Blog - Shilpa Bhouraskar

Case Management in Layers

Dilemma in Case Management

We have this strange dilemma in the homoeopathic world. It is about this expectation that if someone is changing prescriptions very often they are not doing a good job. In fact if someone asked a practitioner to pick their successful cases they would invariably pick those that did well on one remedy. All those cases that got an equally good outcome but needed a series of remedies are just not good enough.

I went through the same dilemma as a student and intern. There was this huge gap between the everyday cases we took under supervision while training at the college hospital to the ones I saw in seminars. The cases we took went through ups and downs, many prescription changes,using intercurrents, acutes, and newer repertorizations as layers unfolded through the weeks and months. It was the classical peeling an onion approach. But the seminars seemed to be full of cases where one remedy did the trick or where a rare remedy produced a miracle cure.

What you will never learn at Seminars

It was not until I sat with these same wonderful teachers in their own clinic that I really understood the missing pieces - the difference between their seminar cases and everyday cases. I saw cases in every form. Those cases that did very well on one remedy or cases where unknown remedies did the job much efficiently than any known remedy. But the majority of the clinical cases went through the same process of basic principles that I learnt in those OPDs. These cases needed frequent remedy changes as and when new layers emerged. Eventually the cases did well although through a longer zig zag process. So overall the success rate of these practitioners was still high.

But interestingly these everyday cases rarely found their way for the seminars. Somehow the focus of most seminars is to teach advanced concepts to advanced practitioners. You expect to learn about newer remedies or newer ways of case taking that will fine tune skills or better the current success rate. You expect to learn things that are not taught in school. Hence to be fair the seminars needed to have cases that are focussed on these aspects rather than everyday homoeopathy.

Unfortunately most of the seminars are full of students and very new graduates.

Hence I am a big fan of training and mentoring new practitioners through a well formed course that go through weeks or months. My everyday knowledge comes to the forefront much better when I mentor my students on a day to day basis. I can then help them unfold layers at every followup. Similarly it is easier to share failures and successes when I connect with my online course students every week.
I remember almost every case that came through the student clnic at the start of this year was solved using a step by step layered approach. They learn using intercurrents or acutes or miasmatic nosodes every time there is a followup.
But if I was speaking for a weekend seminar I will simply not have the time to cover these vital steps in those few hours. It is a trailer where you have to fast track the journey as you present the cases due to time barriers.

So this time I thought I should share a case where I work using a layered approach. And I will talk about a journey of the patient in 3 months that happened during a single term in the student clinic where I supervised. It is not about a miracle cure or a rare unknown remedy but it is an immensely valuable learning about every day homoeopathy.

Do you use this approach in your practice? I would love to hear your feedback and frank comments.


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Wow Shilpa what an interesting case!
I really enjoyed hearing about the unfolding levels of suppression;- very multi-layered. Thank you ! Sunny :-)

Excellent example of healing layers Shilpa! Thank you for taking the time to share this unique case!!

I really enjoyed listening to how this case unfolded and the different layers that showed through. Thank you for providing such a valuable learning.

Hi Shilpa
It was very interesting to see how this case progressed through the layers. We can only treat what is presented to us and some clients take a few consultation to open up. The remedy prescription help with this as well.
I use this approach quite a lot in my clinic.

Thank you for this presentation. It shows a lot of sensitivity to the state of the patient.
And thank you for speaking of the presentations of remedies from famous teachers that give the impression of all their cases being single-remedy successes. They can perhaps give a misleading impression that this has to be the norm.
My own experience about that is that a friend of mine went to one of the famous presenters to have his case taken. The homeopath was brilliant, the experience of having his case taken was something my friend appreciated. And the remedy he was prescribed did many wonderful things for him.
For about a month. Then it quit doing anything. Up to that point he had had several good conversations with the homeopath. But as soon as the remedy quit working, the famous homeopath stopped answering the phone, stopped returning phone calls, stopped answering emails.
This gave both my friend and me the impression that this particular famous homeopath kept a practice of all single-remedy patients by dropping contact with anybody who did not fit in! That may not be the truth about it, but from the patient's point of view and from mine as a student, it was an unfortunate reinforcement of what appeared to be dogma.
So I'm very happy to see this sensible approach presented.
(PS. My friend is now seeing a not-famous homeopath who is available to be consulted by phone and who, when he suspects the remedy picture may have changed, gets him back in so he can retake the case.)

Thanks everyone and thanks Sarah. I am really glad you shared this very important experience.
Its unfortunate that your friend could not follow on with the homoeopath. And yes in his case that remedy simply did its job and a new remedy was indicated. While this solitary experience does not mean that all single remedy cures are a myth or that all new remedies are transient in action. But it does open up a new understanding that has helped me both as a student and practitioner.
That while studying new remedies or even older poly crests through clinical cases in books or journals or even seminars, its worthwhile making sure that the action of that single remedy has been followed through at least for one whole year.

Thank you. Very interesting

Thanks Shilpa. I used a layer aproach often. Sometimes you have to as people often block out things that are too painful to remember and life movels along. I find it is good to let people know that we are working like an onion and that to take note of memories comeing up, it is all part of the process and to keep going. Early on in my practice I often had clients that would stop comeing when the memorys would start to surface as they didn't want to go there and seemed to not get it that this is part of the healing. This woman has done really well. Both of you have.

Thanks for sharing Sally. Yes this is so true that some patients can find this process difficult. But it is a part of their healing and ours...


Thanks for this interesting case Shilpa. Yes, more often than not, I have found that more than one remedy is required. We are complex creatures and it is probable that we cannot be completely condensed into one remedy picture. And, as Dr, Jaya demonstrated, some patients pick up the fears of their mothers during gestation. Thanks for all the wonderful things you have done for us this year. I always look forward to your beautifully succinct case studies.

Thanks Pauline. Glad you are enjoying the cases.

Hi Shilpa,
Thanks for sharing that case, very interesting.
Sometimes it takes many remedies to clear a case. One I had been treating for a couple of years took several remedies to totally remove a series of warts. Each wart (or 2) fell off with different remedies and would then fail to progress the case further. Throughout the case we had to use intercurrents, constituitional remedies and lastly a common wart remdy to remove the last of them. This was a young girl, early teens, whose mother had utter faith in homeopathy. Unerupted eye teeth moved after a dose of Syphylinum so that orthodontic surgery was no longer needed and moved the case along.
There was no great suppression in the history to suggest why this case should have needed such an array of remedies for a supposed simple problem.Interestingly none of the sycotic remedies commonly used for warts had any effect.
Thanks again for your blogs.

Well done Lynda. Thanks for sharing.

I enjoyed your presentation and listening to this case. As I look back on some of my very successful cases, many were indeed improved by prescribing on exactly what was presenting at the visit and it took several remedies to move into the depth of the case. It is often too easy to want to consider a zig zag case as not our best work, but with the trauma this woman had experienced I Agee that a gentle resolution was a wonderful and artful way to have handled it. Very nicely done. Thank you for presenting it.

Bless you for saying all of this. This is what I am seeing in my own complex cases. It reassures me that I am on the right track and that my experience is valid. It is difficult to make the transition from theory to practice when one is alone trying to find the truth of how healing really happens. But I am finding a lot of validation in what I am reading and listening to on your blog. Thank you.

Dear Shilpa,
very well explained how to manage a case in layers.Yes even i would get stuck with single remedy approach.
But we need to be open and understand that all patients would not go to that deeper level. Thanks.