Minutus

Dear Liz and others,

You said that you implied that your impute would not be valuable
because Japan is so different from Europe. Your concerns with legal
attacks may not far down the road. Certainly it is worthy of worry.
I think that Europe is closer to Japan than the US in terms of social
and cultural maturity. Fundamentalism and extreme capitalism have set
the US back considerably. IMO. So yes, I appreciate your comments.
I actually appreciate comments from Americans too, but I am very tired
of American politics.
I am writing my whole website in English partly because I have a few
English speaking patients, but mostly I have been frustrated with
writing in Japanese and then scrapping everything before it gets to
the stage where I can show it to someone. Also, most Japanese have
little experience with doing something like putting up an alternative
medicine website and as I said, they know nothing about homeopathy.
So I am hoping that English speaking friends and homeopaths will
review the writing before I go through the labor of translating.
(Half of the site is translated.) I just don't see an informative
homeopathic Japanese website now, so this will be a first.

I have written a homeopathic intake questionarire that is meant to
indicate the possibility of a useful subject for further
investigation, but not to mimic a homeopathic interview. Partly, I
don't want to have to read through complex Japanese writing (in the
equivalent of script). Also, I feel that many clients are not used to
expressing themselves in writing and find the demand for writing on a
questionairre cause more anxiety than it is worth. So most of my
questionnaire involves circling words. Additional words, questions
etc from anyone would be most welcome.

When describing the intake process as a page on the site, it seems
reasonable to publish and make reference to my intake questionnaire.
In other words the document would be public, but I would also include
it in my welcome package. What do you think?

I would very much appreciate it if you, Liz, or anyone else would be
willing to review this questionnaire and add comments. I would send
the questionnaire to any individual who is interested regardless of
willingness to comment.

Best,
Ellen

With all due respect, I would like to challenge the need for a questionnaire given to the patient (it should be next to the practitioner who can check he/she did not forget anything....).
Doesn't that remove all spontaneity from the patient? Yes it jogs his memory, and knowing that we depend at times on small details, we find ourselves drowning in a sea of information, certainly neatly presented, but how do we use it?
I start by asking "what can I do for you?" or something similar, or also "why did your wife drag you to see me today?" as this is a local reality, then I go into grunting mode. Then "what else?", then going over what the patient said and asking him to explain, refine, detail everything.
Once that is done, we go through the past history, the systematic questioning of all systems and organs/functions, the diet, the modalities, the sleep and dreams and finally, when they are used to the inquisition, to the M/E questioning; this is followed by the physical examination.
That way it is possible to see what is the hierarchy of problems the patient expresses, areas of resistance where he does not want to go (then you know it is important) as he does not expect to be questioned about it; it is a lot easier to clam up and hide something if you have seen on a questionnaire that this will be approached.
I often joke with my patients that they will tell me everything, even what they do not know, because I have been trained by the KGB. Not following a pattern, a specific, rigid plan allows for improvisation, reaction to some words, change in body language, in face expression, in face colour; add to that info from tongue and pulse reading and some physical findings, you have stripped your patient of almost everything important at the first visit and planted the seed for more revelations later on as he/she realises how much there was to be talked about.........and I always tell them that as soon as they get out, they will remember stuff, please write it down and we will use it next time.
It is part of the least effort, the Art of Not Doing.....
Some patients who did have encounters with other practitioners did send me questionnaires before coming; it was the most difficult consultations I ever had, each question was answered with "I wrote that on page XYZ...." Facts are important, how you present them are often more important and more relevant in our type of practice.
Ooooppss, got carried away............
Dr. J. Rozencwajg, NMD.
"The greatest enemy of any science is a closed mind"
Visit www.drjoesnaturalmedicine.blogspot.com for articles and information.

Dear Dr. Roz,

I have struggled with this questionnaire question for precisely the
reasons that you give. If you look at my questionnaire, it is not
made up of the kinds of questions that we normally even want answered.
It simply covers the basics areas of mind and body. That is, the
bigger sections of the Repertory. The patient circles the relevant
areas and I may or may not get back to that area. I also have many
different strategies for particular patients. It depends on how I
feel about them and how the interview goes. Particularily the opening
varies. Many Japanese are much more structured in their approach then
I am. I want to give them the feeling that I have a structure even
though from their point of view, I am in free fall.

Also the questions about vaccinations typically do not get answered
during an interview. Most people simply don't know. Even if they get
back to their mothers, the mothers don't remember or didn't notice. I
certainly didn't. Diseases of ancestors and the patient's birth and
infancy also suffers a similar fate. A questionnaire increases the
likelihood that such questions will be answered.

