Case Taking & Evaluation

[Soroush Ebrahimi]

Dear Colleagues

Because some colleagues have been posting cases for us to evaluatea s a group, I thought it is perhaps necessary that we should lay some common rules down so that our investigations have more of a chance to be fruitful.

I am sure there are masters amongst the participants of this forum and I seek their patience and guidance with the points that will be discussed.
Please feel free to share any case taking ideas that may be helpful to others.

The following is also of use to those who like myself have not reached the higher etchelons of Homeopathic analysis - i.e. Not those who by simple observation of the patient can zoom on to the required remedy! For the rest of us mortals, we need a scheme and I hope this is of help.

I am indebted of course to Hahnemann himself who gave detailed case taking instructions (please DO read Organon 6th Ed), my teachers, colleagues and the blessed Dr Pierre Schmidt who wrote many little booklets of instructions. He is in fact the one who made a lot of effort to introduce LM potencies to the homeopathic world as this had been relatively ignored.

Although the following is mainly about chronic cases, I will touch on acutes too and as you can see I have attached a guide for acute case-taking.

Before a patient arrives, I make sure that I am comfortable and refreshed. I wash my face, have a nibble on something so I am not hungry during the interview and visit the toilet if necessary. (If you need to answer the call of nature during the interview you cannot remain unprejudiced!!). Make sure the air in the room is fresh and at a suitable temperature. Make sure that there is water and tissues available in your consulting room.

Through out do not forget that you are the boss - You must remain in control of the interview and the situation.
If you feel unsafe about anything - rectify it. Not all patients are going to be 'nice'. They could be violent and they could be mentally derranged. Be on guard for your own and your patient's safety.
[You should also know first aid and CPR in case something happens to your patient during the interview. What will you do because of the stress of the case the pt suffers from a heart attack?)

Homeopathy is about OBSERVATION. The homeopath is also a detective. He must ask questions if there are any doubts or suspicions - NEVER GUESS or assume!! Do not leave any stone unturned.

If you have taken the appointment call yourself, you should observe the tone and manner of the pt making the appointment.
That is when your case taking starts!
Observe how pushy or placid the pt is. Must the time be to suit you or them?
Note the urgency in their tone etc.

When they arrive, make sure you observe them carefully and whether they are on time, early or late.

Make sure you shake their hand. Is it hot, cold, dry, sweaty. Whether it is soft hand shake or hard hand shake etc.
(Note it down quickly before you forget).

It is best if you can offer a choice of seats from the arm chair to hard chair.

Other than very young children you must see the patient on their own. After the introductions, ask the person accompanying the patient to leave. It has been my experience that patients will keep a lot from you if they are not alone. Don't be fooled by family relationships. If they have brought a relative with them and if the pt does not mind you can sometimes get some info out of the relative that the pt had not given to you. See them alone too.

With children see them with their older relative, but also seek to see them on their own and then their relative alone (mums are better than dads in giving cases).

If something makes you feel uncomfortable with a particular patient, make a note about it and if you feel insecure, ask for a colleague to sit with you. (Carefully postpone the interview if you have too.)

Some patients will bring with them the results of allopathic investigations blood-tests and X-rays etc. ALWAYS take a good look at them and appear interested in them - even if you feel these are irrelevant to your case taking. Failure to do so may create a negative attitude in the pt who knows nothing about homeopathy and may think you are not interested in his problems and symptoms.

If during the interview a remedy comes to mind, just note it in the margin and forget it. Otherwise you may become prejudiced and will try and fit the remedy to the person!

If they are waiting for me to start them off, I normally ask them to start from where it is important to them, or the begining.
During this process you must not forget your aids: What Where When Why How (how much?/How many?)??????????

Leave gaps in your notes between each symptom (sx) so that later on you can ask the relevant questions and fill in any modalities or concomitants. Don't forget to ask what makes things better or worst.

NEVER interrupt a pt.
Always ask your question when they have stopped giving your case. Mark your notes with the questions so you can go to them.

If the pt start with mental/emotional sxs you must at some point change tack so that you find out about their physical sx and vice-versa.

