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The initial and follow-up Homeopathic visits are designed
to first learn about the Whole patient, and then to assess how that
Whole patient evolves under treatment. For Homeopathic purposes, the Whole patient consists of the disease the patient is bearing + the patient + the patient’s circumstance, including Past Medical History, Family and Social History, Physical Examination and ancillary studies. HISTORY OF THE PATIENT’S DISEASE. As far as the disease afflicting the patient, we have to remember that symptoms vary from disease to disease and from patient to patient. The capacity to obtain symptoms of disease is directly proportional to the knowledge the Doctor has of pathology and his or her ability to obtain sound Clinical Histories. The subject is very complex. So much so that I will be able to cover this section only with very broad strokes, and that for descriptive purposes only. The Doctor may start by asking what the patient thinks brought about the disease. If there is pain, what kind of pain he or she feels, where he or she feels it, whether symptoms are fixed or if they goes from one place to another and, if so, from where to where; what makes them worse, better, or disappear. When do symptoms occur, hour of the day, season of the year. Whether they are periodic or not. How they are affected by the diverse factors. Whether or not symptoms change with changes of position, or when coughing, sleeping, or awakening, or menstruating, or when the patient thinks about them. Whether they radiate or not and, if so, where. What treatment, Allopathic or other, is the patient receiving? How is she reacting to those treatments? What other concomitant (or accompanying) problems may appear together with the symptoms of the disease, or before, or after. If there are chills and/or fever, and when. How the patient was before being stricken with the disease, and how he or she is now. How the patient lives his or her disease; if impatiently, with anger, patiently, etc. It is essential to modalize symptoms as much as possible so that the Doctor can link, as seamlessly as possible, the disease the patient is suffering with the patient who bears that disease. HISTORY OF THE PATIENT. As far as the patient, the Doctor will start by observing the patient and listening without interrupting. He or she will ask open questions when the patient appears to run out of steam, and then remain silent for a while after the patient answers. Until eventually the patient has nothing more to say, and has ran out of answers for the open questions. Perhaps some reticent silences may remain here and there. Such silences, that the Doctor will perceive only through experience and instinct, can be crucially important. They may help to understand why the patient has become imbalanced in the first place. Here the Homeopathic Physician will have to tread, with utmost care and tact, until he or she is able to pry that silence open—or at least try. After listening to, and observing the patient, the Doctor may start by asking how are the patient’s days and nights. Does the patient awaken rested? Is it safe to get close to him or her before breakfast? Is there anything he or she must do in a hurry upon awakening? Does the patient have a slump and, if so, when? At what time he or she goes to bed? What does he or she need at that time (window open or closed, to be covered or uncovered, lights on or off, etc.) Whether or not he or she awakens in the middle of the night, if there are dreams that repeat themselves, whether he or she thrashes, etc. Then perhaps the Doctor may ask about menstrual characteristics, pregnancies, deliveries, breast-feeding, menopause. Sexuality and sexual life, including orientation, satisfaction or lack thereof, faithfulness or promiscuity, jealousy, etc. How was the patient’s pregnancy, delivery, childhood, adolescence, adulthood, marriage, divorce, widowhood. Whether the patient has received enough love or not, and how has this fact influenced his or her life. Is the patient competitive? How is his or her self-esteem? Attitude toward music, dancing. Is the patient orderly? Is he or she a pack rat or a thrower away? Is there any guilt? Is he or she spender or saver? What are his or her fears? How does he or she feel in regards to him or herself? Demeanor. How does he or she deal with his or anger, sadness, etc.? Can he or she cry or not, and what about? Is he or she relieved after weeping? Accepts consolation? Does he or she explode when angry, or does he or she swallows his feelings? In either case, how does he or she feel afterwards? Whether or not there is resentment or indignation and, if so, directed toward what or whom, why, and for how long. How fast or how slowly does the patient forgive those who have offended him or her? Does the patient dwell on negative thoughts? Reactions to aging. Is he or she thirsty or thirstless? Hot or cold drinks? Attitude regarding alcoholic drinks and drugs. What taste does he or she prefer? Is he or she hungry and, if so, when? Conversely, is there a time when there is repulsion towards food and, if so, when? What dishes does the patient love or hate? Which don’t agree with the patient? How are the patient’s bowels, urination, perspiring? Does he or she like to bathe? How hot the water? How he or she feels after getting out of