DEPARTMENT OF PRACTICAL CASE MANAGEMENT


Every physician of experience has heard more than once something to this effect: “How could the doctor tell what was wrong when he didn’t examine me?” The reference is usually to some physician whom the patient has previously consulted. The new medical advisor, realizing the necessity of stirring himself, makes the examination which his predecessor failed to make.


EXAMINATION OF THE PATIENT.

Every physician of experience has heard more than once something to this effect: “How could the doctor tell what was wrong when he didn’t examine me?” The reference is usually to some physician whom the patient has previously consulted. The new medical advisor, realizing the necessity of stirring himself, makes the examination which his predecessor failed to make.

An examination may be required for diagnostic therapeutic reasons or, in some cases, it may have only a psychologic value. If the latter, it is just another form of placebo.

It is certainly good medical practice to make a careful physical examination in every case and re-examinations as may be

necessary. It is also good practice to make or have made all essential laboratory studies and tests. The patient’s emotional and environmental background may also require the most careful investigation and evaluation.

In taking the symptoms and case history the physician obtains a more or less insight into the subjective aspects of the patient’s condition. But the objective is sometimes just as important, even more so in certain cases. For some reason many homoeopathic physicians tend to fall into the habit pattern of relying more on the symptoms as related by the patient and less on their own powers of direct observation. This results not only in an unwarranted number of incorrect diagnoses, but also an unjustifiable number of therapeutic failures. In making this statement we are not endorsing the fallacious idea that a correct diagnosis is necessarily essential to a correct homoeopathic prescription.

When a new patient applies for treatment the physician does not know from what source, field of inquiry or investigation he may find the key or combination that will unlock the case either diagnostically or from a therapeutic standpoint. Sometimes he never finds it. Some cases have been the rounds of many physicians and hospitals without benefit of either a correct diagnosis or satisfactory treatment.

Unfortunately remedy selection in homoeopathic practice has not been adequately correlated with the results of laboratory investigation. Seldom indeed does a laboratory report of any kind assist the physician in finding the similar remedy although in rare instances a brilliant prescription has been the direct result of such studies.

Physical and laboratory examinations may be either necessary or unnecessary, harmless or dangerous.

A complete urine analysis should be made on every case and repeated examinations made as necessary. If the reports are negative a yearly check-up is often enough. If there are abnormal findings more frequent examinations are indicated. One of the most common sins of omission on the part of physicians is failure to examine and re-examine the urine and other secretions when necessary. Such investigations are not only a help diagnostically but are of distinct value in following the progress of the case. The same is true in respect to many other kinds of tests and examinations.

Blood counts, blood pressure readings, blood sugar estimations, blood chemistry studies as well as x-ray and fluoroscopic examinations, cardiographic tracings and metabolism tests all have their place and their value and we have no criticism to offer regarding any of them when and if needful desirable for the patient’s welfare or satisfaction.

Sometimes, however, we read of various diagnostic gymnastics that make us rejoice that we are not one of the unsuspecting victims of modern scientific medical investigation. A quotation will serve as an illustration:.

The highest type of urology cannot be practiced without the use of both the cystoscope and the urethroscope. The immense value of these instruments is beyond question… They are, however, instruments that only should be used by those who have not perfected themselves in their use. Their imperative need is limited to such a very small percentage of the cases… that they have been mentioned to condemn their too frequent use at times when no instruments should be used.–Gonorrhoea in the Male and Female, by P. S. Pelouse, M.D., 3rd ed. rev., page 11.

There should be an official directory of “those specially trained” to use the various cunning instruments of torture by means of which mankind is bedeviled. The naive admission that the imperative need for the use of these instruments “is limited to such a very small percentage of the cases” makes one wonder why even “those specially trained to use them” should not fold up and look for work in some essential industry, at least for the duration.

Lumbar puncture for either diagnostic or therapeutic purposes we will mention only to condemn. The spinal canal should never be invaded by any instrumental means or any injection whatsoever.

If an examination carries a risk to the patient that can only be offset by having it made by someone “specially trained” the chances are that the favorable outcome of the case will not be adversely influenced if the proposed examination is omitted altogether.

In reading standard and even outstanding works on diagnosis and treatment one is almost invariably impressed by how long and authoritative the writers are on the diagnostic side of the picture and how short and disappointing on the therapeutic side. Some of the very eminent writers on medicine appear to weary in well doing when they reach the subject of treatment. They have only a few panaceas to suggest. Just now it is the sulfa drugs and the “new wonder drug penicillin”.

Homoeopathy has no panaceas and no specifics in its vast materia medica. It has something infinitely superior–a Law of Cure and the law works in all curable cases.

Eugene Underhill