If your pt has become very upset during case taking, Let them cry - it may be the first time they have cried for a long time, offer them a tissue - Say, please let your emotions come out. (NOTE what was being discussed when they cried - you have been given the heart of the case.) When you think they have cried enough, you must calm them down - offer them a hand, preferably placing it on their shoulder. When they have regained control, now is the time to ask questions about physical matters unless they want to carry on talking about the subject close to their heart. LET THEM.

[I remember one of the first cases I sat on, the pt had miscarried some 14 years before the interview and as soon she was asked about how she felt about the baby she had lost she burst out crying. The homeopath eventually calmed her down, asked physical questions and then came back to the painful area - she cried somemore but was able to tell us how she felt!]

When it comes to questioning about the physical aspects, cover from head to toes systematically.
Ask if they have any particular sensations in any area of their body or about their person (you must some how cover the delusions sx e.g. sensation of people being behind, or a spiders web across the face etc).

Don't forget general questions, about hunger thirst hot/cold, desires and hates, weather conditions etc.

Ask about anxieties, fears, concerns, worries, cares etc

Another question that makes some people think is "How would your best friend describe you?" - if they say I don't know, then change it to 'How would you describe yourself?'

If the pt is about to talk about a sensitive matter they may need some assurance of confidentiality.
Here in UK I obey the code of ethics of Society of Homeopaths.
The rules are simple:
If the pt's life or someone else's life or well being and security is in danger, you must involve the relevant authorities.
This is importantly so if the patient has suffered some kind physical or sexual abuse especially if it is likely to continue - or if the pt admits that they are sexually abusing someone else. If you are part of an organisation, pls find out what the collective ruling is for such conditions.

Also please remember that some diseases may be 'reportable'. e.g. in UK if someone has Syph or Gon a homeopath is not legally allowed to treat them. They must be referred to the Sexually Transmitted Clinic for their shot of a/b. But there is nothing to stop you giving them their remedy before hand - after all you are not treating Syph or Gon (are you?).

There is another clause in case taking that is extremely useful. And that is 'WHAT ELSE?'
Ask this as many times as you like during an interview.

Check to see if there are any maintaining or initiating causes!
If a pt say I have had this for 5 years, try and find out what happened around 5 years ago. It is often the key to solving the case.

With all adult patient ask about sexual function. (Don't be shy!!)
With all females ask about their mensturation history and plot the cycle showing bleeding days, type of clots and also pain days, tension days etc and when relief comes. In fact there are loads of sx associated with menstration as a concomitant.

Plot a pt family-tree medical history. Use circles to show females and squares to show males.
Find out what diseases have been running in the family as far as possible. Cover as far back as the pt knows and also children of the pt (if any) cover brothers/sisters (and their children) aunts and uncles etc.
Once done, you will see at a glance what has been happening.
Put X in the box/circle if the person has died - put age and reason by it.
Of course I have assumed that the pt is co-operative and will openly discuss their case with you.
There are (Syph?) cases where it is very hard work in getting answers from the pt. A right exhaustive process!
This is when the pt is closed and most questions end up in a short response. This is when the art of open questioning comes to the fore.

During case taking please beware that each pt has three lots of symptoms:
1- Those that they were going to tell you about.
2- Those that they were NOT going to tell you about.
3- Those that they are not aware of. These are worth a million because these show the real character of the patient to you and if you know your repertory well you should be able to put these in their slots and solve the case with ease.

The following case (curtsey - Dr Shahrdar) would demonstrate 3 above:
Girl of seven, was complaining of pain in the right side of her chest. The pain was worse breathing. On suspecting a cold coming up and using the modality of worse movement, Bry 6c was prescribed by her father. When she woke up the next morning, she still complained of chest pains. Bry 6c was given and she was sent off to school. However, because she could not stand the pain, she was sent home from school.

As two days before she had knocked her side on to the edge of a swimming pool. It was thought that perhaps a shock/knock had been experienced, she was given Arnica 30c. Several doses were given until the night and the pain would amel only for a short period. The patient was even X-rayed to ensure that her ribs had not broken. X-rays did not show any breaks or cracks. More doses of Arnica were given but did not resolve the problem.

The girl was seeking attention and crying with her pain - she was given Puls 30c but this too was of no use.

(Father gives up and Dr Shahrdar now takes over).

