Record-keeping

- BENERJEE.P,

Record-keeping 

 The preparation of the record is not considered by most people, to be a business of much care and attention. It is presumed that the patient will necessarily make a statement of his sufferings and symptoms, and the preparation of the record consists in merely taking down that statement. But it is not so. I am not concerned with what other pathies than Homœopathy think of it. I can, however, say as a Homœopath that, in Homœopathic treatment, "Recording" is the most important and the most difficult work-important, in that it is on the correct and complete preparation of the record that correct prescribing depends, and difficult, in that patients are seldom in the habit of giving out just what is required, and as such, the record that is required for the purpose of prescription has to be got out of them. It, therefore, demands much tact, consideration and judgment on the part of the physician so as to be able to make out a case from the heterogenous statements of the patient. Hahnemann has laid much stress on the importance of record-keeping. He has actually stated in his Organon that a properly prepared record means half the cure of the case. This is significant. The cure of the patient depends so largely on the record. If the record is fully prepared, there is not much delay in cure, because a correctly prepared record will enable the right medicine to be selected at once, and if the right medicine is selected, the patient is bound to be cured. Let us therefore note with care, that the preparation of the record is a thing of the greatest importance in Homœopathic treatment.

 There are others, however, who do dot consider a record to be of much necessity even. Homœopaths of this class listen to the history of the patient either from him or from his guardians and arrive at some medicine at once. But such hasty prescribing in chronic cases is unsafe both for the physician and for the patient. It is unsafe for the physician, because, he is bound to make a wrong prescription when he does it so hastily, and once he has made several such wrong prescriptions and has therefore failed to cure his cases, there is a tremendous loss of reputation. And loss of reputation means loss of practice. Then again, it is unsafe for the patient, because such wrong prescriptions not only fail to cure him, but also make his case worse in most cases. I would, therefore, advise my reader to realise the necessity and importance of "Record", and wish him never to dare taking up the treatment of chronic cases without it.

 Let me explain the necessity of record-keeping. It is a patent fact that patients are, as a rule, anxious to give out only those symptoms that cause the greatest trouble and sufferings to them. But all those symptoms are not, as a matter of fact, necessary for prescribing. Only some of them are necessary, and again these have to be arranged and classified in respect of their importance for the purpose of prescribing. And unless a record of the symptoms is made, there cannot possibly be this classification.
 Then again, it is not unoften, that the most annoying symptoms given out by the patient, happen to be of no use in selecting the medicine. Perhaps, the symptoms that are required and that may lead you to the remedy, have to be crossed out of the patient. And unless a record is prepared, this crossing of the patient so as to elicit those symptoms that are necessary to complete the picture and to enable you to arrive at the remedy, is not possible. Unless there is a record it is not possible to find out where the incompleteness of the case lies and how that incompleteness can be rectified.
 The third thing is, that without a record, correct prescription is impossible. The symptoms in any chronic case are always complex and conflicting, and they seldom suggest one single remedy. And when more than one remedy is suggested, the record, that is to say, the study of the record, is the only thing which can help yon to single out the right remedy to the exclusion of the others.

 The fourth thing is, that without a record in front of you, it is never possible to watch and study the action of a remedy after it has been used. You cannot possibly depend on your memory to understand what symptoms have disappeared or what new symptoms have appeared, what changes are taking place, and what old symptoms are coming back. In judging all these, a record is indispensable.
 Last of all, unless there is a record, you cannot remember what medicines are being used from time to time and in what potencies, and you cannot, therefore, know how long you have to wait and when you have to repeat the dose or make a second prescription.
 The above must convince you of the necessity and importance of record-keeping, and I will now try to explain to you the method of preparing the record. The first thing when a patient comes to you for chronic treatment, is to ask him to make a statement of his sufferings. He should be asked to state slowly, so that you may take down your notes; and he should be allowed to state out in his own language, and there should be no interruption. You should, however, see to it, that he does not wander from his subject, in which case however he may be reminded to keep to it. You should take down his symptoms in his own language, and you should write down the lines pretty apart one from another. When however the patient has finished his statement, you should allow him further time and ask him to recollect if there is anything else yet. When he has made any further statements, these should also be taken down. In this connection, let me give you an idea as to how the statements should be recorded.
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 The book selected for the purpose should be a bound book of foolscap size, and there should be five columns in it as shewn in the next page.

1 2 3 4 5

Statements made by
the patient.
Modalities, showing
how the different symptoms
recorded in
Col. 1 are aggravated
and ameliorated. (Particulars
of the generals
recorded in Col. 1.)
Nature, temperament
etc. of the patient, as
studied out by the
physician while taking
down the case.
Name of
the medicine
used,
with
potency.
Date of
using
the
medicine.

