Ideal Homeopathic Training?

From an interview of Andre Saine...sorry, I will post the reference when I find the article in its entirety.

Q: In your opinion, what should a systematic homeopathic training include?

A.S.: Ideally, it would be a training where a student would, prior to entering medical school, receive a broad general education in the liberal arts and sciences, and especially a very solid foundation in philosophy. Hahnemann referred to this subject in an article called the Medical Observer published in the second edition of his Materia Medica Pura. In this article he mentions that good judgment and the capacity to observe accurately are not innate faculties but must be acquired through proper education and training. He mentions that the study of the classic Latin and Greek authors is essential in order to develop these faculties.

Similarly, Hering taught his students at the Allentown Academy that we physicians could learn as much from Socrates as from Hippocrates on how to examine the patient. Incidentally Hippocrates said that the most difficult aspect of medical practice is judgment. It is not different today.

The study of liberal arts and sciences with a strong foundation in philosophy is essential to prepare the future physician to develop good judgement by promoting an openness of mind and critical and sound reasoning, a sense of history and the capacity to describe one’s perceptions accurately so as to be able to proceed with care and intelligence. Once in medicine, the student should be presented with a philosophy of medicine encouraging him or her to develop a general and critical understanding of the study and practice of medicine.

The study of medicine should have three major goals: first, to train doctors to become excellent diagnosticians. Not only to be able to recognize the pathological process, but to recognize the phenomenon of disease globally and from its beginning. To be able to investigate not only all the symptoms but all the circumstances, factors, influences and causes involved. To be able to constantly individualize.

To achieve this goal, the student of medicine must study the basic biological sciences—anatomy, physiology, histology, etc.—with a special emphasis on microbiology, genetics, hygiene and psychology, always with the perspective of the whole, thus permitting a global understanding of human nature and the dynamic relationship of man with his environment, followed by the study of pathology, the study of signs and symptoms, differential diagnoses, diligent and thorough case taking and physical examination. Only then would the science of diagnostics takes its full value.

By becoming a good diagnostician, thus by being able to recognize the fundamental causes of disease, the physician would then be able to achieve the second goal, which would be to eliminate the process of disease at its origin and teach the patient how to live a life that is conducive to good health. The third goal would be to assure that the doctor receives all the necessary training permitting him to master therapeutics and, above all, homeopathy, the science of therapeutics.

Starting in the first year of medical school, the students would learn the philosophy of homeopathy, the repertory, materia medica of the acute remedies, acute prescribing and first-aid. Also they would start to observe experienced and skilled clinicians at work. In the second year, they would complete what had not been covered in first year and start the study of chronic prescribing and its materia medica. In the clinic, they would participate in case-taking and examination of the patient under supervision. In the third year, they would continue their study in chronic prescribing and at the clinic, would start to manage cases under supervision. In the fourth year, they would complement their training of homeopathy by studying its application in the various fields such as pediatrics, gynecology, obstetrics, neurology, psychiatry, cardiology, etc.

By this time, the graduates in medicine would have done about 2,400 hours of didactic training and 2,400 hours of clinical training. One could then choose to spend one or more years in residency. There they would work on special training with perhaps the more experienced and skilled practitioners in our profession, continuing their study, perfecting their clinical skills and doing research.

Afterwards, the recent graduates would be asked to return to receive 50-100 hours of continuing education for the following 4-5 years. There are subjects in homeopathy that can be tackled only after a few years of practice. There should also be a possibility for recent graduates to bring their more difficult cases to their teachers, maybe to a college clinic with fixed hours for this purpose, where they could watch the more experienced homeopaths work on those cases; this is the way they will become experts. This would be the final step in their training where the expertise would be transmitted from the masters to the more advanced students.

In the field of therapeutics, complementary care to homeopathy would be learned in parallel, such as psychotherapy, hydrotherapy, physical medicine, etc. Then we would have a well rounded physician who would be prepared to deal with the most difficult acute or chronic cases, a physician trained in truly classical medicine. After such training and about five to ten years of practice they would have had all the opportunities to master their discipline.

Unfortunately, to my knowledge, this form of training has never been offered and that is the main reason why so few people have ever really mastered homeopathy. The closest we have come to this was when Lippe took charge of the Homeopathic Medical College of Pennsylvania in the mid 1860’s. He made sure that the entire faculty shared the same understanding of homeopathy and provided a unified training.

On the faculty, beside Lippe, there was Hering and Guernsey. When we look at the list of graduates from those years we find an unprecedented list of names such as Constantine Lippe, E. A. Farrington, T. L Bradford, E. W. Berridge and Walter James, all of which contributed in major ways to the profession. One day, very soon I hope, we will be able to provide an adequate system of education to our students.