My hope is the this kind of questionnaire will decrease the time we
need to spend reviewing over body systems etc. The real meat of the
interview is not in the questionnaire.

I will send you my questionnaire. You will note that it says in the
beginning that I will not follow the questionnaire in the interview.
I would tend to use pointed questions based on the questionnaire at
the end of the interview.

Blessings,
Ellen

I respect your ‘challenging the need for a questionnaire’, but I’ll present a slightly different perspective. I do use an emailed questionnaire whenever possible, and find it very helpful. Almost everyone shows up with a list of pharmaceuticals (prescribed and over the counter). With that list ahead of time, I can look up those drugs and see their known side effects, and nutrient depletions. That sometimes gives me a different perspective on their symptoms. Also, very often the gently ‘jogged memory’ does help them in putting a time line together earlier rather than later in the process. Sometimes (depending on what they described in the phone call requesting an appointment) I ask them to keep a diary of their water, food, sleep, symptoms for a few days before the interview. But otherwise, the interview itself goes on with the overall spontaneity – ignoring the form unless something jumps out and needs to be discussed. I completely agree, listening carefully to the client’s expressions of symptoms, hierarchy and the character, content and emotion of their vocabulary and body language, are the keys to a productive interview.
Donna
D C Rona, PhD, ND, DHM
From: minutus@yahoogroups.com [mailto:minutus@yahoogroups.com] On Behalf Of Dr. J. Rozencwajg, NMD.
Sent: Saturday, September 12, 2009 2:24 AM
To: minutus@yahoogroups.com
Subject: Re: [Minutus] Homeopathic intake questionarie
With all due respect, I would like to challenge the need for a questionnaire given to the patient (it should be next to the practitioner who can check he/she did not forget anything....).
Doesn't that remove all spontaneity from the patient? Yes it jogs his memory, and knowing that we depend at times on small details, we find ourselves drowning in a sea of information, certainly neatly presented, but how do we use it?
I start by asking "what can I do for you?" or something similar, or also "why did your wife drag you to see me today?" as this is a local reality, then I go into grunting mode. Then "what else?", then going over what the patient said and asking him to explain, refine, detail everything.
Once that is done, we go through the past history, the systematic questioning of all systems and organs/functions, the diet, the modalities, the sleep and dreams and finally, when they are used to the inquisition, to the M/E questioning; this is followed by the physical examination.
That way it is possible to see what is the hierarchy of problems the patient expresses, areas of resistance where he does not want to go (then you know it is important) as he does not expect to be questioned about it; it is a lot easier to clam up and hide something if you have seen on a questionnaire that this will be approached.
I often joke with my patients that they will tell me everything, even what they do not know, because I have been trained by the KGB. Not following a pattern, a specific, rigid plan allows for improvisation, reaction to some words, change in body language, in face expression, in face colour; add to that info from tongue and pulse reading and some physical findings, you have stripped your patient of almost everything important at the first visit and planted the seed for more revelations later on as he/she realises how much there was to be talked about.........and I always tell them that as soon as they get out, they will remember stuff, please write it down and we will use it next time.
It is part of the least effort, the Art of Not Doing.....
Some patients who did have encounters with other practitioners did send me questionnaires before coming; it was the most difficult consultations I ever had, each question was answered with "I wrote that on page XYZ...." Facts are important, how you present them are often more important and more relevant in our type of practice.
Ooooppss, got carried away............
Dr. J. Rozencwajg, NMD.

"The greatest enemy of any science is a closed mind"

Visit www.drjoesnaturalmedicine.blogspot.com for articles and information.