At this stage, it was decided to pay more attention to her mental/emotional state and to prescribe on the totality of that picture. The observations of this young girl were as follows:

Whilst crying intensely, she was sitting next to her father and wanted to lean on him. At the same time she was saying "For God's sake do something for me. Can you not see how much pain I am in? Why won't you do any thing for me?" All the time she was crying.

Rubrics:

Begging

Clinging, persons or furniture, to

Delirium, crying for help

Weeping, pains with.

The only remedy covering the above symptoms is Stramonium. Stram 6c was prescribed. After about 3 minutes the patient's pain was much less and after a quarter of an hour her pain had ceased altogether and the patient was peaceful.
After about 4 hours, there was a slight experience of pain but much less than before. Stram 6c was repeated. Just before her bed time the same thing happened and the remedy was repeated and the in the morning the child was completely well.
Attention needs to be drawn to the fact that the reason the last prescription was successful was that the mental/emotional state of the patient was taken into consideration. Note that there was no need to ask her any questions but the observation of her situation and the way she described her pain was sufficient.

Although traditionally in most acute cases little attention is paid to mental and emotional state of the patient and in the main physical symptoms are considered, only diagnosis on the totality - including mental and emotional status can ensure that success is nearly 100 per cent.

In a difficult case I once asked the patient "Is there anything that you had decided that you were not going to tell me?"
I was surprised how much came out!

Everything the patient says or does is of importance and should be noted down - sometime verbatim.

Some clues - if they give rise to a question in your mind MUST be followed - even if they seem irrelevant at first.
When I was a 2nd year student homeopath we were allowed to sit in the clinic and observe case taking of final year students.
A lady about 35 arrived complaining about severe PMT. "I am like a mad dog and feel sorry for my husband and child and colleagues for having to put up with me." (Here pls note sympathetic as an observed sx!!)
Any way after a quite an unfocussed interview the colleague asked if any one else had any questions. A couple of other colleagues asked some more questions. I had noticed that this lady had an accent that I could not identify. So I said to her - that I had detected a slight accent, but could not place it. Where was she from?
She said she was German.
So I said "Oh - you must have been in UK for a long time because I could not tell that it was a German accent."
She said that she was 17 when she had come to UK.
I asked "what brought you to UK at that age?"
She took a deep breath. O-O - I knew we had hit something!
Her face changed!
She said that she had a big argument with her mother and she had decided that she had to leave her mother and to go as far away as possible. There was an opportunity for her to come to UK so she did.
My colleague who was taking the case took over then and a good result was achieved.
She came back a month later to report. She LOOKED different all smiley and cheerful.
She said I have only come to say THANK YOU. I have been so well. (Good old Nat-m!!)

So if your inner self wants to ask a question, make sure you do too.

Time is often at a premium, especially if you have another patient waiting.
With pts who have been to see their doctor and have only discussed their asthma or skin trouble or ... it is a new thing to be interviewed in detail. It is often a new experience for them. Sometimes your allocated time is not enough to take a full case or the pt has not 'emptied his/her heart'. Please make time for them - perhaps by another appointment, so that she can.

Sometime you may have a feeling that the pt is not levelling with you. I would normally tell them straight about what I feel and have had a couple of interesting results. It is when the pt is trying to hide something painful.
We had a case of a pt who cried from the moment she sat to give her case. She spoke almost non-stop for 90 minutes yet at the end of it I had a feeling she had not told us the whole truth. We repertorised the case and it came down to two remedies but there was no way we could pick one of them for sure.
So some days later we invited her for another interview. Why? she asked. "Because we have a feeling that you have not told us everything!" OK then!!
At the interview she went straight to the point that had profoundly hurt her and it was a tragic story and she responded well to her remedy which we then selected with ease.

Don't forget - what else?

If there are maintaining cause, then tell your patient about them and ask them to rectify the matter.
Make sure they have a balanced diet.
Make sure they drink plenty of water. At least two litres of water per day.
[This can be hard for some pts as they are thirstless.
I tell them that apart from the homeopathic remedy I am going prescribe them a very expensive medicine that is not so easy to get hold of, but they must take it every day. The patient become visibly concerned. Then I say that the medicine is 2 litres of water a day. They immediately relax about and accept it!]

