Key notes and Quick Prescriptions
Yesterday I was scrolling some of my interesting case notes from the charitable clinic I used to consult at in India. It was an experience of a lifetime during the first few years of my practice as I joined a a small team of experienced practitioners under the supervision of a wonderful homeopath Mr Gunvante.
Through the years my practice has shaped into a specialised setting of chronic complex cases where I work at more deeper levels, but I still love going through those notes from that clinic to keep in touch with my favourite remedy expressions that formed a part of that simple everyday homeopathy at its best.
It now seems interesting how we managed to work with hundreds of patients with good outcomes using a simple kit of just around 50 remedies.
Case management at Stage 1 and 2 in an acute setting -
As many of the homeopaths who have been working in acute clinics will agree that working with cases using just keynotes is a very different dynamic than working with chronic complex cases at higher stages.
It is interesting how patients came with an expectation of getting a remedy just for their specific complaint and hence the case taking was kept focussed and directed towards eliciting peculiars from a maze of common symptoms.
It was all about working at Stage 1 and 2 of homeopathy as I have described in my ebook The Quest For Simillimum predominantly so the rules were a bit different during the case management process as compared to a Stage 3 consult.
The remedy potencies varied but the repetition ranged from every few minutes to every few days. At times more than one remedy was given in alternation. Most Stage 1 remedies were prescribed in combinations.
Again this was a very different hat to wear for someone who was used to a single remedy with infrequent repetitions.
Other major difference was that more often than not, remedies were changed during the followups as presentations changed. So remedy relationships were kept in perspective so as to complement the first prescription.
Finding Peculiars symptoms and making prescriptions
The critical task during the case analysis was aimed towards filtering out the peculiar from the common diagnostic symptoms until we could find the leading keynotes. These keynotes generally pointed to one of the well indicated remedies in our Materia Medica.
So it was crucial that we knew the remedies in our kits really well because prescriptions were made on the spot.
The "Bold type" symptoms from Allen's Key notes, Bhanja's Homeopathic Prescriber, Boericke and Phatak's Materia Medicae were our main resources.
If a case had an unknown peculiar then the Boenninghausen Repertory, Boger's Synoptic key or Phatak's repertory became our life line.
Having said that the best part of such clinical settings was the joy and fulfillment of being able to find the response for these cases within the very next day if not minutes.
The key to good prescriptions was also about some good observation and objective symptoms.
What was also interesting was that some of the most peculiar concomitants were elicited during the general examination as objective symptoms.
Eg Cracks all across the tongue in every direction confirmed Nitric acid, Hair on the middle phalanges ( hair in abnormal places) was occassionally the keynote for Thuja, the exact purple shade of the wound pointed to a Lachesis or consolidation at the apex of the left lung in an Xray pointed to Sulphur.
When there were no peculiars
When there were no local peculiars symptoms we simply had to rely on Stage 1 information or diagnosis. A lot of these prescriptions were based on combinations of tissue salts and isopathy. Many times there were specific mother tinctures that were clinically indicated for certain conditions which worked extremely well.
But in cases when Stage 1 and 2 remedies did not give us the results, we had to be creative and think outside the box to work at Stage 3 but without the elaborate case taking. Eg using generalization concepts or working out synthetic prescriptions or even giving another related remedy within the same subkingdom or group.
At times it was eliciting the related miasmatic indications and giving a relevant nosode as an intercurrent. All these were ways to find the best possible remedy and make the best of the limited resources we had.
Overtime some remedies and their indications became second nature and hence today I want to share the clinically confirmed keynotes of one of my very favourite remedy through this case example.
Hope you may find these indications useful in your practice as well.
I love to hear about your experiences in acute settings. So please feel free to share some of your favorite remedies and their clinical keynotes.