Dec 31, 2017
Year in Review Mash-UP with Case Inventory Part 2:
Five Ways to Learn from Your Results
(this is a lightly edited version of the podcast transcript)
It IS the time of year for reflection, review, and resolution, is it not?
Perhaps you engage in your own personal reflection this time of year, maybe guided by a spiritual practice or desire for change, new habits, you know.. the standard lines of resolution.
Why not bring your homeopathic Practice- with a capital P- into consideration?
To start, let’s dig a bit deeper into the word ‘Resolution’
late Middle English: from Latin resolutio(n-), from resolvere ‘loosen, release’
I love that idea- to loosen, or release in the origin of the word, because the first definition of resolution according to Webster is:
1) a firm decision to do or not to do something:
2) the action of solving a problem, dispute, or contentious matter
3) the process of reducing or separating something into its components
the smallest interval measurable by a scientific (especially optical) instrument; the resolving power.
We can only consider what we can see clearly, and we can only respond to the degree that we understand the totality. Hahnemann says this in the Organon- that we can only take those symptoms which the patient can describe or that we can observe- without prejudice.
Likewise, the extent to which we breakdown a problem will often determine how well we see the full picture, and our potential for success.
So too must we as homeopaths figure out what are our elements of practice: materia medica, philosophy, analysis, repertorization… and work on these faithfully not only when we’re being paid to do so, but because only by paying attention to these separate components of homeopathy- the small intervals of the whole- can we reap the reward of an improved practice overall.
So how do we pull this all together into something usable?
I’ve pulled together five different approaches to case inventory and review, each of which would enable you to highlight an aspect of homeopathic practice that you can ‘resolve’ to study for improvement, should you choose to do so.
#1: Karen Allen’s Approach
Karen Allen is a well known and respected American homeopath. She practices out of San Francisco, has served as a board member and past president for the Council for Homeopathic Certification, and the Education Director for Homeopaths Without Borders. She has taught and lectured extensively in the US and abroad, and offers multiple long-distance education opportunities for homeopaths online via her site karenallenhomeopathy.com.
“what i find is that I can always get better at what I do. I haven’t yet had a month were 100% of my clients had a fabulous outcome. And as long as there are clients who are not getting better, or not getting very much better, or whose healing has stalled, I have things to learn.”
But Karen doesn’t stop at platitudes and philosophy. She takes her commitment to improvement to action and describes what she does this way:
“ I get a piece of paper and go through every case I have touched in the last 3 or 4 months.
On paper, i draw 3 columns.
In the first column go cases with no success- I note the chief complaint and remedy given.
Second column- cases with some result- relief, palliation, in the process of getting better.
Third column- cases where I think this person will NOT go back to their former level of ill health.
Then, I see what percentage of cases ended up in each column.
The first time I did this, my column one- no success- consisted of 50% of my cases.
Honestly, out of that first audit, my surprise was that it was even that good. Because my sense was that I was failing for 90% of the people coming to se me. And it wasn’t true.
And I believe most practitioners who have never audited their practice feel they are failing because they forgot about those people who are doing great.
They only remember the person having an aggravation of symptoms and th person who didn’t have a good outcome.
over time, my outcomes have gotten better.
For the last tend years on average, 15-20% are in C1 (no success)
30-35% are in C2 (some result)
35-45% in C3 (won’t relapse)
I feel good about those statistics. When 70-80% of the people who come to see me are benefitted, I feel that I can hold my head high.”
#2 Serendipitous Colleague Approach
This fall I inherited a case from another homeopath. The patient had moved across the country, and the sending practitioner graciously forwarded all of her notes and case files.
So envision and excel spreadsheet. In the horizontal row is the date, type of visit, then single word descriptor of complaint 1, 2, and 3 for that consultation. For example: anxiety, cough, insomnia.
It occurred to me that whether this was a unique document created by the homeopath, or an export of records that one keeps in their software just as standard record keeping, you can *use* it as way of evaluating and auditing by simply looking at it in a different way.
Is the pathology getting less serious and limiting over the time span of using remedies?
Is there evidence of Direction of Cure- inside out, important to less important organs, top to bottom?
Is the person improving to the extent that your consultations are less frequent?
Are they getting acutes- fevers- where they did not before, indicating a higher level of health?
Are the chronic exacerbations that the patient experiences as acute flare-ups, less frequent?