Make sure they do NOT use the sweetener aspartame or monosodium glutamate MSG, as well as things like camphor etc.
Aspartame causes so many sx that it may fool you. Always check. See www.dorway.com
=========
Evaluation
You must evaluate what are the most significant symptoms.
Go through your case and list your significant symptoms and put them in order of importance.

As far as possible select the rubric that best matches the symptom.

Cross reference and eliminate any remedies that are not present in first two rubrics. (Some programmes of course do this for you - saving a lot of time)
Then take into account the remedies under the third rubric and eliminate any remedies not shared with the first two.

Continue till you end up with three or less remedies. Check your MM to make sure you have a good match.

Let us imagine there has been a murder and witnesses report that the murderer was a male.
You now need not look at females as suspects - however you must be careful that you do not let go any males who have disguised themselves to look female.

Let us say that the second clue is that the murderer was bald. Be careful that he is now not wearing a wig.
And so on.
There are so many similar remedies and our repertories are not perfect. So try and learn materia medica as much as possible.
Pay good attention to any peculiar sx or to modalities and concomitants. These are sometimes enough to solve the case for you.

If you are not sure about the remedy - DO NOT PRESCRIBE IT. You must be SURE.
(who said homeopathy was easy??)

Lastly your patient notes are confidential - keep them secure.

I also attach a guide for you if you are taking an acute case. In using it, do not forget to pay attention to mental and emotional state of the patient.

I hope the above is of value to you.

Wish you Good healing
Soroush

PS. I ask once again - If you have any useful tips, please share them with us.
[Non-text portions of this message have been removed]

[Soroush Ebrahimi]

{Because we are now embarking on case-solving as a group, I have been asked to repost this post that was sent in September]
Dear Colleagues

Because some colleagues have been posting cases for us to evaluate as a group, I thought it is perhaps necessary that we should lay some common rules down so that our investigations have more of a chance to be fruitful.

I am sure there are masters amongst the participants of this forum and I seek their patience and guidance with the points that will be discussed.

Please feel free to share any case taking ideas that may be helpful to others.

The following is also of use to those who like myself have not reached the higher etchelons of Homeopathic analysis - i.e. Not those who by simple observation of the patient can zoom on to the required remedy! For the rest of us mortals, we need a scheme and I hope this is of help.

I am indebted of course to Hahnemann himself who gave detailed case taking instructions (please DO read Organon 6th Ed), my teachers, colleagues and the blessed Dr Pierre Schmidt who wrote many little booklets of instructions. He is in fact the one who made a lot of effort to introduce LM potencies to the homeopathic world as this had been relatively ignored.

Although the following is mainly about chronic cases, I will touch on acutes too and as you can see I have attached a guide for acute case-taking.

Before a patient arrives, I make sure that I am comfortable and refreshed. I wash my face, have a nibble on something so I am not hungry during the interview and visit the toilet if necessary. (If you need to answer the call of nature during the interview you cannot remain unprejudiced!!). Make sure the air in the room is fresh and at a suitable temperature. Make sure that there is water and tissues available in your consulting room.

Through out do not forget that you are the boss - You must remain in control of the interview and the situation.
If you feel unsafe about anything - rectify it. Not all patients are going to be 'nice'. They could be violent and they could be mentally derranged. Be on guard for your own and your patient's safety.
[You should also know first aid and CPR in case something happens to your patient during the interview. What will you do because of the stress of the case the pt suffers from a heart attack?)

Homeopathy is about OBSERVATION. The homeopath is also a detective. He must ask questions if there are any doubts or suspicions - NEVER GUESS or assume!! Do not leave any stone unturned.

If you have taken the appointment call yourself, you should observe the tone and manner of the pt making the appointment.
That is when your case taking starts!
Observe how pushy or placid the pt is. Must the time be to suit you or them?
Note the urgency in their tone etc.

When they arrive, make sure you observe them carefully and whether they are on time, early or late.

Make sure you shake their hand. Is it hot, cold, dry, sweaty. Whether it is soft hand shake or hard hand shake etc.
(Note it down quickly before you forget).

It is best if you can offer a choice of seats from the arm chair to hard chair.