 In column 1, should be recorded the statements of the patient. Each line should be pretty apart one from another, and each statement should be kept separate. In column 2, should be recorded the modalities, at least in respect of the more important symptoms. Each modality should appear just against the symptom to which it relates. In the third column should be recorded, the nature, temperament, demeanour etc., of the patient, as the physician can understand these from a study of him, while he makes his statement before him. In this column, the physician may make such other notes also as he may consider necessary and helpful for purposes of prescription. He should also record in this column the results obtained after the use of each medicine. The fourth and the fifth columns, should be set apart for noting the name of the medicine with its potency and the date on which it is administered. Some physicians, however, dispense with these two columns running from page to page, and they prefer to have them only at the last page of the record. But, this does not seem to me to be very convenient, as it happens at times, that the patient also mentions while making his statement, the names of the medicines he has taken from time to time, and unless these two columns also run through all the pages, from the first to the last, it grows inconvenient to note the names of these medicines. The most important thing that should be kept in view, while making the record, is that there should be nothing indefinite or inexplicable about the entries made. All entries should be clear, unambiguious and precise, so that any other physician also, may be in a position to prescribe on your record.

 When however the patient has finished his say, it is your turn to put questions to him for eliciting further facts so as to make the record complete and sufficient for the purpose of selection. Each symptom given by the patient and recorded by you in column 1 is only a general symptom and you have to obtain the particulars in respect of each of these generals and then make the record point to a remedy. You must remember always, that the object of the record is to paint the picture of the patient, and as soon as this picture is complete your selection of the remedy is half done. From the statement made by the patient, the picture will never be found complete, and it therefore becomes indispensably necessary to put questions to him. But in putting questions to the patient, one very important thing must be borne in mind, which however has already been explained to some extent, namely that, no leading questions must be put. Another thing yet. While putting your questions, you must neither be thinking of any remedy, as that would bias your mind for that remedy and lead you to put such questions only as would clear up the picture of that remedy and that remedy alone. This will therefore throw you into tremendous errors. You must have your mind free and your endeavour throughout, in filling up column 2, will be to particularise the symptoms noted in column 1. If this can be done successfully and without any previous bias for any particular medicine, the picture that you will paint in your record will be a true picture of the patient before you. And when you have got a true picture of the patient before you, in your record, the picture of the remedy in your Materia Medica, to which it is most similar, will at once flash across your mind, provided of course, that you have already a thorough study and knowledge of the Materia Medica. If however, it happens that in spite of all your endeavours, there come up in your mind, two or three medicines (instead of one) which seem to be similar to the record in front of you, it would be necessary for you to put further questions to the patient, so as to collect the differential points of each of those remedies and eliminate those that are not indicated arriving at the one that is indicated.

 Let me add that, I cannot overrate the importance of column 2 - the column for modalities, or in other words, the column for particulars, as, it is this column which will help you the most in making your selection. Let me repeat that in column 1 you have noted down only the general symptoms e. g., dysentery, wind in the bowels, fever, cough etc. etc, and unless you note down in column 2 the particulars in respect of each, you cannot be led to any one particular remedy. Mere fever, cough, or dysentery would lead you to any remedy in the Materia Medica, but if you can get the particulars in respect of these, e.g. ,-if you can find out in respect of the fever that it comes on at 9 or 10 A. M., you are perhaps inevitably led to Natrum Mur.; if you can find out in respect of the cough that it is relieved by a cold drink, you are perhaps led to Causticum; and if you can find out in respect of the dysentery that there is relief after each motion, you are perhaps led to Nux Vomica. Thus, you see that it is column 2, that will lead you to the remedy. Column 1 represents any patient that has these, but column 2 represents only that particular patient whose case you have recorded. It is column 2, therefore, that singles out your patient from all other patients suffering from the same symptoms. And as your object in making the record is to paint the picture of the particular patient in front of you and not of any patient having those symptoms, you must take special care to make this particular column particularly complete and sufficient.

 It is very very necessary to ascertain the nature of the patient and his mental symptoms, as these are very valuable for the purpose of prescribing. These may, however, be best studied and ascertained by a close scrutiny of the patient while he makes his statement before you. In the case of patients sending their statements by correspondence, some idea of the nature and temperament has to be obtained from the language of the correspondence. It is a fact that oral statements and written letters equally bear the stamp of their authors, and the physician has to learn to study and understand it. Any way, the nature and temperament of the patient must be ascertained and recorded in column 3 as already advised, because, these will facilitate the task of prescription. Of all symptoms, the symptoms of the mind are the most important and useful, as the mind is the man.