Homeopathic Training

It doesn't, good point. This is the job of a good path course, or phys exam course, I believe.

Hey, All,

Sorry for the tardy response but this is a doozy of a discussion and I’ve been reflecting on it quite a bit. So to your question, Andrea, "What, specifically, would you want to see on a homeopathy curriculum for diagnosis in the allopathic* sense?”

*allopathic does not refer to a system of medicine, i.e. [=that is to say] western medicine; it refers to how a medicine is prescribed. Hahnemann created the word allopathy to distinguish it from homeopathy , i.e. prescribing medicine based on reasons "other" than the Law of Similars.

…unfortunately to your question, I don’t know. I actually haven’t thought about it yet because there’s a more fundamental question that needs to be answered first:

How important is diagnosis?

We must answer this question first because your question’s answer depends on it: If diagnosis is established as important, i.e. it makes us better prescribers, then we need to answer your question and investigate the specific training that would help us be better prescribers; if “the value of it is still up for debate, in the modern sense,” as you say, however, i.e. it doesn’t make us better prescribers, then there’s no need to investigate the specifics.

Now in light of the fact that I’ve been focusing on whether diagnosis is important enough to warrant further training in the first place, I hope it’s clear that I have been answering your question and not been “babbling” and speaking "with vague premise."

So, how important diagnosis is?

My feeling on this question has changed over time. In order to fairly answer it, we first have to have a common understanding of the word, diagnosis. What I’ve learned about diagnosing may perhaps be different to what you know as it’s taught me that the value of diagnosis is not debatable; it’s fundamental to what we do. Let me explain.

As per my previous post, diagnosis is rooted in the words, through understanding. Through understanding a problem, we can fix a problem. Understand the disease, fix the disease. Isn't this what we as homeopaths do? But, unfortunately, there's a misconception amongst us that we don’t diagnose. Let’s have a look at the meaning again. Diagnosis means through understanding or through knowledge of a problem, we can fix it. Understood this way, we can see that diagnosis isn’t just limited to medical professionals. Lawyers and plumbers also diagnose. Lawyers diagnose a client’s problem first in order to advocate for them and champion their cause. Plumbers diagnose, or understand, the cause of a leak first before fixing it. And, yes, we diagnose every time we see a patient. How?

When we take a case, we are diagnosing. In fact, it’s one big diagnosing, i.e. we are gathering knowledge of our patient to understand their disease state(s) in order to prescribe for them the most similar Rx. Through understanding, we may uncover a never-well-since. Through knowledge, we select the optimal posology (potency and frequency of dose) for the patient. By being diagnosticians, we understand a patient’s short-lived response to a remedy may have been caused by the antidoting effects of a new and recent stress. We diagnose constantly. It’s in our job description, Aph. 3 (italics are mine):

If the physician clearly perceives what has to be cured in disease, i.e., in each individual case of disease (knowledge of disease, indication),
if he clearly perceives what is in medicines which heal, i.e. in each individual medicine (knowledge of medicinal powers),
if he applies in accordance with well-defined principles what is curative in medicines to what he has clearly recognized to be pathological in the patient, so that cure follows, i.e. if he knows in each particular case how to apply the remedy most appropriate by its character (selection of the remedy), prepare it exactly as required and give it in the right amount (the correct dose), and repeat the dose exactly when required,
and, lastly, if in each case he knows the obstacles to cure and how to remove them, so that recovery is permanent,
then he knows how to treat thoroughly and efficaciously, and is a true physician.

Notice, too, that Hahnemann says here a “true physician” and not a “true homeopath”. Why? I spoke about this in my previous post that a physician is one who knows nature (diagnoses), i.e. observes the language of nature in the sick, so that she/he may help cure the sick. Essentially, a physician has 2 fundamental responsibilities:

1. understand the problem, i.e. diagnose
2. apply principles to fix the problem, i.e. prescribe the appropriate Rx

To clearly perceive what needs to be cured and know what is curative in medicines to apply the Law of Healing requires that we be good diagnosticians. Is it not then mandatory? It’s what we do. It defines us and Hahnemann dedicates an article on the topic, The Medical Observer, http://www.wholehealthnow.com/homeopathy_pro/medical-observer.html.

It’s important to distinguish that diagnosing is different in the eyes of an allopath (i.e. drug prescribers using principles “other” than Similia) and a homeopath:

Allopaths define and diagnose disease as objective signs + subjective Sx’s.

In addition to these objective signs + subjective Sx’s, homeopaths define and diagnose disease as any departure from the average healthy state of a patient, i.e. the qualitative differences that individualize a patient’s Sx’s (sensations, modalities, concomitants, objective Sx’s, etc.) + physical generals + etiologies, i.e. we use both the western medical diagnosis and the patient’s most characteristic Sx’s.

Lippe was described as one of the best diagnosticians who ever lived and it translated to his incredible success. He was able to treat and cure patients with amazing rapidity, esp. during times of epidemics, because of his amazing ability to understand the disease state before him. Upon entering a home, he’d observe whether or not the windows were open or closed, the room dark or unlit, the amount of covers and clothes being used by the patient, were they on or off, the presence or absence of a glass by the bedside table, with ice or without ice, just a sip missing or the glass empty, etc. He did far more in curing fever by just diagnosing the pulse than a generation of MD’s have by using their thermometers and blood tests.

