Choosing The Best Rubrics
I have often asked practitioners what they found the most challenging thing in the entire patient management process.
Over the years I have realised beginner practitioners have challenges in one of the following processes that incorporates a homoeopathic case management.
1) Case taking
2) Case analysis that also includes miasmatic totality, susceptibility and prognosis.
3) Creating a Totality of Symptoms.
4) Matching this totality with the most indicated remedies in the Materia Medica – includes use of repertorization process.
5) Differential diagnosis and determining the first prescription and dose.
6) Eliciting Remedy Response and determining the second prescription/s until the case improves completely depending on the scope of homoeopathy.
My Personal Challenges and Materia Medica
Personally when I started my practice, the most frustrating part of case management process was matching my totality with the most indicated remedy in the Materia Medica.
While I seemed to do quite well with my case taking and I could even elicit the totality and core essence of a case well, I struggled to find a remedy that matched this state.
One possible reason could be that there were a just handful of remedies that I could say I knew really well in those years and prescribe confidently. While we were "taught" around 400 remedies in my training and were expected to memorize them well, I could never manage to remember them.
I could never understand remedies from reading a book directly because they lacked something. The only remedies that I could ever learn and still remember clearly were those those that were filtered through a clinical case. I found it extremely futile and boring to memorize a set of indications of remedies just because they were dumped together in a book.
Having said that I thoroughly enjoyed the clinical cases from books journals or in lectures. I spent hours going through journals and archived cases to find my remedies. I observed cases being prescribed by my teachers in practice and made sure I recorded the remedy indications and the response that followed during the followups. I would compare cases of the same remedy. The idea was to see the many varied expressions of a remedy in clinic, using various approaches and to really get that depth of the remedy understanding and pathogenesis.
Now this was a slower process and while I knew some remedies really well, my materia medica was quite limited. So it was rare for a remedy to pop in my head as soon as I took the case in my first few years of practice unless I had read or seen it prescribed before.
Hence the only way I could find remedies in most of my cases was by repertorizing and trying newer remedies if they were indicated.
In a way my patients became my best teachers....
Repertorization and converting symptoms into Rubrics
The most tricky part for me was converting the symptoms into rubrics. While the totality of the case was quite clear and depended on the "stage" I took the case at, I wanted to make sure that the rubrics exactly represented the depth, core and essense of my patient's totality.
(For more information on the concept of stages and its relevance in homoeopathic practice, kindly have a read of the free ebook - The Quest for Simillimum on the left of this page).
Over the years after some extensive research into the repertorization process and making many mistakes, I could come to a stage where the process has become much easier. I want to share some hints that have helped me over the years to ensure that one can take the best possible rubrics that are represented in a case.
I will explain this through a case example so you can understand the subtle differences in the type of rubrics chosen, what to take and what not to take in a given patient.
Don't forget to put your thoughts on what you think about this in the discussion forum below.