We must first gain the patient’s confidence and relieve him, as far as possible, from the sense of restraint and embarrassment. This is favored in a general way by a calm, dignified, but at the same time quiet and sympathetic manner on the part of the examiner; a demeanor confident, but not pompous; simple and direct, but not aggressive; cheerful, but not flippant; serious, but not grave or funeral. We should try to put the patient at his ease by adapting ourselves to his personality and mood.
We should not confuse the patient by a too penetrating gaze at some objective feature which may attract our attention. We may learn to observe objective phenomena accurately without seeming to do so. If a patient sees us gazing fixedly at some part of his anatomy, he is likely to become anxious and forget other matters which are of more importance to us as prescribers.
The same is true of the use of instruments and the performance of the various acts of a physical examination. A nervous patient will often be seriously disconcerted by so simple a procedure as listening to his heart action with a stethoscope – sometimes even by taking his pulse. It is best, therefore, with nervous patients, to postpone such examinations until near the close of the examination, or until he has lost his nervousness.
The patient should be encouraged to tell his story freely and relieve his mind. We want the history and symptoms of the case from the patient’s standpoint first. If the physical examination is made afterward, when the patient is composed, there will be less danger of confusing or prejudicing his mind.
The first part of the examination should be conducted in an easy, semi-conversational manner. The best results, from the Homoeopathic standpoint, are obtained by making him forget that he is under examination. One can be painstaking and systematic without being over-formal. The mere thought of undergoing a formal examination is disconcerting to the ordinary patient.He dreads it as he dreads going to a dentist. he wants to feel, and it is best for him to feel, that he is relating his troubles to a sympathetic friend who has the resources at hand to help him. It is a good rule to keep the patient talking, but say little yourself during an examination; to let him tell his story in his own way, without interruption, except to bring him back to the subject if he digresses. We may start him in his narrative by asking when and how his trouble began, and we may instruct him to be as definite as possible in relating his history and in locating and describing his sensations *as they seem to him. We should not laugh at him nor pedantically correct his errors.
We should not ask “leading questions,” nor “put words in his mouth,” but let him express his feelings and observations in his own way. Afterward, we analyze, complete, correct and interpret his statements in accordance with the principles of homoeopathic symptomatology as set forth in a former article.
Notes of the patient’s statements should be made while he is talking, but quietly, without ostentation.
It is well to leave a space between the symptoms as they are written so that, when the patient has finished his voluntary statement, one can glance quickly back over the page, see what has been left out and write it in. Questions are then put in such a manner as to complete each symptoms as to location, sensation and modality and fill in the record.
As a matter of convenience in writing and keeping record it is well to divide the page into three vertical columns- the first for date and remedy, the second for the symptoms and the third for the modalities or conditions. This makes a page that the eye quickly takes in at a glance.
We should not hurry a patient in his narrative. We may quietly keep him to the point and prevent rambling and inconsequential statements, but that is best done, as a rule, by maintaining an attitude of business-like absorption in the medical features of the case.
It is well to keep in mind always, during the examination of a case, some working classification of symptoms – as *General, Particular and Common. In examining a case we are gathering data, facts, particulars, from which we are later to determine the characteristic features of the case by the logical process of generalizing. If we are to generalize correctly we must have all the facts and be sure of them.
One thing at a time and all things in order, with an eye to the outcome. First, the analysis- facts from the patient’s statements, then the nurse’s, relative’s or friend’s statements, and then our own observations. Then comes the synthesis – the review and study of the symptoms and construction of the case, classifying symptoms as we generalize. Comparison of the symptoms of the patient with the symptoms of the materia medica in repertory work follows, and finally the selection of the indicated remedy by the exclusion process.
It is well to practice on the simple cases first, in order to become familiar with the technic. The hard cases will come soon enough and they our skill and patience to the uttermost.
The suggested classification of symptoms into general, particular and common symptoms is applicable to difficult as well as simple cases; to chronic as well as acute disease. The general plan can be modified and adapted in various ways, but the principles underlying it are always the same.
The form of the examination and the direction it takes should conform to the classification of symptoms adopted, and one may well have blanks printed to use as a guide and reminder.