Other than very young children you must see the patient on their own. After the introductions, ask the person accompanying the patient to leave. It has been my experience that patients will keep a lot from you if they are not alone. Don't be fooled by family relationships. If they have brought a relative with them and if the pt does not mind you can sometimes get some info out of the relative that the pt had not given to you. See them alone too.

With children see them with their older relative, but also seek to see them on their own and then their relative alone (mums are better than dads in giving cases).

If something makes you feel uncomfortable with a particular patient, make a note about it and if you feel insecure, ask for a colleague to sit with you. (Carefully postpone the interview if you have too.)

Some patients will bring with them the results of allopathic investigations blood-tests and X-rays etc. ALWAYS take a good look at them and appear interested in them - even if you feel these are irrelevant to your case taking. Failure to do so may create a negative attitude in the pt who knows nothing about homeopathy and may think you are not interested in his problems and symptoms.

If during the interview a remedy comes to mind, just note it in the margin and forget it. Otherwise you may become prejudiced and will try and fit the remedy to the person!

If they are waiting for me to start them off, I normally ask them to start from where it is important to them, or the begining.
During this process you must not forget your aids: What Where When Why How (how much?/How many?)??????????

Leave gaps in your notes between each symptom (sx) so that later on you can ask the relevant questions and fill in any modalities or concomitants. Don't forget to ask what makes things better or worst.

NEVER interrupt a pt.
Always ask your question when they have stopped giving your case. Mark your notes with the questions so you can go to them.

If the pt start with mental/emotional sxs you must at some point change tack so that you find out about their physical sx and vice-versa.

If your pt has become very upset during case taking, Let them cry - it may be the first time they have cried for a long time, offer them a tissue - Say, please let your emotions come out. (NOTE what was being discussed when they cried - you have been given the heart of the case.) When you think they have cried enough, you must calm them down - offer them a hand, preferably placing it on their shoulder. When they have regained control, now is the time to ask questions about physical matters unless they want to carry on talking about the subject close to their heart. LET THEM.

[I remember one of the first cases I sat on, the pt had miscarried some 14 years before the interview and as soon she was asked about how she felt about the baby she had lost she burst out crying. The homeopath eventually calmed her down, asked physical questions and then came back to the painful area - she cried somemore but was able to tell us how she felt!]

When it comes to questioning about the physical aspects, cover from head to toes systematically.
Ask if they have any particular sensations in any area of their body or about their person (you must some how cover the delusions sx e.g. sensation of people being behind, or a spiders web across the face etc).

Don't forget general questions, about hunger thirst hot/cold, desires and hates, weather conditions etc.

Ask about anxieties, fears, concerns, worries, cares etc

Another question that makes some people think is "How would your best friend describe you?" - if they say I don't know, then change it to 'How would you describe yourself?'

If the pt is about to talk about a sensitive matter they may need some assurance of confidentiality.
Here in UK I obey the code of ethics of Society of Homeopaths.
The rules are simple:
If the pt's life or someone else's life or well being and security is in danger, you must involve the relevant authorities.
This is importantly so if the patient has suffered some kind physical or sexual abuse especially if it is likely to continue - or if the pt admits that they are sexually abusing someone else. If you are part of an organisation, pls find out what the collective ruling is for such conditions.

Also please remember that some diseases may be 'reportable'. e.g. in UK if someone has Syph or Gon a homeopath is not legally allowed to treat them. They must be referred to the Sexually Transmitted Clinic for their shot of a/b. But there is nothing to stop you giving them their remedy before hand - after all you are not treating Syph or Gon (are you?).

There is another clause in case taking that is extremely useful. And that is 'WHAT ELSE?'
Ask this as many times as you like during an interview.

Check to see if there are any maintaining or initiating causes!
If a pt say I have had this for 5 years, try and find out what happened around 5 years ago. It is often the key to solving the case.

With all adult patient ask about sexual function. (Don't be shy!!)
With all females ask about their mensturation history and plot the cycle showing bleeding days, type of clots and also pain days, tension days etc and when relief comes. In fact there are loads of sx associated with menstration as a concomitant.

