonMcCabe. I think, he is the author of that book!

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