Hahnemann devotes twenty-two paragraphs in the “Organon” to the subject of the examination of the patient- Paragraphs 83 to 105.
In the footnotes to these paragraphs he gives many suggestions and special directions for conducting an examination. They teach among other things, *how properly to frame our questions a very important matter. It is not expected that one will ask every patient all the questions which Hahnemann gives in these important footnotes, but that we shall select and apply such as bear upon the particular case in hand. They are for general guidance in the art of questioning.
There is a point in Paragraph 83 that deserves special attention for a few moments.
Hahnemann says: “This individualizing examination of a case of disease… demands of the physician nothing but *freedom from prejudice and sound sense, attention in observing and fidelity in tracing the picture of the disease.”
“Without prejudice!” Said quickly it sounds simple, easy, almost trite. It is a “bitter dose” to swallow, nevertheless, when we stop to explore the depths of our own minds. In this respect it is like the old-fashioned bowl of “boneset tea” I had to swallow semi-annually in the spring and fall when I was a country boy in Wisconsin. Hot and well-sweetened it was to be sure; but bitter! Bitter was no name for it! I can still hear mother say: “Now shut your eyes, son and *swallow it quick; then you won’t taste it – much!” Sounds easy but – try it.
Who of us is without prejudice? The prejudice of a materialistic mind; of pathological theories which seem too often to be antagonistic to homoeopathic principles; of doubt as to the use of the single remedy or of use of any medicine at all; the prejudice of “a constitutional aversion to work!” Many of us are “born tired.” We don’t like to work. Laziness, selfishness and an “easy conscience” are responsible for more homoeopathic sins and shortcomings than anything else, for good homoeopathic prescribing means *work!
These are our worst enemies, and the worst enemies of homoeopathy. Against these, if we are to succeed in our work, there must be a constant warfare within ourselves, until they are conquered by the establishment of correct methods and practice and a genuine interest in the work is evolved. No man who is in the grip of settled doubt or prejudice can do good work. The commercial salesman of today, for example, is not regarded as competent, nor in the proper frame of mind to gain success until he is able to *”sell himself,” as the experts put it. That means that he must acquire and hold a thorough belief in and conviction of the usefulness, indispensability and value of the goods he has to sell. For him it means study, effort, personal self-discipline until he develops a genuine enthusiasm for his goods, his house and his work. It means *Confidence – in himself and in his goods.
Nowhere will prejudice show more clearly than in homoeopathic examination of a patient. If one approaches a case prejudiced in favor of some pathological theory his examination will insensibly, but inevitably, be limited by that theory. He will not get all the facts of the case, nor properly interpret those he does get; and without all the facts he cannot study or treat the case correctly.
Prejudice and doubt may be overcome by reflection, study, self- discipline and auto-suggestion; by cultivating the scientific spirit; by returning often to a consideration of and reflection upon the broad general principles underlying our art with the purpose of reforming methods, strengthening morale and correcting faulty mental attitude, or point of view; all looking toward the development of a more practical, more accurate and more comprehensive technic.
Dr. Close was born November 24, 1860 and came to study homeopathy after the death of his father in 1879. His mother remarried a homoeopathic physician who turned Close's interests from law to medicine.
His stepfather helped him study the Organon and he attended medical school in California for two years. Finishing his studies at New York Homeopathic College he graduated in 1885. Completing his homeopathic education. Close preceptored with B. Fincke and P. P. Wells.
Setting up practice in Brooklyn, Dr. Close went on to found the Brooklyn Homoeopathic Union in 1897. This group devoted itself to the study of pure Hahnemannian homeopathy.
In 1905 Dr. Close was elected president of the International Hahnemannian Association. He was also the editor of the Department of Homeopathic Philosophy for the Homeopathic Recorder. Dr. Close taught homeopathic philosophy at New York Homeopathic Medical College from 1909-1913.
Dr. Close's lectures at New York Homeopathic were first published in the Homeopathic Recorder and later formed the basis for his masterpiece on homeopathic philosophy, The Genius of Homeopathy.
Dr. Close passed away on June 26, 1929 after a full and productive career in homeopathy.