Hi Kerry
When I mentioned that I send a questionnaire to patients, I did not explain exactly what was in it - I only ever ask for basic facts that will be diffcult to recall in a consultation, in particular those facts for which I need dates (in case I want to do a time line) I begin by practical details: their date of birth, Dr's name and address (in case I need to write to their GP) their medical history (childhood illnesses, operations, accidents etc. and approximate dates of these) their vaccination history plus any reactions they may have had, any medication and/or supplements they may be taking and finally their family medical history (illnesses, causes of death in siblings, parents, grandparents etc.)
I do not ask any personal questions about likes, dislikes, environment, personality etc. nor anything about the presenting complaint. These are left for the interview...for obvious reasons, as Dr. Roz has explained.
Hope this helps
Liz
With all due respect, I would like to challenge the need for a questionnaire given to the patient (it should be next to the practitioner who can check he/she did not forget anything....).
Doesn't that remove all spontaneity from the patient? Yes it jogs his memory, and knowing that we depend at times on small details, we find ourselves drowning in a sea of information, certainly neatly presented, but how do we use it?
I start by asking "what can I do for you?" or something similar, or also "why did your wife drag you to see me today?" as this is a local reality, then I go into grunting mode. Then "what else?", then going over what the patient said and asking him to explain, refine, detail everything.
Once that is done, we go through the past history, the systematic questioning of all systems and organs/functions, the diet, the modalities, the sleep and dreams and finally, when they are used to the inquisition, to the M/E questioning; this is followed by the physical examination.
That way it is possible to see what is the hierarchy of problems the patient expresses, areas of resistance where he does not want to go (then you know it is important) as he does not expect to be questioned about it; it is a lot easier to clam up and hide something if you have seen on a questionnaire that this will be approached.
I often joke with my patients that they will tell me everything, even what they do not know, because I have been trained by the KGB. Not following a pattern, a specific, rigid plan allows for improvisation, reaction to some words, change in body language, in face expression, in face colour; add to that info from tongue and pulse reading and some physical findings, you have stripped your patient of almost everything important at the first visit and planted the seed for more revelations later on as he/she realises how much there was to be talked about.........and I always tell them that as soon as they get out, they will remember stuff, please write it down and we will use it next time.
It is part of the least effort, the Art of Not Doing.....
Some patients who did have encounters with other practitioners did send me questionnaires before coming; it was the most difficult consultations I ever had, each question was answered with "I wrote that on page XYZ...." Facts are important, how you present them are often more important and more relevant in our type of practice.
Ooooppss, got carried away............
Dr. J. Rozencwajg, NMD.
"The greatest enemy of any science is a closed mind"
Visit www.drjoesnaturalmedicine.blogspot.com for articles and information.

Hi Kerry
When I mentioned that I send a questionnaire to patients, I did not explain exactly what was in it - I only ever ask for basic facts that will be diffcult to recall precisely in a consultation, in particular those facts for which I need dates (in case I want to do a time line). I begin by practical details: their date of birth, Dr's name and address (in case I need to write to their GP) their medical history (childhood illnesses, operations, accidents etc. and approximate dates of these) their vaccination history plus any reactions they may have had, any medication and/or supplements they may be taking and finally their family medical history (illnesses, causes of death in siblings, parents, grandparents etc.) Some people need time to recall dates, or need to ask their parents when exactly they had one or other childhood illness.
I do not ask any questions about their personal life story, their likes, dislikes, environment, personality, temperament, mental/emotionals etc. nor anything about the presenting complaint. These are left for the interview...for obvious reasons, as Dr. Roz has explained. The beauty of the questionnaire is that if I have their medical history with dates next to me, as we go through their life story, I can begin to match dates with events if something seems to have an aetiology, like onset of diabetes after parents' divorce, for example. This flags up something which could potentially be very important and allows me to dig a little deeper. I also do not ask any questions about their current physical health in general, as I do a top to toe check on all systems, as Dr. Roz has said he does. The presenting complaint is explored in detail, along with its modalities etc.
When I send the questionnaire, I explain that it will save a great deal of time at the first appointment, allowing me to concentrate on them and their complaint. I ask them to bring the questionnaire with them to their first appointment - a few forget, and in my experience, even if they promise to post it later, or bring it to the next appointment, they never do - this in itself tells you something about the patient - not a Kali Carb, I'll bet!
Hope this helps
Liz
With all due respect, I would like to challenge the need for a questionnaire given to the patient (it should be next to the practitioner who can check he/she did not forget anything....).
Doesn't that remove all spontaneity from the patient? Yes it jogs his memory, and knowing that we depend at times on small details, we find ourselves drowning in a sea of information, certainly neatly presented, but how do we use it?
I start by asking "what can I do for you?" or something similar, or also "why did your wife drag you to see me today?" as this is a local reality, then I go into grunting mode. Then "what else?", then going over what the patient said and asking him to explain, refine, detail everything.
Once that is done, we go through the past history, the systematic questioning of all systems and organs/functions, the diet, the modalities, the sleep and dreams and finally, when they are used to the inquisition, to the M/E questioning; this is followed by the physical examination.
That way it is possible to see what is the hierarchy of problems the patient expresses, areas of resistance where he does not want to go (then you know it is important) as he does not expect to be questioned about it; it is a lot easier to clam up and hide something if you have seen on a questionnaire that this will be approached.
I often joke with my patients that they will tell me everything, even what they do not know, because I have been trained by the KGB. Not following a pattern, a specific, rigid plan allows for improvisation, reaction to some words, change in body language, in face expression, in face colour; add to that info from tongue and pulse reading and some physical findings, you have stripped your patient of almost everything important at the first visit and planted the seed for more revelations later on as he/she realises how much there was to be talked about.........and I always tell them that as soon as they get out, they will remember stuff, please write it down and we will use it next time.
It is part of the least effort, the Art of Not Doing.....
Some patie=nts who did have encounters with other practitioners did send me questionnaires before coming; it was the most difficult consultations I ever had, each question was answered with "I wrote that on page XYZ...." Facts are important, how you present them are often more important and more relevant in our type of practice.
Ooooppss, got carried away............
Dr. J. Rozencwajg, NMD.
"The greatest enemy of any science is a closed mind"
Visit www.drjoesnaturalmedicine.blogspot.com for articles and information.