Plot a pt family-tree medical history. Use circles to show females and squares to show males.
Find out what diseases have been running in the family as far as possible. Cover as far back as the pt knows and also children of the pt (if any) cover brothers/sisters (and their children) aunts and uncles etc.
Once done, you will see at a glance what has been happening.
Put X in the box/circle if the person has died - put age and reason by it.
Of course I have assumed that the pt is co-operative and will openly discuss their case with you.
There are (Syph?) cases where it is very hard work in getting answers from the pt. A right exhaustive process!
This is when the pt is closed and most questions end up in a short response. This is when the art of open questioning comes to the fore.

During case taking please beware that each pt has three lots of symptoms:
1- Those that they were going to tell you about.
2- Those that they were NOT going to tell you about. (Towards the end of my interviews, I ask bluntly - Is there any thing that you had decided not to tell me?)
3- Those that they are not aware of. These are worth a million because these show the real character of the patient to you and if you are a sharp observer and know your repertory well you should be able to put these in their slots and solve the case with ease.

The following case (curtsey - Dr Shahrdar) would demonstrate 3 above:
Girl of seven, was complaining of pain in the right side of her chest. The pain was worse breathing. On suspecting a cold coming up and using the modality of worse movement, Bry 6c was prescribed by her father. When she woke up the next morning, she still complained of chest pains. Bry 6c was given and she was sent off to school. However, because she could not stand the pain, she was sent home from school.

As two days before she had knocked her side on to the edge of a swimming pool. It was thought that perhaps a shock/knock had been experienced, she was given Arnica 30c. Several doses were given until the night and the pain would amel only for a short period. The patient was even X-rayed to ensure that her ribs had not broken. X-rays did not show any breaks or cracks. More doses of Arnica were given but did not resolve the problem.

The girl was seeking attention and crying with her pain - she was given Puls 30c but this too was of no use.

(Father gives up and Dr Shahrdar now takes over).

At this stage, it was decided to pay more attention to her mental/emotional state and to prescribe on the totality of that picture. The observations of this young girl were as follows:

Whilst crying intensely, she was sitting next to her father and wanted to lean on him. At the same time she was saying "For God's sake do something for me. Can you not see how much pain I am in? Why won't you do any thing for me?" All the time she was crying.

Rubrics:

Begging

Clinging, persons or furniture, to

Delirium, crying for help

Weeping, pains with.

The only remedy covering the above symptoms is Stramonium. Stram 6c was prescribed. After about 3 minutes the patient's pain was much less and after a quarter of an hour her pain had ceased altogether and the patient was peaceful.
After about 4 hours, there was a slight experience of pain but much less than before. Stram 6c was repeated. Just before her bed time the same thing happened and the remedy was repeated and the in the morning the child was completely well.
Attention needs to be drawn to the fact that the reason the last prescription was successful was that the mental/emotional state of the patient was taken into consideration. Note that there was no need to ask her any questions but the observation of her situation and the way she described her pain was sufficient.

Although traditionally in most acute cases little attention is paid to mental and emotional state of the patient and in the main physical symptoms are considered, only diagnosis on the totality - including mental and emotional status can ensure that success is nearly 100 per cent.

In a difficult case I once asked the patient "Is there anything that you had decided that you were not going to tell me?"
I was surprised how much came out!

Everything the patient says or does is of importance and should be noted down - sometime verbatim.

Some clues - if they give rise to a question in your mind MUST be followed - even if they seem irrelevant at first.
When I was a 2nd year student homeopath we were allowed to sit in the clinic and observe case taking of final year students.
A lady about 35 arrived complaining about severe PMT. "I am like a mad dog and feel sorry for my husband and child and colleagues for having to put up with me." (Here pls note sympathetic as an observed sx!!)
Any way after a quite an unfocussed interview the colleague asked if any one else had any questions. A couple of other colleagues asked some more questions. I had noticed that this lady had an accent that I could not identify. So I said to her - that I had detected a slight accent, but could not place it. Where was she from?
She said she was German.
So I said "Oh - you must have been in UK for a long time because I could not tell that it was a German accent."
She said that she was 17 when she had come to UK.
I asked "What brought you to UK at that age?"
She took a deep breath. O-Ooo - I knew we had hit something!
Her face changed!
She said that she had a big argument with her mother and she had decided that she had to leave her mother and to go as far away as possible. There was an opportunity for her to come to UK so she did.
My colleague who was taking the case took over then and a good result was achieved.
She came back a month later to report. She LOOKED different - all smiley and cheerful.
She said I have only come to say THANK YOU. I have been so well. (Good old Nat-m!!)

