Delayed responses ... was LM question

[Rosemary Hyde]

Just an added penny's worth on this subject. David's comment about "keeping
the patient under control" is paramount, I think. Another contribution to
this effect, besides using placebo, is having the patient check back with
you fairly frequently at the beginning of treatment. That way, you're much
more likely to become aware of subtle healing signs that will not make much
of an impression on the patient's awareness otherwise. I have found it
extremely difficult with many new patients, especially if they are not very
self-aware, to figure out if the remedy has worked or is working, unless
I've been in touch with them at least biweekly. For what it's worth...

Rosemary

[Wendy Howard]

Joy wrote:
and

I can't help but feel that you're missing my point. If a remedy is working
within minutes or hours, then the connection is pretty clear and robust ...
just as you say.

Joy, there is an *enormous* difference between minutes or hours and an
interval of around 91 days!

If there is a period of 3 months between the taking of the remedy and ANY
sign of improvement (I'm not talking about cases where the practitioner was
able to discern improvements that the patient wasn't necessarily aware of)
then I think the connection is open to question.

Open to question. Simply that. No more, no less. In other words, it's
prudent to bear in mind that our interpretation of the sequence of events in
such a case might be subject to bias, and to be very careful about
attributing progress to a homeopathic remedy unless we're very very sure of
the connection. Some of the cases I've read where this sort of interval is
experienced have rung very loud alarm bells for me, and have made me
question the practitioner's perspective somewhat.

Regards
Wendy

[David Little]

At 10:50 AM 4/29/2003 -0700, you wrote:

Hello everyone,

The psychology of case management is just as important the posology.
One has to have a relationship with the patient. Most of the old
homoeopaths worked in the community, did house calls, and assisted the
family during birth, crisis and death. They really knew the individuals
they were treating. They saw them in their daily lives and knew their
psyches, habits and relationships. That is the advantage of being a family
doctor. Today most doctors are too isolated from the patients and
community. Homoeopaths should observe their patients personally when
possible. Friendly house calls are still the best way to see who the
patient really is and how they live their lives! It is good to drop in on a
patient and see the family dynamics. This often tells a much different
story than the one the patient tells you in the office!!! Case management
should be as flexible as possible.

Giving a person a few pills and sending them off for a month to be
totally on their own is not the best method. It is too mechanistic to
automatically make every patient wait one month before the first follow up.
So much can happen in the first month that it is one's duty to review the
situation very closely in the beginning. What happens if we gave the wrong
remedy or a partial simillimum and it starts causing accessory symptoms
right away? Do we want to wait for one month to regularize the vital
force? What happens if the remedy cause no response and the patient is
thinking of doing something else already? Such things happen all the time.
The first month is too important to let pass without paying very close
attention to the patient. Some patients understand waiting and watching but
most do not. They become very impatient and think they need more medicine.
Such persons are candidates for placebo as a control method. The placebo is
the best second simillimum!

I believe it is best to have a few consolations with the patient
during the first phase of the case. I usually speak to a person four days
after I give my first test dose. Then I speak to them every 7 to 14 days
for the first month. Once I know their remedy, and the way in which they
are reacting to it, I speak to them less and less. During that first month
one can usually see the subtle signs of healing even in slow moving cases
and make a good assessment of their remedy reactions. If the reaction is
tardy or excessively slow one can adjust the dose and potency and repeat
the remedy to speed the cure. Sometimes a few more succussions, a few more
teaspoons, and a few skillful repetitions will stimulate a more progressive
improvement. There is no need to wait for 1, 2, or 3 months to see if the
remedy is working. Hahnemann was right when he said such a long time period
can be cut down to 1/2, 1/4 or less the time it takes with the 4th Organon
method.

The science of reading remedy reactions is very important. Hahnemann
saw most of his patients once a week or every two weeks in most cases. Most
of these follow ups can be done on a telephone. I can usually tell what is
going on in 5, 10 or 15 minutes. If there is any confusion one can see the
patient in person. In India I don't use the telephone. I just have the
patients "drop by" while I am taking cases and give them a quick check.
This establishes a deep connection with the patient and increases the bond
of trust.

Sincerely, David
---------------
"It is the life-force which cures diseases because a dead man needs no more
medicines."

Samuel Hahnemann

Visit our website on Hahnemannian Homoeopathy and Cyberspace Homoeopathic
Academy at
http://www.simillimum.com
David Little © 2000

[Rosemary Hyde]

Thanks, David. You could see from my message that I've backed into this
awareness, and your writing about it enlarges the perspective about
establishing that close relationship with a patient that I'm learning is
crucial, really, to good case management.

Rosemary