Certainly, I do not disagree, just I do not use it and I presented the reasons why.........we all have brains that function differently and different experiences leading to different styles.
As students, we tend to emulate the teachers who impressed us most, until we realise we have to find our own personal approach, the one that will work best for each of us.
Dr. J. Rozencwajg, NMD.
"The greatest enemy of any science is a closed mind"
Visit www.drjoesnaturalmedicine.blogspot.com for articles and information.

Hi Dr. Roz,
Yes I see what you mean. Half of the time, people change their main complaint through the interview. They get some insight into their condition by discussing their history and then want to fix the deeper problem. I wouldn't want anyone to be committed to their first statement their main complaint. Maybe I will erase the part about the main complaint. But part of it is impression management. I want people to feel that I am serious.
When I am pretty happy with the interview and then mechanically going through all the systems, often I find it pretty unproductive. That's where the questionnaire would help. I think I will take out the part about emotions too. Most people are unaware of their emotional tendencies. I always find that out during the interview.
Blessings,
Ellen
Got your questionnaire.
Nice one.
And if it helps you getting better information, very good.
But I am still worried that the spontaneity of the first answer and the reactions, as well hidden as they can be, to questions might be blunted by allowing the patient to construct a structured answer that might not be the real answer.
For example, he might list his ailments in chronological order of appearance, or anatomically form head to toes; you are then missing that despite having chest pains and high blood pressure, what worries him is that sensation of constriction in the throat unrelated to the chest pains, which could be the center of the case as him being prevented to express deep feelings.
Precise details about vaccinations, surgeries, etc,...can be obtained at the next interview, the only important thing though is to know which drugs are used so that their side-effects can be considered and tentatively taken out of the list of the patient's own symptoms.
Understand me well, I am not saying that what you are doing is wrong, only presenting the reasons why *I* would not go that way.
Dr. J. Rozencwajg, NMD.
"The greatest enemy of any science is a closed mind"
Visit www.drjoesnaturalmedicine.blogspot.com for articles and information.

Hi Liz

It was Ellen who was asking about questionnaires not me.

Kerry

Dear Sanket,

I start differently every time. Standard routine type people start
with filling out forms. Anxious people get body work or they start
pouring out their story. As I said, the questionnaire is not a guide
for the interview. It is an effort to shorten the hemming and hawwing
over vaccinations, childhood diseases, and every little problem.

I like one approach where I tell them that I have a magic wand. I can
fix anything. I say ping and pretend I am hitting their head with the
wand. I ask them to list me everything that I could possibly fix. As
they list, sometimes I playfully say ping. I tell them that actually
I can't guarantee a fix, but its a game. If I have the list, I can
eyeball it and say, what about your knee? Playful people like the
game. A Kali probably would not invite such playfulness. After they
make the list, I eyeball it and tell them to tell me about the most
important things. Usually what they don't remember is not important.
The list helps to prevent getting lost on one problem.

I suppose for Sankaran's method, getting stuck on trivial problems is
not a problem. Often their chief complaint is not the center of the
case. If left on their own though, many patients would only discuss
what they had come to discuss. That is their chief complaint. How do
you get around that?

Anyway, by the next appointment, or when I give them their remedy they
are telling me new problems and symptoms. Until they have an
aggravation of a suppressed problem, they really don't usually
remember suppressions very well.

I am thinking that the Indian way of giving each patient only 15
minutes is maybe ok. At least for a few people in the West. It takes
time to get to know a person and to gain their trust. It would be
nice if we knew those people ahead of time and did not have to waste
so much time breaking the ice.

There are people who give only tissue salts or flower remedies in the
beginning. I wish I had more skill, but that makes sense for some of
these more closed people. What do you do for those types?

Another difficult concept is the importance of strange rare and
peculiar symptoms. Near the end I tell them about them. I wish I had
a better way of describing an SRP. But many cannot give me those
symptoms until they start experiencing a remedy. Then they begin to
get the hang of homeopathy.

Blessings,
Ellen