Minutus

Dear Rosemary,

I have trouble sometimes after I give an acute or an miasmatic remedy
concerning when to stop. Of course the acute gets better so you stop. But
sometimes as you say the acute tells you something that you did not know, or
it seems to be healing much more than you expected, partly because you chose
a remedy that matches the case. So in that case, I keep using the acute
until it seems to have no place to act. Automatically quiting the acute
just because the actute problem got better doesn't make sense to me. Then
when the acute remedy has run its course, I am left wondering where do I
go next. Usually back to the general remedy, but sometimes that feels
cloudy. Too much has happened in since I quit the general remedy. The same
thing happens with miasmatic intercurrents. Do you experience this
ambivalence?

Blessings,
Ellen
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Hi, Ellen.

Actually, first let's define an "acute." Strictly speaking, this is a
situation caused by an agent or situation external to the patient's vital
force and overpowering to the vital force of many people, like an injury or
an epidemic.

Symptoms that seem acute, but that recur periodically are much more likely
to be expressions of the underlying state of the vital force -- hence their
modalities and symptoms may well enhance the information already available
if they occur after the initial casetaking -- or they may provide an entry
point into the case if they are the main presenting complaint.

If there are no good symptoms left after a remedy has apparently treated an
acute exacerbation, you've probably either had some suppression, or the
patient is definitely cured --the difference should be pretty clear.

Most often, however, even if there's been a temporary or partial
suppression, in addition to your awareness that this has happened, you can
also still see a remedy picture that tells you what to do next. The
situation may require just waiting till the next acute exacerbation.

If the remedy was not curative, something else (quite possibly the same
thing again) will come up soon enough, giving you a clue where to go next.
And you will then also know what remedy doesn't work, even though you would
swear up and down that it should :-0

It can take some persuading to get patients educated enough to realize that
sometimes waiting is the best policy , but that's a lot better than feeling
pressured into doing something when the next step isn't clear.

You can always use Sac lac, of course, in these situations, if the patient
must take something.

Personally, I've found that flower remedies used as intercurrents in this
type of situation tend to muddy the picture, so I now don't use them for
this purpose. Obviously, others have had more positive experiences with
flower remedies as intercurrents, and I need to learn more in that regard.

Rosemary

Dear Rosemary,

Some acutes are obviously external accidents. Like epidemics, the response
of the vital force is also just typical. Generally, this kind of case is
simple and straightforward.

As you say, it's the acute/half suppression/aggravation combination that is
so confusing. The patient typically thinks it is an acute until you go over
the history again. If then if it is an aggravation, you can usually
pursuade them to wait it out or whatever is best. If it is the
half-suppressed apparent aggravation that is confusing. So you are saying,
when confused wait?

As a student, I am not expecting much payment, so I just don't charge for Rx
like "wait". I can imagine charging would not sit well with most
patients. What do you do? After saying wait, I still tend to spend time
checking on the px to find out if we are ready for a remedy. The time I am
spending does not go down much even though the patient is taking no remedy.
I go nuts with patients who don't tell me when they are having problems (ie
the suppression is finally coming out) so we can get started with the case
again. People who are new to this can't imagine that their newest problem
is somehow related to the entire healing process. They think of one
unrelated problem at a time. So I keep checking. This would be a bad way
to make a living.

Blessings,
Ellen
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Hi Ellen,
Yes!!!! If you don't know what or where your target is, how can you
aim at it?
And more re this below:
I think it is VERY important that you change your mindset away from
"I'm charging for prescribing a remedy", to "I'm charging for taking,
analyzing, *and managing* this case"!!! For helping this person,
within the homeopathic framework, according to the needs of the moment.
If *you* have a clear sense that you are very much "on the case" even
when the prescription is "wait", then that assurance will (WILL!) be
conveyed to your patients--which will be vastly to *their* benefit, as
well as yours.

