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Creating Waves of Awareness

(Article published in Chronicle)

Introduction

It is said that we should never hide anything from the doctor and the advocate, because hiding some crucial points can negatively influence the remedy selection as well as the outcome of legal remedy. In spite of knowing this fact, unfortunately, many patients do not give the details while consulting a doctor. This is more common among those who come under Avoidant personality trait. In addition to that, lack of observation skills, patient listening, and above all, wrong interpretation from the doctors’ side can also make the situation worse!

 

Some patients do not tell certain points during consultation. It may be due to the following reasons:

 

  • Unintentionally due to forgetfulness and apprehension
  • Personality trait (avoidant personality)
  • Iatrophobia
  • Loss of memory due to some disease
  • They think that certain details are not relevant for treatment
  • Feel very shameful to share with the doctor
  • Doctor is not communicative enough to tell more details
  • No privacy in the consultation room due to the presence of other patients, nurses, internees, bystanders, etc.
  • The secret may affect the reputation of the patient
  • The secret may leak-out through the doctor
  • Doctor may scold the patient, especially when not following the restrictions strictly.
  • Peculiar nature of the patient (Alumina patient)
  • We never get more details when someone else has come for medicine. (We get only common symptoms from them)

 

What do they usually hide from us?

  • Marital disharmony
  • Familial problems
  • Sexual desire and related troubles
  • Troubles related to the genital organs
  • History of sexual exposure or sexual abuse
  • Sexual perversions
  • Extra marital relations
  • Vulgar dreams, thoughts, etc.
  • History of criminal activities
  • Negative qualities like stealing, abusing, cheating, troubling others, etc.
  • Bad habits like alcoholism, drug addiction, etc.
  • Anything that will affect the reputation of the patient or his family
  • Feelings like greedy, jealousy, misery, extreme religious and political views, etc.
  • When they disobey the restrictions advised by the physician (food, smoking, drinking, bed rest etc.)
  • Details of treatment taken in between, from another doctor

 

Hiding the symptoms or details is more common when the patient is our relative, neighbor, family friend, colleague or a member from the same family. This is mainly because of fear of leaking the news, and also due to shyness. A new person may not have such kinds of feelings, and here, there are no ties other than the doctor-patient relationship. Hence, we often get better response than our treatment by referring our family members to other doctors! It shows that, a stranger can be the best patient! Apart from hiding the symptoms, a family member or a close friend may not follow our instructions strictly compared to the stranger. That is the main reason for flourishing of our practice at new regions, where as, developing a sound practice at the place where the doctor is born and brought up is relatively difficult.

 

How to manage them?

Tendency to hide symptoms can be managed by giving some basic information during the first visit itself. Before we prescribe, we should convert each patient to a homeopathic patient, because most of our patients are allopathic minded, coming from the hands of specialists who do not entertain detailed case taking. Therefore, most of the patients hide the “irrelevant” points while consulting us. Always give appointment for fresh cases on a particular day wherein follow-up cases and acute cases are not entertained. We should also provide some privacy for the patient to communicate properly. A few patients feel difficult to express their problems directly in words, hence ask them to write down the problems, preferably in a printed case-taking format. Never share the personal details of the patient with others. We should not disclose the full identity of the patient while presenting the case during a seminar or through a public media. Unfortunately, many doctors do it! Of course, when the patient has given a written consent, we can surely present that particular case for presentation.

 

Here are some cases from my records that changed the prescription when the patient finally revealed the secret:

 

Case 1: Mr. N, a postgraduate student, consulted me with his parents. The main complaint was continuous hiccough since 3 days. He was unable to attend his college and to perform his routine activities. His parents were worried very much, because somebody had told that continuous hiccough could be due to some serious disease! His parents told me that he had to do some strenuous work during the function at his college. Since then, he started getting continuous hiccough and loss of appetite. He also got muscular pains due to heavy physical work.

 

I prescribed Mag phos 6x powder in repeated doses in warm water. Next day, he called me again and said that the hiccough is still continuing with muscular pains. With a request not to tell his parents, he confessed me that during the function at his college, he had taken alcohol for the first time in his life. Actually, it was the “strenuous work” mentioned by the parents! The hiccough started after that, but he could not tell me during the first visit in front of his parents who are very religious and strict.

 

Two remedies given in the repertory came to my mind - Ran bulb and Acid sulph. Apart from hiccough from alcohol, muscular pains are also prominent in Ran bulb. Hence, I prescribed a few doses of Ran bulb 30, and asked him to repeat only when there is no improvement after the first dose. Placebo was also given to take continuously for his mental satisfaction. The hiccough disappeared after the first dose itself. I asked him not to repeat the doses, and continue only the pills (placebo) for few more days. Of course, a strong suggestion was also given to avoid alcohol consumption and get rid of peer pressure from his classmates.

