DOCTOR & THE PATIENT

1. DOCTOR & THE PATIENT

2. THE DISTINCTION BETWEEN CURE OF DISEASE AND RELIEF OF SYMPTOMS REMAINS AS VALID TODAY AS IN THE PAST

3. NO PATIENT SHOULD LEAVE A MEDICAL CONULTATION FEELING THAT THEY WILL “JUST HAVE TO LIVE WITH IT” , EVEN WHEN THE DISEASE IS INCURABLE

4. Who is more important?

5. PATIENT • Patient is derived from Latin word “patiens” • It means sufferance or fobearance

6. DOCTOR • Relieve suffering • Homoeopathic perspective • The physicians high and only mission is to restore the sick to health as it is termed.(aph 1)

7. Case taking • Homoeopathic perspective • Hutchinson’s method

8. Homoeopathic method • It is a unique art of getting into conversation, observation and collecting information from patient as well as from bystanders to define the patient and diagnose the disease

9. Allopathic method • It is the process of recording the complaints of the patients and to arrive at a diagnosis and to treat according to that.

10. Homoeopathic method • Described in Organon of Medicine by Dr.Hahnemann in aph 83-104.

11. Aims of first consultation • Homoeopathy • Individualisation • Diagnosis • Hutchison’s • Diagnosis • Nature of the patients perception of the problem

12. Requisites for eliciting the picture of disease • Homoeopathy • Aph.83- • Freedom from prejudice • Sound senses • Attention in observing • Fidelity in tracing the picture of the disease • Hutchison’s • Knowledge of disease & its patterns of presentation • Ability to interpret a patient’s symptoms & signs • Confidence in one’s ability to strike up a relationship with very different individuals

13. Steps in making diagnosis • Homoeopathy • Establish the symptoms of the patient by case taking to get a numerical totality • Interpret the numerical totality on the basis of generals , particulars to arrive at a conceptual image • Hutchison’s • Establish the clinical features by history & examination • Interpret the clinical database in terms of disordered function & potential causative pathologies , whether physical , mental , social or a combination of these

14. Importance of observation • Homoeopathy • In aph. 84 & 90 • Ascertains how much was peculiar to the patient • Hutchison’s • Nature of the problem will be immediately obvious

15. How to talk with the patient • Introduce yourself & offer a greeting • Observe the patient with care • Avoid having patients full face in front of you • If patient sit to your left , at an ankle to desk , the situation is less formal & clues such as agitated foot & hand movements are more evident • The seating arrangement also makes it clear that it is the patient who is the centre of attention , rather than any one present

16. History taking • In aph 84 “the patient tells the history of his sufferings , those about him tell what they heard him complaints of...” • In hutchison “give the patient the chance to begin with what they feel is most important to them, & avoid pre-judjment of issues or exclusion of what at first may seem less important

17. In aph 84 “ by keeping silence physician himself , he allows them to say , all they have to say and refrains from interrupting them , unless they wander of to other matters.....” • Hutchison encourage the patient atleast initially to tell their own story without interruption from spouse , carer , or any one else present. They can have their say later

18. Direct & indirect questions • In aph 87 “physician obtains more precise information respecting each particular detail , but without ever framing his questions so as to suggest the answers to the patient • In hutchison –indirect qns can be regarded as invitation for the patient to talk about the general area that the doctor indicates is of interest

19. History taking according to hutchinsons • Age & address • Marital status • Social & occupational history • History of previous illness • Family history • Presenting complaints • History of present illness • Treatment history

20. History taking according to homoeopathy • Age & address • Presenting complaints • History of presenting compaints • Past illness • Personal history • Social history • Life style • Family history • Generals • mental • Obstetrical history • Menstrual history • Provisional diagnosis • Repertorisation • Final selection of remedy

21. Hutchinson’s • Observe your patient • Trust your patient • Avoid suggesting symptoms until patient has finished. • Categorising the main symptom • Note taking • Keep eye to eye contact & make notes • Direct questions • If you notice an abnormality not mentioned by patient • Make sure that you & the patient are talking about the same thing

22. Hutchinson’s • Relate the history to the patients occupation , past history , & family history • Non verbal clues • Does patient catch his breath , change in breathing pattern etc • Vocabulary • Use words that patient can understand • Social issues • Relating complaints to a social or personal conflict (somatisation disorder)

23. Hutchisons • Exaggeration of symptoms • Difficult patients • Angry patients • Controlling the consultation • Always stop yourself from showing an angry reaction in response • Disress-try to solve the distress of he patient • Tearfullness – relief that doctor has begun to understand a problem that no one has listened to • Confusion-dementia , drug abuse , encephalopathy , focal brain disorder • Information through a third party is liable to distortion

24. Symptom analysis • Homoeopathy • Location • Sensation • Modality • Associated symptoms • concomitants • Hutchison • Location • Radiation • Severity • Timing & duration • Character • Aggrevation • Relief • Symptoms have a anatomical or physiological basis

25. chronology • Homoeopathy • HERING’S LAW OF CURE • LEVELS OF SUPPRESSION • MIASMATIC CHANGE • Hutchison • Time course of development • Timing of onset • THEY TELL ABOUT THE NATURE OF PATHOLOGICAL PROCESS

26. Previous illness • Homoeopathy • Miasmatic background • Herings law of cure • Hutchison • Previous illness • medication

27. Special questions for women • Homoeopathy • Aph 94 • Pregnancy • Sterility • Sexual desire • Miscarriage • Menstruation • leucorrhoea • Hutchisons • Ocp • Menstrual history • Obstetrical history

28. Occupational history • Homoeopathy • Aph 94 • Those conditions which tend to produce or maintain disesae • Hutchison • Occupational disease

29. Thank you