Whatever you charge--whether much or little--should be "by the
appointment", not by "what or whether I prescribe". You can use the
appointment as seems appropriate: Maybe the follow-up is only brief,
it takes only a few minutes to realizing that the best prescription now
is "wait" (or whatever it might be). At that point if you don't want
to just turn them out early, why not use the time for "patient
education", filling in gaps, making sure the patient understands what's
going on, and why you have chosen "wait" as your next prescription? In
my experience this "catch-up and fill-in" time can be extremely
valuable, can make the difference between a patient that's confused and
dissatisfied ("why didn't she give me anything?"), or a patient that is
open, curious, watchful, and "on-board" with you! It also, in my
experience, makes the patient feel (realize) they *are* getting their
money's worth, even if all you are doing is talking about peripheral
issues. Lifestyle counseling? "Friendly exhortations" (aka "good
advice")? There is SO much more that a homeopath can -- and should!!
-- do, in addition to prescribing remedies. You need have NO apology
about saying "wait", when that's what's needed! Better you take time
to "aim carefully", rather than shooting wildly just because you figure
your audience is expecting some "action"!
That's one among many reasons that, IMO and in my experience, it's very
good to set up regular check-in times--even if it's only a phone call,
"Everything's still fine!" or, "Well, here's what's happening, but I
don't know if I should come in about it..." It should not be left up
to the patient to know or decide when they need to see you; they don't
*know* how to evaluate their own situation within the homeopathic
framework, at least not until you've worked with them, and "educated"
them sufficiently. And *even* at that point (from my past experience
as an educated patient), when one is feeling unwell, one is not
necessarily making good choices or decisions. (I recall feeling so
lousy that I couldn't figure out what to tell my h'th, so the call got
put off month after month... Regular check-in would have been better!)
And it's especially tricky if you let it be "on you" to check in with
them...
With some patients and situations this might at times be necessary if
you are to bring them along, but try to set it up differently...
Yes indeed, and that's why you charge for your *time*, not the result!
(Well, if you choose to give them a "break" here and there on charges,
that is another matter. But if you do, it should be *your gift* for
your reasons, not something you owe them for not prescribing!)

Okay, end of lecture!
)
Shannon
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Dear Ellen,
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Dear Rosemary,
Thank-you for that beautiful presentation of the facts of life. I am just a
student so I will continue my humble posture, but I am archiving your
response for that day when I am certified.
Blessings,
Ellen
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Dear Shannon,

Thanks for the pep talk. Obviously you have had your share of
difficulties.

I have a fee schedule set up to do what you are saying, and I get good
results with most treatments, but because I am not certified, many people
think I am just practicing on them. They are doing me a favor by being my
patient. That's fine. It pushes me to finish my course work and get
certified. Actually, once it is established that homeopathy works because
the patient has experienced the results, payment is a much easier issue.
But nevertheless, I have had many people quit when they are getting really
good results because 1) from their perspective the results are beyond their
wildest dreams and that is good enough and 2) because ... Who knows. They
bought a new house and suddenly they are strapped for money was the most
recent situation. I really want to feel that I have finished cases. That
is more important to me than payment. So the second set of fiancial reasons
is really upsetting. And I don't charge much. Frequently I forget to
bill. Or better said, in my heart of hearts, I don't want to bill. But
somewhere on this learning curve, I am going to have to learn to act like a
professional. ah ah. I will try to be better about billing and setting
formal appointments rather than chasing the patient. Although that works.
If the case is difficult and I am determined to learn from it, I will chase
the patient. I have to give people a lot of credit for staying with me when
we don't get satisfactory and quick results.

Blessings,
Ellen
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Dear Ellen,
)) Yes, indeed, a bad way to make a living.

As I've said a number of times in Minutus posts, I've found that educating
patients what to expect and look for is crucial. They need to learn about
the Vital Force and how it expresses itself, as well as about how remedies
assist the vital force. In a way, I'm teaching them a new language, that of
their own spirit and life force.

Then I can work with them as allies, and they are extraordinarily helpful in
letting me know symptoms and effects that otherwise I'd never learn about.
We become a team.

They also realize that they're not paying me for a prescription -- they're
paying me for working with them, teaching them, helping them, and being on
their side in the quest for improved health on all levels. Our
consultations, whatever their outcomes, even a suggestion to "wait," are
worth much more than they pay me monetarily, and most often they're very
aware of that. I'm not functioning as a dispenser of remedies but as a
skilled assistant for their own health quest.

Also, scheduling regular follow-ups is crucial, or you do indeed miss those
great opportunities when suppressed symptoms re-appear. At first I didn't do
this after the first consult or two, but I learned that if we don't schedule
regular meetings, we can't accurately track the healing process. Usually
follow-ups are every 4-6 weeks, but it depends on the client, the stage of
healing, the illness, etc..., so it could be 2 to 16 weeks. We schedule the
next appointment before the client leaves, each time. Most clients nowadays
use e-mail, so I also encourage them to e-mail me little weekly or bi-weekly
updates, which also helps catch the odd re-emerging symptom or indication of
cure.

We're all students, pretty much forever -- each client presents new learning
opportunities. At some point, it becomes important to value our own work
enough so that we feel comfortable asking for reasonable compensation, with
no sense of apology.

And yes, I've learned, finally, that if the picture is confused, it's much
better to wait than to jump in and give something just because I feel
pressured to do something. True acutes evolve sometimes hour by hour, and
the picture can change that quickly from vague generalities to more specific
remedy pictures. It helps, also, to be able to recommend harmless,
non-suppressive, soothing, often traditional treatments for specifically
uncomfortable acute symptoms when a patient is very uncomfortable, the
picture is still unclear, and it seems important to do SOMETHING. "Granny
medicine" can be a great help. (as can things like relaxation techniques,
EFT, and flower remedies).

Rosemary