Where do we get our patients to manage? Either referred from patients we have helped, or from other homoeopathic doctors, or the homoeopathic pharmacy (if we are lucky enough to live where there is one), or acquaintances of friends who are discouraged with usual medicine.
Our duty to them as homoeopaths is manifold:
First in importance, is to pick the right remedy and
To remove obstacles to cures.
To stop harmful practices and give placebo if needed to keep them from taking other things.
To give them enough understanding of homoeopathic philosophy to cooperate in their cure.
To institute proper diet, hygiene, protection and state of mind.
Second, to win the patients confidence by what you are-by your profound humanity, by your ability to see them as they could be whole.
By your painstaking thoroughness in questioning and in examination.
By your attitude toward science, having tests when these are harmless and diagnostically helpful.
Many of the most truly homoeopathic doctors object to this on the grounds that they do not need laboratory tests, nor a diagnosis for cure. Often they do not need it for symptoms removal; in functional cases, not even for cure. But modern patients in my experience are too medicine conscious, through magazines if nothing else, and class you as unscientific and lose respect for you if you disregard all this. Moreover your actual prescribing will be improved if you know the pathological tendencies-and conditions.
For instance: recently I was called to a woman of 72 who could “keep nothing on her stomach” for three days. No pain anywhere bowels normal, clean tongue, but an indefinable sense of being “very Ill.” Ipec. 2C. Blood pressure 170/80, pulse excellent. No fever. Urine examined showed 1.4 percent sugar and slight albumin and casts.
No acetone or diacetic acid. Nausea temporarily relieved by sips of cold sparking water and orange juice though vomited the whole quantity for which she had thirst. Phos. 2C. (Whole attack started with the shock of seeing a man killed, trampled by a crowd in the chicken market.) Slight relief from Phos., but return of vomiting next day with beginning air hunger and acetone breath. Dusky look, restless. Cupr. 2C., 1 dose. Blood sugar 190. Sent to hospital as approaching diabetic coma.
The second act of homoeopathic is, to me, far more difficult: the determination of when another remedy is needed. Many of the most satisfactory homoeopathically trained patients can be allowed to ride on a remedy which is helping until they themselves tell you they need another boost. But many will feel neglected and must be seen daily even when you know you will not change the remedy.
If you have a competent nurse on the case who notes symptoms well she can often tell whether you are really needed and help you convince the family if you are not. On the other hand a nervous or inept nurse needs the reassurance of your frequent presence. (Some day Id to write a parody of Seton- Thompsons book and title it: Wild Nurses I Have Known! It takes ones utmost self-control, tact and patience to deal with families; to keep the delicate balance between hope and fear-in critical cases-so that their forces are not exhausted yet they are somewhat prepared for possible bad outcome.
One of the conventional question in case management is always “Shall the doctor tell the patient if they have a serious or fatal disease?” A wise man once said, “When it is time for them to know, they will know and tell you. After that you can discuss it with them.” But for ones own protection if one is sure of the diagnoses a near relative must be told. Yet untold harm is done by doctors making brutal statements both of diagnosis and prognosis. Human resilience is incredible.
(I was called recently-emergency-to a woman of 65 in a tonic convulsion, blue with rolling eyes, stertorous breathing and cold sweat. Not incontinent. She had never had such an attack. The family thought she was dying. Her pupils reacted to light and were equal, there was no Babinski. They were lamenting as though she were not there, but I could see in her eyes that she understood. The thumbs were drawn in. Cupr. followed by Opium 1 M. brought her around in an hour or so and that afternoon she wanted to get up and do her washing!).
Many suggestible patients are convinced that they have diseases or will have them which they definitely have not. No amount of reassurance avails with some, but a simple statement that “You just havent the symptoms of that,” with a little smile, will do wonders. (Never tell such a one what the symptoms are, though!).
To go back a moment to another reason why homoeopaths need diagnosis: I lost a delightful family as patients because I kept my diagnosis to myself. A cocky boy of 11 returned from boarding school where they had mumps and his mother phoned me be had it and to come and see him. I said, “but you arent swollen or sore in the mumps gland-the parotid.” “Oh! I have it, though,” said he.
He was a very phosphorus type of child. He had cervical adenitis. I had worried about the possibility of tuberculosis with him and built him up with remedies. I had actually given him Tub. bov. 1M. but had not told the mother who was very apprehensive, least I scare her, knowing I could cope with the conditions. She thought he didnt get well quick enough for mumps, called another doctor who diagnosed tubercular glands and I lost the family. Since then I write a letter to myself, containing the diagnosis, and post it to myself and it on file unopened in such cases!.
The most difficult cases to manage are the new patients who dont yet understand what they must not do: that they must not suppress again an eruption or discharge that the homoeopath has been trying to bring out again. Always warn your patients with suppression in their histories, if a rash or discharge reoccurs, to do nothing and let you know.
Aggravations are not so hard to handle if you warn patients. Tell them that they may occur and that it will be a good sign if they do.
Another problem is the veteran patient with access to homoeopathic remedies. Give out-of-towners or inaccessibles with children cases of remedies by all means, but numbered not named, and have them phone you which to give. Be sure there are various bottles of placebo under different names. But even then they will vex you: In one kit I gave, No. 18 is Sepia. My patient found it so effective for her state of mind that she got to taking it on her own! Maybe we should call in the cases for revision and change the signals!.
One of the worst problems is when the patient has a disease considered fatal, for which there is one prescribed treatment which at least prolongs life, and where the deceases rare and there are no data of treatment by pure homoeopathy in large series of cases. For instance, I have a case of mylogenous leukaemia in a man of 42. X-ray therapy of the spleen is de riguer. He and his friends would not consider omitting it. Nor do I consider myself justified in urging it, as I would the omission of quinine in malaria, sulfa, drugs in pneumonia, etc.
I believe homoeopathy can help this case, for the man comes out clearly to a remedy (Phosphorus) and the case has had suppression enough to give any fatal trouble (psoriasis, sinus, piles, etc.). But am I justified in trying to battle for Phosphorus alone? He has improved on it, although his blood count rises periodically. He is stronger and works more than he should.
His post nasal drip has returned, and an eruption. He then got a sore throat away from New York and a doctor friend gave him 150 grains sulfadiazine. He returned looking ghastly. There is one case surely in which the diagnosis is like a millstone around the neck!.
One danger of the homoeopathic doctor is to be a sphinx, another to be euphoric. It takes balance, character, firmness and faith and untiring industry to be even a decent homoeopath.
No paper, however brief, on homoeopathic case management should go without comment on what you may let the patient do while the remedy is working; calendula ointment, echinacea succus, oil of lavender, pinus pumilio salve, hydrotherapy, mullein oil, plantago oil, arnica cerate, postural drainage in ears, normal salt solution as a cathartic and in beginning migraines.
As to the real essence of remedy management, you can read your Kent on The Second Prescription and the types of aggravations. Philosophy can be learned from books, but I have to see a book or hear a course in medical schools on the thousand and one things that make a doctor a great success in private practice and with patients.
It is fantastic what the patients ask you to manage. From being tactful with their jobs so they dont them (in mental illness, alcoholism, etc.) to protecting them their families, to managing their nurses and their servants; from keeping peace with schools and colleges on inoculations, to getting the children to eat and the wives to like sex; from coping with selfishness to breaking bad habits (sleeping pills, tobacco, liquor and worse); from teaching technique and unattractive girls to being asked advice about divorce; from the giving of courage to face death and suffering for themselves or others beloved, to teaching the patients a bit of the philosophy behind illness, its cause and the opportunity it affords.
