DOCTOR THE PATIENT THE DISTINCTION BETWEEN CURE OF
DOCTOR & THE PATIENT
THE DISTINCTION BETWEEN CURE OF DISEASE AND RELIEF OF SYMPTOMS REMAINS AS VALID TODAY AS IN THE PAST
NO PATIENT SHOULD LEAVE A MEDICAL CONULTATION FEELING THAT THEY WILL “JUST HAVE TO LIVE WITH IT” , EVEN WHEN THE DISEASE IS INCURABLE
� Patient is derived from Latin word “patiens” � It means sufferance or fobearance
� Relieve suffering � Homoeopathic perspective �The physicians high and only mission is to restore the sick to health as it is termed. (aph 1)
� Homoeopathic perspective � Hutchinson’s 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
� It is the process of recording the complaints of the patients and to arrive at a diagnosis and to treat according to that.
� Described in Organon of Medicine by Dr. Hahnemann in aph 83 -104.
� Homoeopathy � Hutchison’s �Individualisation �Diagnosis �Nature of the patients perception of the problem
� 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
� 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
� Homoeopathy �In aph. 84 & 90 �Ascertains how much was peculiar to the patient � Hutchison’s �Nature of the problem will be immediately obvious
� 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
� 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
� 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
� 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
� Age & address � Marital status � Social & occupational history � History of previous illness � Family history � Presenting complaints � History of present illness � Treatment history
� � � � 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
� Hutchinson’s �Observe your patient �Trust your patient Avoid suggesting symptoms until patient has finished. �Categorising �Note taking Keep eye to eye contact & make notes �Direct the main symptom questions If you notice an abnormality not mentioned by patient Make sure that you & the patient are talking about the same thing
� 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)
� 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
� Homoeopathy � Hutchison � Location � Sensation � Radiation � Modality � Severity � Associated � Timing symptoms � concomitants & duration � Character � Aggrevation � Relief � Symptoms have a anatomical or physiological basis
� 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
� Homoeopathy � Miasmatic background � Herings law of cure � Hutchison � Previous illness � medication
� Homoeopathy � Aph 94 � Pregnancy � Sterility � Sexual desire � Miscarriage � Menstruation � leucorrhoea � Hutchisons � Ocp � Menstrual history � Obstetrical history
� Homoeopathy � Aph 94 � Those conditions which tend to produce or maintain disesae � Hutchison � Occupational disease
- Slides: 29