#3 Circle of Consultation
I mentioned earlier a graphic that I created called the Circle of Consultation.
I’m proposing this as the 3rd framework for case inventory and audit.
For the patient-
the case: acute, chronic, suppressed, miasmatic, iatrogenic…
what kind of case is it?
this is a point I consider when starting any case as a way to get my bearings, but it’s a thing to look at again if the case is not progressing well.
This might be helpful if the the patient undergoes surgery in the course of working with you, or there’s a trauma.
The other patient quadrant includes obstacles to cure, commitment to homeopathy, finances, concurrent treatments, etc.
So the patient quadrant asks us to consider the type of case the patient comes to us with, and then the smaller gears that that case is functioning around.
The practitioner side is split between management, and prescribing.
Management includes patient education, follow up, case management with applied philosophy, and practice procedures.
The Prescribing quadrant includes: case taking, analysis, synthesis, repertory skills, materia medica knowledge
No doubt there are many more concepts that can be- and will be- added to each of these quadrants.
I welcome your comments on the graphic, as I continue to consider it as a tool, to improve, for improvement.
Check it out here:
#4 The Organon
One of my interviews for 2018 is with Kim Elia. If you know who Kim Elia is, then you’ll expect that we talked a lot about The Organon. Kim is an incredible keeper of homeopathic history and has detailed, exquisite recall and understanding of The Organon, in all its editions and translations.
We touched briefly on integrating The Organon into teaching, and Kim shared that he brings in aphorisms through presenting a case, so that he can illustrate Hahnemann’s directives through actual cases, making the aphorisms applicable and relevant.
Auditing a case by using the Organon is simple.
Select a case with multiple follow ups.
Review your decisions at each turn.
Compare what you did to what Hahnemann directed.
Did you follow Hahnemann’s directions?
Did you deviate?
What was the outcome?
What would Hahnemann have done?
What might the outcome have been?
You can take this as far as you want. To do so, you will have to have a working knowledge of which aphorisms apply directly to practice, and to which aspects of practice. If you don’t know, then that in itself will serve as a pretty beneficial action.
A good resource is Manish Bhatia’s Lectures on the Organon, available through hpathy.com. There are currently 2 volumes available, with excellent cohesive lectures for each aphorism. If you don't already know Wenda O’Reilly’s version of the Organon, it has helpful margin notes that give the main idea for each aphorism, which makes it a helpful desktop resource to help you find the section you need without having to carefully re-read each aphorism in full, until you find what you’re looking for.
I expect to present my interview with Kim Elia in March’s episode, so be sure to catch that, because we go into more depth about how to get more out of the Organon.
#5 Finally… Just re-do an old Case
At a recent meeting of my state’s Association of Homeopaths, we were talking about this topic of going over old cases. Another homeopath shared that she will frequently pull an old case and do it again. With a few years distance, she will see the case differently, repertorize with greater skill, consider different approaches.
You can consider:
a new approach that you aren’t quite ready to use with cases in progress…
a new approach that you *are* using with newer cases
take more time for remedy differential
consider families or groups related to the remedy originally prescribed
consider the miasmatic indications if you didn’t look at that the first time around
search for published cases using a remedy that prescribed- contrast those where your case was *also* successful with that remedy, and cases where it was not. There will be equally useful information about the remedy- and your patient- either way.
Try different repertories, or consulting different MM than you did the first time around.
Each of the approaches I’ve suggested chart a course for different waters. They can be specific, conceptual, philosophical, or a combination of the three.
Play around with all of them, see what suits you and your needs at this time, and most importantly, what you get results from.
Like any new approach, don’t take my suggestion as valuable just because I’m taking the time to write and record this :) Try the suggestions, change them, challenge them.
I myself will be putting each of these methods to the test. And I think it will be hard- to take the time, to be consistent, to follow through. But I think some assessment is better than no assessment. Once a month, once a year, twice a year….just try it. And see if you can circle up with a few colleagues to share your results and experiences with- and let me know how it goes.
So that wraps up the final podcast for 2017>>>
I am SO grateful to all of you, my listeners, and all of my guests who graciously say ‘yes’ when I email them out of the blue. They often have no idea what this podcast thing is, but they love homeopathy, and they love to talk about their work, and so they do. I know we all benefit from it, and so in turn does the rest of the world.
So until 2018, take care, be well, and stay observant.