 

Case 2: Miss A. consulted me with her mother, for her chronic constipation. On the basis of presenting totality, I prescribed Bryonia. Within a few days, she felt better. Thereafter, she used to get same troubles occasionally. Same remedy was repeated in higher potencies, and she was feeling much better. As a routine, I presented this case in our monthly clinical meeting. After the meeting was over, my colleague (who practices near my clinic) told me that the same patient occasionally comes to him with breathlessness! When we exchanged the complete details of the patient, we could confirm that it is the same patient brought by the same mother! When they visited me next time, I asked the reason for hiding breathlessness while consulting me, and consulting the other doctor for the same. Then the mother had to disclose the secret. “Doctor, your medicine is the best for constipation and the other doctor’s medicine is very effective for breathlessness – but she had no relief from the alternate option. Due to fear of scolding, we had to hide this from both of you,” she said in a whispered voice. So the actual thing happening was: I used to treat her for constipation and send the disease to the respiratory system; the other doctor was doing the opposite! Finally, our combined decision to give a single dose of calc carb 200 cured her completely - causing great financial loss to both of us, as she was our regular patient!

 

Case 3: Mrs. K. was under the treatment of several doctors including Homeopathic and Ayurvedic doctors. She has got sub mucus fibroid with menorrhagia, severe low backache, and fibroadenoma of the breast. Apart from medical treatment, she also performs some religious practices and regularly visits some spiritual healers, because she doubts some black magic done by her sister-in-law. After taking the case, a number of remedies like Lachesis, Sabina, Sepia, Phosphorus, Nitric acid, etc came to my mind. But, I was not satisfied with the case, hence I prescribed placebo and asked her to consult me later for a detailed case taking. She again called me after a few days and said that her complaints are getting worse. Her husband was forcing her to go for hysterectomy. I told her to consult me once again and give more details that are mandatory for the prescription of a more suitable drug. Again she consulted me and told nothing about her uterus, but about her life situation, which was not disclosed to the doctors she had consulted before. Her husband is a businessman, fully engaged in business activities. Even though he is a silent and gentle person, he had no time for the family. He became diabetic before 10 years, since then he lost interest in sexual relations. This lady has been suppressing her sexual desire since then. As per her words, her religious faith and regular prayers provided energy for her to avoid any extra marital relations. With her will power, somehow she could suppress her desires.

 

Only three points guided me to the drug - Ailments from suppressed sexual desire + superstitious + glandular affections. I prescribed Conium mac 200 one dose. Within a few days, she reported that mentally she is better; he periods are less painful with normal bleeding.

 

Her treatment is going on. Last week I received a phone call from her saying that there is 1 cm reduction of fibroid size. I have suggested her to give the copy of both USG reports for record keeping. I am also treating her husband constitutionally with Lycopodium.

 

Conclusion

When the patient hides something from the doctor, it is not only his mistake; we are also responsible for that mistake, because we have failed to create such a free atmosphere for the patient to disclose everything before us. A sound doctor-patient relationship is mandatory. Our rough behavior and rigid restrictions can also force the patients to hide some crucial points necessary for the prescription. During the case taking process, we also interrupt when the patient goes “out of topic”. When they go out of topic, just listen patiently, because they may give some hints, which can probably take us to the similimum. I have also noticed many patients commenting that they feel much better by telling everything to the doctor. “A well-taken case is half cured” - the words written by Dr Elizabeth Wright is worthiest!

Views: 107

Tags: case-taking, homeopathy, homoeopathy

Comment by sajjadakram on June 6, 2011 at 7:33am

Good work.Please post the repertorial analysis if possible.

sajjad.

Comment by Dr Ravindra Saraswat on June 6, 2011 at 8:00am
In daily routine practice we all Homoeopaths also face this type problems..... in fact a a good & great work.
Comment by Dr. Wequar Ali Khan on June 6, 2011 at 10:26am
very thoughtfully penned article, opens the door to approach such patients. The hide and seek attitude of some patients often delay the treatment procedure,costing the doctor time energy and  money.
Comment by Dr Muhammed Rafeeque on June 7, 2011 at 12:17am
Thank you all for the comments. Only repertory reference was done for these cases.
Comment by DR. Sushil Bahl on June 7, 2011 at 2:09am

conveyance us the real practical problem, we face with some of the patients in daily routine.

Also the suggestions to overcome the problem,with the patients who intend to hide, are quite practical.

Over all a good article, to be read by all of us.

Comment by Dr Muhammed Rafeeque on June 9, 2011 at 12:21am
Thank u dr.
Comment by kuram srinivasachar anand on June 10, 2011 at 10:31am
Good cases sir !  Many times we know they are hiding certain information But they will not reveal beyond certain limit. We have to do with whatever they have partially told and we may be wrong in selecting remedy! I think in such cases when you suspect that the patient is hiding information, it is better to frankly tell them that hiding information will not help them.
Comment by Dr. Valerian Mendonca on June 11, 2011 at 1:55am
Comment by Dr. Aamir Mustafa on June 11, 2011 at 8:10am
Good job sir keep it up we learn more information with these cases.
Comment by Dr Muhammed Rafeeque on June 13, 2011 at 1:02am
Thank u all for the comments.

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