the water and drying up? Level of exercise. Whether he or she is patient or impatient. Reaction towards horrible things, blood, pointed objects. Is the patient religious? Superstitious? How important is exercise? HISTORY OF THE PATIENT’S CIRCUMSTANCE. What are the patient’s feelings towards others, occupation, passage of time, money. What he or she finds intolerable in others and him or herself. How is or was his or her relationship with parents, teachers, fellow students, siblings, friends, spouse, children, co-workers, subordinates, bosses. Reactions to personal loses. Significant people and events in the patient’s life, and how they affect him or her. Drugs and addictions. Reactions to seasons and weather. How does the patient feel in the seaside and mountains, and what does he or she prefer. How is he or she affected by the weather and by seasons of the year. Care he or she takes of others, pets, objects. Whether the patient is sociable or prefers small groups or being alone. Hobbies and occupations. Whether or not he or she likes or dislikes the job, and why. Is the patient stubborn? Or capable or not of delegating responsibilities, etc. Here again, every symptom and each one of the patient’s answers must be modalized or individualized until the patient’s circumstance fits, in the Homeopathic Physician’s mind, with the patient and his or her disease. PAST MEDICAL HISTORY. Here the Doctor will search for situations, treatments and operations. And, of course diseases, particularly those that point toward a chronic imbalance. The Doctor shall also attempt to gauge what kind of an impact those situations, treatments, surgeries and diseases may have had on the patient. For instance, whether or not some feelings remain toward an abortion several years back and what are those feelings, or if a road accident still has an impact on the patient years after it has happened, or if a patient has never been well since the delivery of her child, etc. FAMILY AND SOCIAL HISTORY. To be obtained in a fashion similar to that in standard Allopathic History. COMPLETE PHYSICAL EXAMINATION. Here again, the complete Physical Exam (yes, even if the patient only came to see us just for a sore throat or something equally innocent), is to be conducted in standard Allopathic fashion. ANCILLARY STUDIES. Only those that may be necessary to clinch the clinical diagnosis of disease. DIAGNOSES. After completing the above mentioned studies, the Homeopathic Physician must discern two diagnoses, the Clinical and the Homeopathic. SELECTION OF TREATMENT. Treatment will vary according to the needs of the patient. The Homeopathic treatment is the sole responsibility of the Homeopathic Physician. This selection includes what to do with treatments the patients may be taking. In the instance of Allopathic treatments, it is important to decide jointly with the Medical or Osteopathic Doctor who originally prescribed those treatment. This is particularly pertinent in patients who are receiving Allopathic treatments for chronic conditions. DISCUSSION WITH THE PATIENT. Nothing is done by dictum in Homeopathy. The patient must see the logic in what the Doctor proposes and must be willing to follow the treatment suggested by the Physician. This discussion includes Homeopathic approaches and treatments, how Homeopathy works, what to do with the treatments the patient may be using at the time of the visit and what to do with them. The discussion, that can be quite lengthy, must continue until the patient’s doubts are clarified and his or her questions satisfactorily answered. At the end, the patient is encouraged to call the Doctor whenever he or she feels the need to get in touch with the Homeopathic Physicians for reasons of reporting, asking questions or clarifying doubts. These calls, that are not charged, must always be answered personally by the Homeopathic Physician. DURATION. First visits never take less than one hour. The presence of the Doctor is indispensable throughout the visit. In these visits, the Doctor checks in detail whatever changes the Homeopathic treatment may have brought about in the Whole patient (i.e., the patient + patient’s disease + the patient’s circumstance). Follow-up visits should include checking up any abnormalities found in the initial visit’s Physical Examination and also of anything abnormal that may have appeared in ancillary studies. The same remedy is seldom administered throughout the course of a Homeopathic treatment. More often, remedies are changed as the Whole patient changes; some remedies may be discontinued, others added or replaced. Sometimes, the potency of a particular remedy may have to be changed. The time needed for evaluation of the patient’s changes—or lack thereof—takes most of the visit. Follow-up visits end with recommendations regarding continuation or changes in the original therapeutic plan. Every aspect of the treatment, including its alterations and results of ancillary studies, are to be fully discussed with the patient. Here again, the patient must be encouraged to get in touch with his or her Homeopathic Physician as often as he or she considers it necessary. As far as duration, follow-up visits never take less than 30 minutes. The presence of the Doctor is indispensable throughout the visit. back to frequently asked questions |
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