Taking the case – and the teacher’s dilemma

crossroadsTAKING THE CASE – AND THE TEACHER’S DILEMMA

Recently my colleague Gary Weaver posted an article by Carol Dunham on case-taking. The article was wise, learned, extensive and – let’s face it – somewhat wordy. Extremely wordy.  So on an initial reading, the brilliance of the actual comments regarding case-taking becomes dulled, presented within an analytical and theoretical context which is either familiar from the Organon, or Dunham’s own form of analysis which is not a matter of consensual self-evident fact.

And here I finally get to the point. It has been a constant dilemma for me as a teacher, and I’m sure others will be familiar with the problem. How much should we as teachers summarize and format material to make it more “user-friendly” – or subject students and other interested parties to the character-building occupation of tackling the source material, in all its wordiness? For me this dilemma is particularly acute, since I think it’s crucial for people to go to source, to check all information with primary materials and not to accept anything as given “just because I said”…

I have in the past insisted, nay pleaded, with my readers that they go to source when reading my articles, whether I’m referring to anyone’s Lesser Writings, the Therapeutic Pocketbook, Materia Medica, the Bible, and any other primary materials. I’m willing to bet that most people just read the summary/comment/examples and don’t go to source. So do I write about Organon knowing that for some – my article is the closest they’re going to get to the original work? Ditto about provings? And that some will feel once they’ve read an article (mine or anyone else’s) there is no further need to plod through source material – or tiresome character-building activities of similar nature?

My conclusion? Character-building can wait. Too many important works are being put aside, ignored and crumbling into dust because of character-building and those who have no time for it.

Humanity has a deep-seated need to be original, to be new, to create followings rather than to follow solid, proven methods. Much of the original homoeopathy that achieved such magnificent cures in the 19th century has been lost to us through the “broken telephone” style of transmission by teachers, and through each instructor layering additional strata of novel debris over the original treasures.

The challenge – which I believe is the only way to resolve the dilemma – is to ensure that we as teachers set aside our own novel ideas and imaginations for the meantime, however vivid, and in teaching the essential principles of this method remain as close as possible to source.

So back to Dunham . Much of Dunham’s article relates to elements clearly given in the Organon – like cures like, taking only the symptoms that have changed, examining history, matching the symptoms demonstrating deviation from health – which for the homoeopath are the only indications of a disease state – with a remedy that may cure and more. Dunham goes into description and discussion of objective and subjective symptoms and the great value of study of physiology and pathological anatomy. He presents his theories regarding pathological change and presenting symptoms.

However, to my mind the most practical punch of this article is in Dunham’s description of the practice of case-taking, rather than in his analytical and theoretical conclusions. His descriptions will hit a nerve for all practicing homoeopaths, and will help prepare a student towards a better understanding of the complex encounter with the patient in the homoeopathic appointment. And once you have read these words and absorbed their importance – go read the original article here! (bold is mine)

[Examination will reveal some objective symptoms]. Further examination reveals other objective symptoms. For others, as well as for subjective symptoms, we must depend on the testimony of the patient and his attendants. We have then to listen to testimony, to elicit more testimony by questioning and cross-questioning the patient and his friends, and to form conclusions from their evidence.

We have to weigh evidence, and here we encounter a task which is similar to that of the lawyer in examining a witness, and success in which requires of us obedience to the rules for the collection and estimate of evidence. We must study our witness, the patient; is he of sound understanding? may we depend on his answers being true and rational ? He may be naturally stupid or idiotic, he may be insane, he may be delirious under the effect of the present illness. Or, putting out of view these extreme suppositions, is the patient disposed to aid us by communicating freely his observations of himself, or is he inclined to be reticent?

You will be surprised at the differences in patients in this regard. Some meet you frankly, conscious that by replying fully, and by stating their case carefully, they are aiding you to help them. Others act as if they felt that in meeting the doctor they have come to an encounter of wits, in which they are determined that their cunning shall baffle his shrewdness. Others again are morbidly desirous of making themselves out very sick, and will unconsciously warp their statement of their symptoms so as to justify their preconceived notion of their case ; and if you question them, however you may frame your question, they will reply as they think will make out the case you seem to apprehend. Others, on the contrary, so dread to give testimony which, they fear, may make it certain that they have some apprehended disease, that they cannot bring themselves to state facts as they are, but twist and misstate them as they fain would have them.

