The Follow Up

When physician had taken the case & prescribed similimum medicine, the physician expects response in patient’s condition. What should a physician do when patient came for follow up? Answer to this question depends upon patient’s reaction toward remedy. Dr. J.T. Kent had given us possible twelve observations which are made after administration of the similimum medicine. Which are—

1.    A prolonged aggravation & then final decline of the patient.

2.    Long aggravation but final and slow improvement.

3.    The aggravation is quick, short & strong with rapid improvement of the patient.

4.    No aggravation, with recovery of the patient.

5.    The amelioration comes first & the aggravation comes afterwards.

6.    Too short relief of symptoms.

7.    A full time amelioration of the symptoms, yet no special relief of the patient.

8.    Some patients prove every remedy they get.

9.    The action of the medicine upon provers.

10.                     New symptoms appear after the remedy.

11.                     When old symptoms are observed to reappear.

12.                     Symptoms take the wrong direction.

So, these were twelve observations that Master Kent had given. What changes we sought in patient after giving similimum medicine?

We as a physician should look for both good & bad changes. What will physician will do in follow up? When patient had taken given homeopathic similimum medicine & then come for his further follow up, physician needs to look for changes in patient. Which may be good or bad, but one should know what needs to be done, especially in chronic cases & in acute also! So now what changes one have to find in case? Answer of the question is depend upon case, there may have following possibilities—

1.    Case has some aggravation but relief in complain.

2.    Case is in standstill situation after little improvement.

3.    Patient produces other symptoms which are not of current disease, but of medicine which is given to the patient in first prescription.

4.    Patient does not react to the medicine.

5.    Patient’s response to the first prescription is in satisfactory or good enough.

6.    A complementary medicine needs to be given.

7.    Case shows new group of symptoms, that is symptoms changed but there is no relief to the patient.

8.    Case shows symptoms of another miasm that the case had before. 

All these possibilities I had seen in my practice were based on twelve observation of Dr. J. T. Kent. I had seen that many of my students do not follow these observations during their practice. I insist them to do so.

Now if physician have above mentioned possibilities in the follow up, then he must give further prescription according to the case. Let’s understand these.

·       When a case has some aggravation but relief in complain, that means our medicine had acted. When medicine is right then there will be homeopathic aggravation. (Ok for those who are wondering what is homeopathic aggravation; it is slight, but noticeable intensification of patient’s current symptoms after given similimum homeopathic medicine, along with simultaneously better feeling.) Homeopathic aggravation is good sign in case. By which we can interpret that the case is curable & prognosis is quite favorable. Then one must not disturbed given medicine till it completes its action, one can give placebo for patient’s satisfaction.

·       When to repeat dose? Yes the repetition is necessary in some cases. When physician gives first prescription & then wait for its reaction with patient & finds that the medicine is acting and patient having improvement. But after some days or weeks may be patient stop improving. So then the repetition of the medicine (which was given in first prescription) is must. But to do so one must have to wait till medicine had acted in first place. And there is another situation where one can repeat same medicine. When first prescription had acted and there is relief to patient, but after some days original symptoms of case are seems to appear then one can also repeat the same medicine.

·       As I mentioned above ‘Patient produces other symptoms which are not of current disease, but of medicine which is given to the patient in first prescription.’ Then what one should perceive? & what should do? It is quite simple it is wrong medicine! In this case patient must be antidote first. When patient says medicine cured me those symptoms but now I have these symptoms. Ok means medicine is partly indicated but still it is wrong one. For curing the case one must give similimum medicine. So when wrong medicine given & it produces ill effect on patient then it must be antidote.

·        Patient does not react to the medicine means given medicine & potency is wrong. So what one should do in this case? He has to re-take the case thoroughly. When patient does not react to medicine this condition is call “status quo.”

·       What happen when we give wrong potency? There may be two possibilities; one can be higher potency than it needed or another is lower than it needed in case. If there is high potency then it will produce more aggravation in case, which is completely unnecessary. Yes our master Hahnemann said that potency & dose should be minimum, to avoid unwanted aggravation. What if potency is lower than it needed? Simply it will give relief to patient nut not satisfactory. So if the medicine is similimum than one must change its potency. Dr. J.T. Kent had given an opinion regarding potency that same potency be not repeated on more than two times.

·        We give exact similimum medicine to the patient but failed to complete cure. There are relations between remedies, and there are medicines to complementary to other medicines. In these cases our follow up should be complementary to first one.

·        When case shows new group of symptoms, that is symptoms changed but there is no relief to the patient indicates a new medicine. But before give another medicine make sure that these symptoms are not symptoms of the medicine given. If it is not, then on basis of current totality one should give another medicine.

A physician is dealing with case, suppose it is psoric case. During anti-psoric treatment patient shows symptoms from another miasm which may be sycotic or syphilitic, then he must not give anti-psoric treatment, but he should re-investigate case and have to change his way of treatment. That means he should treat the current miasm that case posses.

So, this was about the follow up, hope it helps in case study.