Zen Of Case Taking.
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Nov / Dec Vol V No 6.
Parinaz Humranwala.

Zen is a Japanese Buddhist sect that seeks enlightenment through meditation and intuition rather than in traditional scriptures.

The traditional scriptures books on Organon by our masters laid down in our texts form the base on which every Homoeopathic builds and evolves his perception of case-taking. This article will seek to reiterate the basics and lay down some ideas that may assist the Homoeopath in efficient case-taking.

There are a number of skills that need to be learnt by the Homoeopath that will enable interviews to become more enlightening and thereby improve the accuracy of the prescription. The following skills are not only the answer, but they have proved useful.

SKILLS OF CASE-TAKING

1. Not using a laid down case proforma.
2. Attentive listening
3. Observing.
   Actions-Tone-Words spoken - Sitting posture - Facial expressions
4. Infrequent questioning
5. Minimal questioning encourages to keep the conversation flowing. Words like "Oh", "Then", etc. Nodding, Shrugging, Raising the eyebrows to show your involvement in the conversation.
6. Three important questions:
   1. What has been the happiest moment in your life?
   2. What has been the saddest moment in your life?
   3. What would you ask for from Almighty if you had to live life all over again?.

1. Not using a laid down case proforma:

I am of the firm belief that case taking must always be done on a blank paper. No proforma or laid down case-record sheets should be used. As the patient speaks each word, each idea, it is as if a line is written upon this page, like an image. Gradually the composition takes shape. But the form changes: a line, a movement, makes an apple into a face, a car into a house. Each line, each movement changes the image as it evolves and the persons life appears before you like a drawing on the paper. What initially may have seemed to be an Arsenic would later be discovered to be a Sulphur.

This skill is essential as turning pages of your case-record while entering data, distracts the patient and secondly the chronological order of the patients complaints are lost in a case record. If a patient tells me first that My father had cancer family history would be first on my paper. Even years later, I would know what the patient spoke first. Adequate space should be left to fill up answers to the questions you may ask later.

Dr. Gladwins method of case-recording could prove to be useful to Homoeopaths. Dr. Gladwin recommends a plain sheet which must be divided into 2 parts. The left part must record as the patient tells the symptoms of the disease, and the right part must record the symptoms of the patient. At the end, the left part must be torn and thrown away and the right part should be used to prescribe on.

2. Attentive listening:

A Homoeopath can be compared to a Catholic priest sitting inside the confession box. The penitent expresses freely without holding back, without censorship, his deepest fears and failings, while the priest, meditating with him, receives all that was said in the spirit of pure acceptance. Through this mutual effort of two human beings, meeting in an atmosphere of total concentration and acceptance, a true relationship takes place bringing about a healing in the depths of the soul. This process of establishing relationship lies at the heart of good case taking.

The first approach is to allow the patient talk unfettered by the restrictions of your questioning. Time should not be, but unfortunately is, an issue in an interview and hence questioning and controlling the length of the answers is often resorted to.

Out of every thousand words spoken only ten may be really important. It is therefore essential to focus your attention especially towards those few words.

The patient needs to feel that all the energies of the doctor are concentrated on his problem, - no distraction, no looking away, no answering the phone, no fiddling with objects on the desk. The patient is the centre of the universe. Even looking away to write breaks this contact, this intense out-pouring of energy towards the other being. I have myself felt this diversion adversely affects the interview when I have been forced to look away to note something down.

While listening to a patients story, especially a sob-story, the doctor must not get emotionally involved in the patients emotions.

3. Observation / Behavioural Assessment/ Body language:

Why is it important to observe a patient? A few years ago a girl came to me with a few vague complaints. During the interview she told me she was neglected by her parents and sisters. She felt lonely. She had an affair but the boy left her without reasons. Tears streamed out of her eyes. I tried my best to console her, as my heart reached out for her pathetic situation. I prescribed Pulsatilla and asked her to return a week later. For the next follow-up her sister came in first asking the patient to wait outside. She inquiringly asked me what her sister had told me, which refused to divulge. She then told me all what the patient had said, which was true. "You see," the sister told me "all this is crap. She is not lonely, she has had no boy friend, all this is with the intention of getting sympathy. She has been to two Homoeopaths earlier because you all listen, and she chose you as she heard you were good at psychotherapy." These words brought me and my prescription into doldrums. I summoned the patient in, who confessed that she had lied in the first interview.

The patient always presents his best before you. He may lie to give a better image of ones own self. Hence your observation is more important. What you see of yourself during the case-taking is the best evidence and should be valued the most when prescribing. The body language and behaviour of the patient will tell much of what is happening at the subconscious level.

a Actions;.

The following para is quoted form "More magic of the Minimum Dose" by Dorothy Shepherd - who quotes a case from the mental asylum.

"A middle-aged man in the asylum never spoke to anybody. He was always standing about as if he was watching for something, or somebody, and if anybody came near him, he quickly drew out of their way, so that nobody should touch him. He had been an inmate for years. The one outstanding peculiarity about him was, he was enormously fat. I asked the medical superintendent about this patient, and he laughingly replied "Just feel him the next time you go for rounds." I made it my business to do so and to my surprise found he was padded with layers and layers of newspapers and journals. No newspaper was safe from him, he never saw any newspapers in the male wing, he always pounced on any paper he found lying about, and added it to his store round his body. It was not that he was cold; no, he thought he was so brittle that he would break unless he protected himself with papers. He was made of glass and must therefore not be touched, unless he had these layers of papers round him, which made him feel safe!.

On observing the action of this patient the rubric docketed under Thuja - Delusion she is made of glass, she is brittle, is very clear.