Thanks for posting this Glen.

I love this response by Andre which is basically adding on to what Hahnemann wrote in The Medical Observer.

I have now been in practice for about a year. Yes, I am getting pretty good results so far. At the same time, I am really beginning to realize the areas in which my training/education was limited.

I actually had the opportunity to receive extra medical training when I worked for an AIDS Service Organization which has helped me immensely even in the Tx of medical/pathological issues not connected with HIV. This training was so immensely valuable for so many reasons- but even just on the basis of learning what are common symptoms of a particular disease, how to differentiate SFX of meds etc.

I really believe that the art of diagnosis is so, so important. I wonder how many of us (without an accompanying medical diagnosis) could indentify the pace, intensity, stage of some disease processes so we could even make a prognosis? I know for myself, that if a potential patient approaches me about the effectiveness of homeopathy in treating a medical condition I haven't treated or heard about successful treatment with homeopathy, I am not sure what to say in many cases.

I also know that while I know how to palpate, percuss, ausculate etc, I am not sure I would be able to distinguish what different breath sounds may mean in the context of a pneumonia- and we know that this is an important skill that helps us narrow down a remedy selection depending on which side or part of the lung is impacted.

I don't think this means that mastering skills around diagnosis and physical exams makes us wannabe allopaths. It also doesn't mean that we have to diagnose allopathically either.

I would especially like more training about homeopathic medicine in the context of various allopathic specialities such as gynecology, neurology, psychiatry etc.

Yes, those of us who aim to practice in a Hahnemannian way based on continued study are definitely on the right track in terms of knowledge of case taking, case analysis, materia medica etc. As a profession, I think we need to stop being defensive about what I see as our lack of a thorough medical training. I also think that we can't keep waiting for TSHM to offer us these things we need to go out and try to find ways to acquire these skills and knowledge.

I know I have spoken about this training issue with Joe Kellerstein. I realize that I learnt things in the Hahnemannian Prescribing course that should have been taught in 1st year. I have noticed in particular the way that remedies are taught (Based on the method advocated by Hering) has helped me significantly in understanding remedies. I also have noticed that my case taking skills have improved dramatically. (This is not necc to blame TSHM at all) I also think we all would benefit from either have a mentor with whom we could preceptor/intern with in a clinical setting.

In spite of what we were told in school, I believe that it is problematic to assume that we can begin practicing homeopathy well after 3 years of formal study. Frankly, it isn't enough. especially since most of us don't have the background in basic sciences. I am obsessed enough with homeopathy (LOL!) that I want to go out and improve my skills so that I can offer the best possible care to my patients.

So, I am hoping that we get enough of a group of interested folks to take up Veronika on her offer to give us more training in physical exam/diagnosis.

So, this was a long rant that has been percolating for a while! I feel really passionate about homeopathy and while Andre can be very arrogant, I do agree with a lot of his points.

Rebecca

Hi, Rebecca,

Thanks for your well-percolated thoughts.

With respect to the good direction that TSHM is taking, I agree with you that it seems homeopathic training is insufficient world-wide. Compared to the ideal training that Andre wrote about, it's not even close. Without any disrespect to other teachers, I've gotten the greatest understanding of homeopathy through Andre's lectures hands down. His standards for education are very high and appropriate in developing very good homeopaths. Speaking in one of his Materia Medica lectures about the ideal educational system, his minimum requirement for a homeopath to be a teacher was incredibly high.

He said that in order to be a teacher of homeopathy, you should be able to show your understanding of homeopathy and materia medica by being able to correctly identify the Rx in 20 given paper cases. For example, if you wanted to teach in the psychiatry department, you should be able to answer at least half the cases without a repertory. For the final 30 minutes of the exam, you are given a repertory to complete the rest of the cases. In his mind, you should score 100%. A very high standard...and why not? Shouldn't we have experts teaching us? Isn't what he's described in the above ideal institution almost equal to the training of allopaths in terms of faculty, curriculum, internship and residency?

For us, how much would you love to be in an internship program that was described above? It would be incredible...a residency...wow...even more so. But first we need the right teachers who will steer us down the right road and teach us how to think at the same time. I don't agree with Andre's recommendation of studying the classical non-medical subjects as this doesn't guarantee that people will learn and understand a more basic requirement of being a homeopath...understanding what it means to be inductive. (How many homeopaths have studied the classics and still have not understood induction?) Think about it...if every homeopath understood induction, there would be no reason to add another qualifying word in front of the word "homeopathy." Instead of "Hahnemannian homeopathy," it would just be "homeopathy" as it rightfully should be.

