First of all, I would like to thank you for your overwhelming response to my last editorial. It reflects that the problems I have faced as a homeopath, are more-or-less universal problems. Today I will move the story forward and share with you some of the most common reasons (problems) that lead to failure in our early clinical practice.
Problem: One of the most common reasons for failure is ‘Rapid Prescription’ – giving too little time to the first consultation. This is more true in India, where homeopaths are often taught to think through therapeutic algorithms rather than the totality. Another reason for rapid prescribing is the need to see more patients in less time because unlike the western countries, the consultation charges that an average newbie commands are miniscule. If a young homeopath in the western hemisphere charges $60 to $100 USD (often more) for the first consultation, an Indian homeopath (and even a conventional doctor) will usually charge as low as $1 to $5 (at most). Exceptions can be easily found in big cities but they do not comprise the bulk. Most patients can not afford more than that. So there is a natural pressure on the doctors to ‘see’ more patients so that they can earn enough to support themselves. This leads to an increasing reliance on therapeutic and keynote approach of practice. It often yields fair results in good hands but the method is less scientific, success is difficult to document and palliation/suppression is fairly common. It is not uncommon here to find doctors/homeopaths who give consultation to anywhere between 30 to 200 patients in a day! Most people in the western world can not even imagine this kind of practice ..and to have ‘fair’ results even at that!!
Solution: This is my advice to the young practitioners. When you start your practice, it’s going to take time, regardless. There will be no long serpentine queues in your waiting room and often you will need to ‘wait’ for the patient. USE this period to work on EACH patient in detail. Take cases in detail, give ample time to your patients – on both the first and follow-up consultations, repertorize each case, cross-question and analyze till you are assured of your remedy and potency selection, don’t repeat blindly on followups – evaluate the response very closely. If you are not sure of your selection during the first consultation, ask the patient to come the next day to give you time to work on the case or give placebo for a week while you analyze the case. Don’t think about the money and fame early in your practice. They will come in direct proportion to your clinical success, so work hard on your patients. Gradually as your practice will flourish, you will be able to take decisions more quickly without doing the ‘guess-work’.
Problem: Very strangely, another most common reason for failure in our early practice is – giving too much time to a case. This often happens in the western countries where it is commonly taught that if you don’t give two hours to a patient in first consultation, you are a bad homeopath! So what happens is that while the case is very clearly presenting all the physical generals, mental generals and relevant symptoms in the first 20 minutes, you continue to plod on, discussing everything in the childhood, adolescence, all the relations ..the whole life story. The patient is often satisfied because no doctor has ever given her so much time before. Nobody has ‘listened’ to her like this before. But the homeopath often ends up with such mass of information that he/she fails to put it together in a coherent way. The relevant information gets mixed up with so much irrelevant information that your remedy selection gets affected and failures result.
Solution: I have said in my last editorial that ‘keep it simple’ when you start your practice. There will be cases which will need two hours to explore them fully but if someone has told you that a 2 hour consultation is a must, get rid of the prejudice! The amount of time that it takes to find the remedy can vary from patient to patient – anywhere from 2 minutes to a lifetime! In general MOST cases will provide you enough material to reach the simillimum in the first 30 minutes. I am again repeating myself that there will be cases which will need more time, but not always. So if you can see the remedy state very clearly, don’t push yourself and the patient too much. You will end up more confused. Also it is NOT necessary that every case will have dreams, delusions and psychological states that need to be unlayered. The physical generals, which are much more easy to obtain and are less subjective, are as important as the mental generals. The importance of a symptom often depends upon it’s ‘strength’ rather than its class. A weak ‘mental’ will prove far less useful than a strong ‘general’. Also when a ‘large’ remedy is very clearly visible – the keynotes are bouncing in front of your eyes, don’t force yourself to find a ‘small’ remedy.
Problem: Patient Pressure. I will also call it the internal pressure to ‘perform’, to ‘please the patient’, to give ‘results’. To prove that we are good, we often end up changing the remedies too soon or repeating the remedies too often. To make this point clear, I will share my first eczema case with you. A lady in her late thirties came to my clinic with weeping eczema on her right leg. It had been there for the last 15 years and she had used every possible treatment. I took the whole case and every detail of the patient, (not just the eczema) matched Graphites perfectly. I gave her just one dose of Graphites 30CH with Sac lac for 2 weeks. On the next visit the lady came to me, nearly jumping with joy. She was very excited and told me that the eczema is already very much less and that she feels great. Nothing had ever done this to her. I was also very happy. I gave her Sac lac for another 2 weeks after which the lady said that the eczema had reduced further but not as much as the previous time. I again gave her Sac Lac for 2 weeks after which the lady came and said that this medicine is not doing much work because the eczema was not clearing as fast as it did in the first 2 weeks. The eczema was disappearing gradually but the lady started becoming restless because she was looking for ‘magic’. As a young practitioner I was not experienced enough to decide about how long I should wait before repeating. Giving in to the patient’s pressure and to speed up the cure, I repeated the medicine. Next time when the patient came, I was shocked to see that the eczema was increasing again. I didn’t know what to do. I gave Graphites 200CH, the eczema increased further. With no mentor well versed in classical homeopathy, I was totally confused. I tried this, then that …but to no avail. A couple of months later, I lost the patient. In hindsight, I think if I had waited for a couple of weeks or months more, the case could have progressed to cure. Haste does make waste!
Solution: So remember, don’t succumb to ‘patient-pressure’ easily. Use your own discretion on when to repeat and when to change the remedy. It is not the patient but YOU who understands the intricacies of homeopathic treatment. Patients will often ‘demand’ quick results, even for problems that have lasted for decades. Don’t be ‘anxious’ to give results. The more relaxed you are, the better will be your results.
Problem: Not learning from our failures. With time your clientele will definitely increase but if you fail to learn from your early mistakes and failures, you will never grow beyond the level of a mediocre homeopath and all your life, you will carry a ‘secret’ frustration within your heart covered with a mask of prejudice, happiness and glory!
Solution: During the follow-ups, evaluate each case carefully, especially the one’s in which you are not getting the desired results. Try to find out WHY you are not getting the desired results. Don’t hesitate to doubt your judgment about remedy selection, potency or repetition in such cases. Don’t carry a false pride (ego) that prevents you from accepting your mistakes. Your failures will teach you much more than your successes. What I have said just now is more important for the young practitioners but remember – it’s NEVER too late to learn and accept your mistakes. Even if you are a seasoned practitoner but carry that ‘secret frustration’ within you, you can still change the course of your practice and life. It’s never too late. Five years of good practice will give you more peace and happiness than the 35 years of mediocre practice!
I hope you will find these inputs useful. You can share your own experiences with me at firstname.lastname@example.org