Observing infants can guide you to the remedy. Infants who want to be carried fast, Ars, Bell, Brom, Rhus-tox, Verat; Infants who love to be rocked Cham, Kali-carb; Infants who hate rocking Borax Prefer to be wrapped Ars, Psor, Puls Prefer to be unwrapped - their little hands and feet crave for freedom Medo, Sulph.

b Tone of the voice.

An Viola odorata has a soft voice, Alumina has a grumbling tone, Tub-bov - a threatening tone and so on. Often cravings regards food are judged by the music of the words. The words I think I like ice-cream. Ice-cream is what I am found of. Icecream I love it. If were to give a Nobel prize, I would give it to the man who discovered ice-cream." The music behind any statement tells more than the statement itself.

c Words spoken:.

I have often found a Tuberculinums mother insisting on the child as soon as she enters my room. "Dont say Good Morning to the doctor" and surely the defiant child will shout, "Good Morning Doctor.".

A Sepia lady with a long list of problems would visit me regularly. She once brought her children along. I remarked - "You have such sweet children." She looked at me sharply and said, "Why dont you keep them?" The disgust of Sepia is very evident from her words.

The first sentence gives you a hint of the remedy and the last sentence confirms it. Often a Lycopodium while leaving shakes hands and flatters you by saying, "Doc ! I am confident to get well. I am in safe hands." An Arsenic often asks you whether you have treated such a case before.

d Sitting posture.

The attitude in which the patient sits - Zincum who keeps moving his legs restlessly beneath the table. Kali-brom who fidgets with everything; Veratrum-alb claps his hands to make a point. Platina sits erect with her nose in the air. Phosphorus who shakes hands while entering and leaving. While leaving he often clasps both his hands between yours - conveying his warmth and regard for you.

e Facial Expression.

A few years ago, a Homoeopath from a foreign country came to observe my prescribing. The new case that came spoke in Gujarati - which he did not follow. She cried and kept her eyes closed in most part of her interview. At the end, I was about to describe her state to the foreigner when he who had observed her closely said "Is she Arg-nit? As Argentum is the only remedy in three marks under the Eyes - closed in melancholia." Yes, Arg-nit was her remedy.

The distressed look, Arsenic, Cactus, Iodum, Stram Contented look Opium, Apis Vacant look Acid-phos, Hell mask like look Manganum, Lyco-pus give us tips to proceed towards the constitutional remedy.

4. INFREQUENT QUESTIONING:

In Homoeopathy, the art of interruption or art of intervention is also important. The urge to interrupt is irresistible but dissuade yourself, unless necessary. The prescriber must realize that there must be a space between his thoughts, his impulse and its manifestation. Perhaps, he wants to clarify a point, the urge to interrupt rises with ones self. But there must be space, a gap of silence, unless you are sure that the question is related and in tune with the flow of the patients interest.

Each word is like a stone thrown into a pond. The shock waves radiate, sending ripples on the surface. And if one just throw stones and kicks the water in a random fashion, chaos results. After throwing each stone watch the nature of the ripples.

1. Often the patient is not clear with his symptoms - at this time asking him to give examples throws more light on his symptom. A lady once told me that her infant preferred to suckle her (rt) breast and refused the (lt) breast. I insisted she showed me to prove her point. Surely the infant fought with the mother with his little fists when offered the (lt) breast and enjoyed suckling the (rt) breast.
2. When a patient emotionally breaks down - he often discloses an important prescribing point.
3. If you have a child as your patient you must ask about complaints from school.

Lachesis and Zincum - play a lot of tricks on their teacher. Merc-sol, Tarentula, China, Amm carb, Digitalis, Lyco are disobedient children. Nux-vom, Lach, Coc. are good at maths, while Alumina, Causticum, Lycopodium and Silicea are poor in maths. Nux-vom, Puls and Sulph children find learning poetry very difficult.

5. Minimal interruption encourages to keep the conversation flowing. Words like Oh, Then etc. Nodding, Shrugging, Raising the eyebrows show your involvement in the conversation.

It is vital to get the patient to express himself as best as he can by maintaining a sense of connectedness with patient. This skill goes a long way in establishing a good trusting rapport with the patient. The skilled Homoeopath should have very little to say; he or she prompts with skillful questioning and encouraging gestures.

6. Three important question:

1. What is / was the happiest moment in your life?.
2. What is / was the saddest moment in your life?.
3. What would you ask for from Almighty if you have to live life all over again?.

These questions have proved very useful in my practice. To give an example. An elderly gentleman aged 50 yrs - unmarried, when asked about his happiest moment - said "It will be the day I die".

His saddest moment, "The day he was born." and to the third question, "Who wants to live again to ask Almighty about anything".

This showed the degree of despair, how much he desired death, and how weary of life he was. This along with his other symptoms led me to China.

CONCLUSION:

We expect a lot from the patient, but as physicians we must set aside our set of prejudices, fears, confusion, petty concerns, while taking a case. Physician needs to be careful of his own body language - yawning or sighing at the wrong time may bring the patients pourings to a grinding halt.

The Homoeopathic interview is almost certainly the most difficult to learn, of all the required skills of Homoeopathic practice. Perhaps the most difficult aspect of the interview is to apply versatility and adaptability to the techniques you use. The patient, as we are all well aware, is an individual and will have individual needs in an interview. But without some basic guidelines or structure, the Homoeopath may lose his or her way in the jungle of the patients verbosity.

Case - taking is a treasure hunt,.
The doctor and patient form a team.
The patient gives the clue,.
The doctor forges ahead in the blue.
Gradually one clue leads to another,.
As the doctor approaches the gold mine, he looks less bothered.
And Lo Behold! there is - THE REMEDY.

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