The Flexible Approach
Suneeta Tripathi.
Cases.
` Nit-ac / Rhus-t.
The approach to a case in my understanding is purely Individualistic and will differ from Physician to Physician, and also from patient to patient. There can be no fixed format which can decide how a case has to be approached. During college days, we were taught how to approach a case, first wish the patient warmly, make him feel comfortable and at ease; but if the patient is in acute distress and if we go theoretically, wishing the patient, he will not be happy. Instead he will be happy from immediate relief of his complaint only. Then we were taught to note down preliminary data like name, age, sex, occupation, education, etc. But in actual practice the patient decides what has to be asked first. Many a time, I meet patients who even before sitting down start off with their problems, one patient said Doctor my menses were expected 18 days back., as yet it has not arrived. This used to happen before marriage also, I took Homoeopathic medicine and I got better, will you please give me some medicine?.
I looked at her. She was still standing with her husband behind her. She was a young Bengali lady 20 yr. old, and, appeared to be a newly married. Obviously, when the patient is overflowing with her problems, the first thing I could not ask her was her name. I asked them first to sit down.
Dr. : Since when are you married?".
Pt.: Since three months.
Dr. : "Do you use any contraceptive measure, pills, or condom etc?.
Pt.: No, Doctor.
Dr. : Then you please get your pregnancy test done before we start the treatment. After
that only I asked her name, age, while giving the investigation chit.
The case was not taken that day. The patient was given an appointment and expected to come again after 3 days, but the patient did not turn up. But one and a half years later, the same lady dropped in with her husband and the same way started with the statement Doctor, I am suffering from constipation since I month and since past 8-10 days I am suffering from pain after stool with slight bleeding..
She was given acute medicine Acid-nit 30 TDS for 3 days and asked to report. This time she returned and her full case was taken. During the interview when asked about her menstrual cycle, she reported that she underwent MTP one and half years ago since she did not want to have a baby so early, and now her menses were regular. So this is how the case taking of this patient was completed in one and half years.
I am not giving full details of this case because the experience I wanted to share was how this lady had presented herself and how her case was approached. In routine cases this is what we do, we first inquire the preliminaries, then chief complaints, physical generals, past history, family history, mind, examination. But this procedure keeps varying from patient to patient. So the simplest rule is to allow the patient to speak m give full freedom and just encourage her to be on the track. Many patient son inquiring about their preliminaries start to explain about their nature. Here I keep aside the preliminaries, and start noting down the nature, mind etc. Again she will come back to the track and then we can start where we left off.
The approach to a case need not always be with a positive state of mind from the Physicians side, if the Physician has to forcibly take the case before going on a vacation to a hill station.
This happened last year when I was on a vacation with a couple of family friends. One of them Mr. R.S. happened to be suffering form cervical spondylosis which was not better with the best possible allopathic medicine. I could feel that he was in acute pain, so I decided to ask a few specific questions and wound up the case, I did not want to spoil my evening in case taking so I started by asking the modalities instead of going to the preliminaries. The modalities best fitted with Rhus-tox.
But I was not spared as Mr. R. S. happened to be the talkative type and was very pleased to receive attention from me and went ahead to describe how probably his complaint had started. He is a chartered accountant and has to sit constantly in one position for long hours from here he went on to his business problems, family problems, society, etc. and I was helpless except to listen to him and do full justice to his case.
Later, keeping in mind his constitutional to be Calc. flour D/D Kali-bi or Lyc, I prescribed only Rhus-tox 30 tds one week. After returning from the vacation the patient reported he was 90 percent better and on his own he is taking the medicine B. D. Instead of TDS. He continued only with Rhus-tox 30 for 2 more weeks and to this date is better. (constitutional medicine not required) He has stopped all allopathic medicines and has never complained of neck pain again.
So this is how patients force us to deal with them in the clinic and outside the clinic during our hours or during vacation. A physician is never at rest, always on duty. The lesson this patient taught me is to deal positively from the start for better results. Although the results were gratifying inspite of my negative approach, I could have enjoyed the experience more had I heartily accepted the patient.
In the end, I would like to quote what our great master Dr. Kent says : As little as you can, keep the patient talking and talking to the line.