With the recommendations Andre gave, plus an emphasis in teaching induction, we would become far more proficient prescribers and we would then be able to achieve the profession-wide success necessary for homeopathy to be able to rise to its rightful place in medicine.

I think far too many people graduate with the idea that after 3 years of study, we're ready to treat any and all patients who walk, hobble, roll or are unable to walk through our doors. Remember, Lippe graduated and successfully prescribed for over 300 soldiers dying of typhoid! Granted that Lippe is said to have been the best prescriber of all time, how many of us could've batted 50% fresh from graduation? It's hard to say. But given the wide-ranging teachings that are "homeopathy" around the world, how many new grads could bat 50%? Remember, good homeopaths had mortality rates of 0-5% in treating typhoid.

In terms of our own education, recent discussions revealed that I wasn't the only one who'd graduated without realizing that I was diagnosing. I don't ever recall even having a discussion on the role of diagnosis as a homeopath. Never learned it till I heard Andre's lecture on philosophy. I never once discussed that one of the roles of diagnosis is to determine the primary cause of disease. I'm not sure how many in our group have learned it either judging by the fact, as a group,we've only managed to identify 3 out of 8 non-dynamic primary causes of disease and obstacles to cure in 3 weeks. Doesn't this say something about our quality of education when we haven't even learned something so basic as being taught that we're diagnosing? In my bio I wrote that I didn't feel like I'd really begun to understand homeopathy until Andre. Joe gave me a great intro and basis to start my practice and experience success but I was still left with many questions. After studying Andre's lectures, I feel I've developed an understanding of, not just of homeopathy, but the phenomenon of disease and healing. Many holes have been filled in and my questions are now fewer because I can answer them myself or at least have notes to refer.

I often think of Klaus Scheimann-Burkhardt's observation and analogy that we are like concert pianists who go out an perform a concerto without having even learned all our scales. We're simply not ready upon graduation and a few years after if we don't continue with quality training. Consider that one of the scales that we should have a basic grasp of is our materia medica. Shouldn't we at least have graduated knowing 20 "acute" and 20 "chronic" Rx's inside out? (I used quotes because an "acute" Rx can be used in a chronic situation and vice versa.) In the old days, homeopaths needed to score a 90% on their mat med exams in order to graduate...90%! I've never met a homeopath who's not graduated from a professional homeopathic school, let alone failed a year.

I have a long, long way to go in terms of my learning and every time I learn something new, I realize how much I don't know and how much more I need to learn. To be cliche but serious, it humbles me that I know so little...and motivates me to keep up my studies. This matter of our education has been percolating in me for a while now, too.

As for Andre being arrogant...I don't see it so much that way or perhaps I've become a little desensitized to it. I think he just speaks directly as it is for the goal of making us better physicians. We've seen how important diagnosis is and when he asked Rachel if she could diagnose and she said no, I don't think his response, "That's the difference between you and me," was arrogant. It may have came off that way for some, but for me, knowing how he teaches, I know he was being frank and saying, "Look, I've attained a very high level of success...if you want to do the same, you need to learn diagnosis." I've listened to his lectures and he's never minced his words. He wants people to succeed. I hear care in his voice when he talks about and to his patients and passion when he speaks talks about homeopathy. I've heard MD's with really poor (and sometimes very offensive) bedside manners that have devastated patients and their family and I've never once heard Andre talk that way; not to his patients or his class. I think I've heard him answer in short ways a few times when someone's asked for the umpteenth time in his umpteenth lecture that they want to know what a patient's "constitutional Rx" is or why he's prescribed Sulphur to a patient who wasn't a ragged philosopher. Before his courses, he asks people to read his articles so that these types of questions don't need to be heard over and over again and it's not done. People don't read up first and then they waste class time. What I do hear is nuggets of useful homeopathy that he teaches. He's not a god; just a person with a lot of passion and knowledge in helping people and teaching other people to help people. As Andre quotes Hippocrates, "Life is short. The art is long and judgment is difficult." We've all got a long way to go if we want to be masters.

Cheers, all.

By the way, I'm going to be nit-picky and mention that we need to be careful in our language again ("allopathic specialities").

Glen,

Didn't I tell everyone to read that article in its entirety?!!! Here you go posting this most excellent excerpt - I fear you will spoil us all in your attempts to get us to talk about the good, the bad and the ugly of our homeopathic experiences.

Rebecca - thanks for joining this discussion, I would like to see this in the diagnosis, and TSHM string so that everyone gets a chance to see this - thanks for your honesty and well thought out contribution. I wonder what Sarah's practical expereinces are....