I might pass without mention the case of those who deliberately conceal or deny the existence of symptoms which would betray the presence of diseases of which, with abundant reason, they are ashamed, because, I take it, you will be minded to have no dealings with those who refuse to their physician their unlimited confidence.

There is another class whose statements are plus or minus what exactness would require. Almost all of our descriptive language is figurative. We describe sensations certainly according to our idea of what effect would be produced by certain operations upon our sensory nerves, E. G., burning, boring, piercing. This involves an act of the imagination. We are differently endowed with the imaginative faculty. Some persons cannot clothe a sensation in figurative language, and are therefore almost unable to describe their subjective symptoms, and are very difficult patients. Others, again, naturally express themselves in this wise, and, where imagination is controlled by good judgment, are excellent patients, because they describe their symptoms well. This is a matter dependent upon natural endowment, and not upon education or culture. Some persons who cannot construct a sentence grammatically will give us most graphic statements of symptoms; while others who have borne off the honors of a university are utterly at a loss for the means to express what they feel.

Finally, some persons have a natural fervor and tropical luxuriance of expression, which leads them to intensify their statements and exaggerate their sensations. And some, like the Pharisee who believed he should be heard for his much speaking, think to attract our attention, and excite us to greater effort in their behalf, if they magnify their sufferings and tell us a pitiful tale. Others, on the contrary, of a more frigid temperament, give us a statement unduly meagre in its Arctic barrenness; or else, fearing to seem unmanly if they complain with emphasis of suffering which is perhaps the lot of all men, understate their case and belittle their symptoms.

In estimating your patients in these regards, judging while the tale is being told what manner of man you have to deal with, what allowances you must make, what additions, what corrections, you will have full scope for your utmost sagacity and SAVOIR FAIRE; and of the value of this estimate of your patient I cannot speak too highly. I have often seen the thoroughly scientific man led astray and bamboozled, where one far inferior to him in scientific knowledge detected the peculiarities of the patient, made the necessary corrections, got an accurate view of the case, and then the prescription was easy. Why, sometimes the patient will, in good faith, state a symptom so incompatible with others that we know and must declare it impossible, and so it is finally admitted to be by the patient.

If it be necessary to make this estimate of the patient, so must we likewise of his friends, who, besides having the peculiarities already spoken of, may be unfriendly to us or to our mode of treatment, and may thus be reticent or reluctant witnesses, or may even mislead us willfully.

We make this estimate of our patient and his friends while he and they are stating the case to us; and this statement we should as far as possible allow them to make in their own way, and in their own order and language, carefully avoiding interruption, unless they wander too far from the point.

We must avoid interrupting them by questions, by doubts, or even by signs of too ready comprehension of what they are telling us. It will of course happen that they skip over important details, that they incompletely describe points that we need to understand fully. But we should note these as subjects for future questions, and forbear breaking in upon the train of our patient’s thoughts, lest once broken he may not be able to reconstruct it. When he has finished, we may, by careful questioning, lead him to supply the deficiencies. We must avoid leading questions, and at the same time must not be so abstract and bald that for lack of an inkling of our meaning, the patient becomes discouraged, and despairs of satisfying us. It is never our object, as it may be that of the lawyer, to show our own cleverness at the patient’s expense, and to bamboozle him. We must, on the other hand, make him feel, as soon and as completely as possible, that we are his best friend, standing there to aid him in so reviewing his case that we may apply the cure. And so we must encourage his diffidence, turn the flank of his reticence, lend imagination to his matter-of-fact mind, or curb the flights of his fancy, as may be required.

We want a statement of the case in graphic, figurative language, not in the abstract terms of science. It does not help us to hear that the patient has a congestive or an inflammatory pain (however correct these conceptions may be); but a burning or a bursting pain is available. Nor does it specially enlighten us to know that the patient feels now just as he did in last year’s attack, unless indeed we attended him then.

 

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