Difficulties in taking a chronic case

Dr Neeraja Kshirsagar

We have to face many difficulties because of the ignorance of the masses who are not accustomed to a detailed narration of their sufferings to enable us for a homoeopathic prescription. Our task is made even more difficult by the easy methods adopted by the modern system of medicine

A] DUE TO NATURE OF THE PATIENT:

1. Modesty conceals the facts: There are certain conditions, sufferings and circumstances which the patient may not like to disclose to the physician out of modesty or shame. Such cause maybe disgraceful character, which the patient or his friends do not like to confess. To these belongs poisoning, attempted suicide, onanism, indulgence in an unnatural debauchery, excess of wine, infection with venereal disease r itch, unfortunate love, jealousy, domestic problems, worry, grief on account of some family misfortune, injured pride, embarrassment, superstitious fear, imperfections of private parts, prolapse or rupture, habitual masturbation which causes the loss of vital fluids, impotency, lack of interest in sexual act in women.

These gives us vague symptoms which make the correct prescription difficult.

2. Habitual to long sufferings: Patient gets accustomed to the long sufferings and may not feel the necessity of narrating the symptoms which have lived for long time. They do not consider that they have anything to do with the prescription. They may not feel it important to speak out. For e.g. sneezing in the morning, blocked ears, constipation etc.

3. Pretension modifies the symptom: There are the patients who exaggerate the symptoms and because of hypochondriasis they narrate more than what they feel. These are called as hypochondriacs and other persons of great sensitiveness and impatient of sufferings, portray their symptoms in vivid colours in order to induce the physician to give them relief. There are some patients who narrate less than they feel. These are patients who suffer from grave disease, yet they do not complain about their sufferings. They hinder the proper case taking. They give the wrong impress of the intensity.

4. Long sufferings which are considered to be incurable: Chronic diseases progress gradually and many symptoms are produced are after the one another and with which patient might have been living since long. But gradually one may develop in ulcer in stomach or high blood pressure which are nothing but the result of chronic disease. Patient ignoring the old symptoms, thinking that they are not curable, seek the treatment for the new disease. For e.g. has to go for stool after eating, urination after drinking water, bleeding piles, dysmenorrhoea etc. 

5. Periodically appearing symptoms are not narrated: There are certain symptoms from which patients suffer constantly along with these symptoms. There shall be symptom such as headache appearing periodically, once in two weeks or once in a month. Diarrhoea appearing during rainy season, rheumatism in winter, constipation in summer. He will narrate only the present complaint.

6. Alternating symptoms: There are certain symptoms that alternate with one another. These alternating diseases belong to the class of chronic diseases. For e.g. headache alternating with diarrhoea. The patient would come for medicine for headache today and for diarrhoea few days after.

7. Self-medication: There are certain patients who take medicine of their own without consultation. Difficult to elicit actual picture of the disease.

8. The influence of the modern system upon the people: The physician trained into modern methods of treatment does not trouble the patient much by the way of asking questions for case taking. Even if the patient wishes to tell him something concerning their symptoms then physician examines the eye and prescribe for the eye. Patients are also accustomed to such procedures and influenced.

9. Indolent patients: There are individuals who would narrate less than what they feel, because of their indolent nature. There are the patients who are suffering from very grave diseases, yet they do not complain any thing about their conditions. These individuals refrain from mentioning a number of their symptoms and they describe in vague terms.

10. Lack of proper expression of symptoms: Some patients are not able to express their subjective symptoms and mental symptoms in proper phraseology. They are not able to convey the proper words and intensity of the symptoms.

11. Introvert patients: Many patients are not comfortable in initial visits to tell all the symptoms to the physician, they are not able to form good communication with physician because of their introvert nature.

B] DIFFICULTIES DUE TO PHYSICIAN:

1. Patient coming from other physician who prescribes un-homoeopathic medicine: When a patient comes from other physician’s hand, which was treated with lots of medicines. Thus, the symptoms and feelings of the patient due to previous course of medicines do not furnish the pure picture of the disease.

2. Lack of knowledge: Due to lack of knowledge of case taking, physician cannot receive the data from the patient verbally and non-verbally that means by observation. He may not have command on case record proforma along with knowledge of all subjects of branches of medicine. 

3. Doctor is prejudiced: If physician is prejudiced, then his observations will suffer. He will try to confirm his remedy by asking leading questions to the patient.

4. lack of patience: Some doctors are in hurry and they make patients in hurry, because of which they may miss the important prominent feeling, expression or observation about the patient. Patient may not be properly ventilated because of impatient nature of the physician. 

5. Lack of repot with patient: Homoeopathic case taking is an artistic method along with scientific method. Even if physician has command on all branches of medicines and case taking proforma, but his communication skill is not good enough, then there is no linear transaction between patient and physician. He will not receive the actual symptoms of the patient. Patient will not be comfortable to ventilate. So, it will not be the good case taking.

B] DIFFICULTIES DUE TO DISEASE: 

1. Pathology progresses and signs and symptoms decrease: In absence of the signs and symptoms choice of remedy is not possible on pathology only when we have to prescribe. Especially at the later stages of the life. 

2. Changed symptom image: By the time a patient comes to a Homoeopath. He must have consumed a few kilograms of strong drugs continuously for a long time. Over drugging must have produced their own symptoms and changed the symptoms of the original disease,

3. Suppression of the disease condition: Many medicines, ointments, mixtures suppress the disease condition.

4. Maze of symptoms: In some cases, there may be plenty of symptoms at a time.it becomes difficult to collect them according to their evolution, chronological order and hierarchy.

5. One sided case: In some cases, there is paucity of symptoms.

B] DIFFICULTIES DUE TO CIRCUMSTANCES: 

1. Paediatric age group: Patient may not be able to give case history properly. Physician has to depend on the observations of parents regarding magnitude and intensity of the symptoms.

2. Old age group: In these cases, the life history is long and patient may not remember the exact past and family history as the exact history may not be available or known by them. Old age patients forget many things to convey to physician because of poor memory and lack of recollection. Hey are very slow to talk. They can not hear and understand properly. They may become emotional at some point of conversation. Lots of patience is required while taking case.

3. Deaf and dumb patients: It causes insufficient communication from both sides, patient and physician.

4. Unconscious patients: Subjective and characteristic symptoms are not available.

5. Mentally ill patients: Physician may not get the exact case history.

6. Language barrier: If the language of patient and physician is not same then physician can not understand the symptoms in the language of patient and it becomes difficult to convert it into the clinical language.

Neeraja Kshirsagar
Associate Professor , Repertory
Dr. D. Y. Patil homoeopathic Medical college
Email : neeraja.kshirsagar@dypvp.edu.in

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