So if your inner self wants to ask a question, make sure you do too.

Time is often at a premium, especially if you have another patient waiting.
With pts who have been to see their doctor and have only discussed their asthma or skin trouble or ... it is a new thing to be interviewed in detail. It is often a new experience for them. Sometimes your allocated time is not enough to take a full case or the pt has not 'emptied his/her heart'. Please make time for them - perhaps by another appointment, so that she can.
[Dr Shahrdar & I saw a man together some years ago. Within a few minutes we were both sure that his remedy was Sulph. However he was talking and we allowed him to go on. At the end he said I have never told any body the things I have told you.]
This 'emptying' is an important part of the healing process!
Sometime you may have a feeling that the pt is not levelling with you. I would normally tell them straight about what I feel and have had a couple of interesting results. It is often when the pt is trying to hide/suppress something painful.
We had a case of a pt who cried from the moment she sat to give her case. She spoke almost non-stop for 90 minutes yet at the end of it I had a feeling she had not told us the whole truth. We repertorised the case and it came down to two remedies but there was no way we could pick one of them for sure.
So some days later we invited her for another interview. Why? she asked. "Because we have a feeling that you have not told us everything!" OK then!!
At the interview she went straight to the point that had profoundly hurt her and it was a tragic story. She responded well to her remedy which we then selected with ease.

Don't forget - to ask What else?

If there are maintaining cause, then tell your patient about them and ask them to rectify the matter.
Make sure they have a balanced diet.
Make sure they drink plenty of water. At least two litres of water per day.
[This can be hard for some pts as they are thirstless.
I tell them that apart from the homeopathic remedy, I am going prescribe them a very expensive medicine that is not so easy to get hold of - but they must take it every day. The patient become visibly concerned. Then I say that the medicine is 2 litres of water a day. They immediately relax about and accept it with a smile!]

Make sure they do NOT use the sweetener aspartame or monosodium glutamate MSG, as well as things like camphor etc.
Aspartame causes so many sx that it may fool you. Always check. See www.dorway.com
=========
Evaluation
You must evaluate what are the most significant symptoms.
Go through your case and list your significant symptoms and put them in order of importance.

As far as possible select the rubric that best matches the symptom.

Cross reference and eliminate any remedies that are not present in first two rubrics. (Some programmes of course do this for you - saving a lot of time)
Then take into account the remedies under the third rubric and eliminate any remedies not shared with the first two.

Continue till you end up with three or less remedies. Check your MM to make sure you have a good match.

Let us imagine there has been a murder and witnesses report that the murderer was a male.
You now need not look at females as suspects - however you must be careful that you do not let go any males who have disguised themselves to look female.

Let us say that the second clue is that the murderer was bald. Be careful that he is now not wearing a wig.
And so on.
There are so many similar remedies and our repertories are not perfect. So try and learn materia medica as much as possible.
Pay good attention to any peculiar sx or to modalities and concomitants. These are sometimes enough to solve the case for you.

If you are not sure about the remedy - DO NOT PRESCRIBE IT. You must be SURE.
(who said homeopathy was easy??)

Lastly your patient notes are confidential - keep them secure.

I also attach a guide for you if you are taking an acute case. In using it, do not forget to pay attention to mental and emotional state of the patient.

I hope the above is of value to you.

Wish you Good healing
Soroush

PS. I ask once again - If you have any useful tips, please share them with us.
[Non-text portions of this message have been removed]

[Piet Guijt]

Hello Minutes Members,

More on 'Taking the case' on:

http://www.wholehealthnow.com/homeopathy_pro/wt0.html
Will Taylor, M.D., offering his insights into case-taking. These articles
originate largely out of material Dr. Taylor has prepared for teaching at
The School of Homeopathy, New York.

regards, Piet Guijt

[Soroush Ebrahimi]

Thank you Piet for this.

In fact if you read his case of the Lach woman, you can see the same
technique.

It is so simple and easy but needs good observation!!

Rgds
Soroush