Jack, when you discussed the endocarditis patient from the TV show, you said that “three days that went by without a Dx was an opportune time for the on-staff homeopaths to take the case possibly return the patient to health…Treatment even without a diagnosis.” We now know that your latter statement is untrue. The on-staff homeopaths had to successfully diagnose the disease state first in order to have been able to prescribe successfully. Andrea, you asked, "How does a homeopath who considers themselves a diagnostician have the edge on someone who doesn't?" With our new found understanding of diagnosis, we can correctly rephrase your question to: “How does a homeopath with greater diagnostic skills have the edge over someone with less?”

To understand this from a practical standpoint, let’s have a look at a few clinical cases where the diagnosis was essential in procuring the cure:

Case #1
This is a well-known story that you may have already heard. A patient saw many homeopaths for the complaint of sticking pains, like a splinter, in the throat (I think it was, or rectum). None could cure the patient. The patient finally went to a homeopath that actually looked in the throat and removed a splinter. It took one homeopath out of many to properly diagnose what needed to be cured.

Case #2
A patient complains of tiredness who is then asked by a well-known homeopath to get a blood test. It reveals low calcium, low albumin and low iron. (See if you can come up with the diagnosis. I had no idea.) He also complains of insomnia with hunger at night that wakes him. He is treated and responds well to the Rx improving up to 80% upon each dose; but he continually relapses to 60% and gets no better than 80%. This pattern continues for months. The hunger at night and insomnia improve but the calcium, albumin and iron counts remain low. The homeopath then asks the patient to get a thorough check up from his MD but again nothing is revealed and the diagnosis is indeterminate. (Any ideas? Still nada for me.) The homeopath then asks him to get a stool guaiac test (I didn’t know about this test) to test for occult blood in the feces (I wouldn’t have thought to check for occult blood). The results were negative and again indeterminate. (Btw, the guaiac test would only explain the low iron, not the low calcium or albumin.) The homeopath then tells the patient to go get a referral from his MD to see a gastroenterologist. The MD refuses. The homeopath tells the patient to go back and tell the MD that he won’t leave his office until he gets his referral. He gets the referral and the gastroenterologist also performs a guaiac test and a sigmoscopy without any revealing results. He then performs an endoscopy and finds sclerosis of the ileus. A biopsy is done and it’s revealed that he has…(any ideas?)

…a wheat allergy, i.e. celiac disease (which usually goes undetected, for 50% of people).

So his disease state was caused by a genetic condition, i.e. so far as the theory went back in 1996 when the case was being discussed, he lacked the enzyme for wheat and so the wheat was causing irritation and inflammation in the ileum to the point where the affected part became sclerotic and caused the malabsorption of certain nutrients. The diagnosis of celiac disease then was essential in allowing the homeopath to understand the primary cause of disease as the primary cause of disease in this case was not an untunement of the vital force, but a genetic abnormality. The patient then did not need a homeopathic Rx, the Rx he needed was to simply stop wheat. Within 3-4 days of eliminating wheat from his diet, he was 50% better.

Case #3
William Ellwood treated a patient for asthma. He gave a physical exam including a stethoscope to check airways. The patient always improved but only to a certain point before relapsing again. This continued for some months before William suspected another cause. The patient went to his GP and was sent for x-ray where it was revealed that he had lung cancer. Now treatment had to be altered to suit the disease and it’s evident that the diagnosis was very important in this case, esp. important was William’s ability to diagnose that something else was at play as the patient should’ve improved given his presenting Sx’s and William’s confidence in his choice of Rx. (Thanks for the story, Nick.)

In all of these cases, diagnosing was essential in helping find the right Rx. It gave “the edge” to these homeopaths as the cures would not have been possible without them, i.e. we cannot cure what we don’t understand or have knowledge of. Greater diagnostic skills allowed the homeopaths in Cases 1 & 2 to diagnose that they were not cases for homeopathy, i.e. the primary cause of disease was not dynamic. In Case 3, William was able to diagnose that an altogether different pathology was limiting the cure of the "asthma".

If we have a clear diagnosis, i.e. we clearly perceive what is to be cured, and know what is curative in medicines, then the road to cure is clearer. If we don’t clearly have an understanding of what’s happening in our patients, then improvement may be limited and temporary as shown in the above examples and both the patient’s time and homeopath’s time is also wasted. Diagnosis is not just about a physical examination, a biopsy, an x-ray, an MRI, a CAT scan or stool guaiac test…it's the observation of the language of nature in the sick, the altered feelings and functions, i.e. any deviation from the average state of health of a person. It’s our bread and butter and job requirement, and I hope that I’ve been able to give you a different perspective on the value of diagnosis.

Please, folks, if you’re reading this…chime in. Say anything. This discussion is so important and fundamental to each of us that it behooves all of us to have a thought or comment and not share it. This forum was created for us to have a place to discuss our love...to talk with other pros in a profession where we are otherwise wizards silently holed up in the tops of our lonesome turrets. Let’s chat it up and have some fun while learning...it's why this forum is here. So...we now have a good start into understanding diagnosis and it should be helping us to start formulating an opinion on how important diagnosis is.

Cheers until the next part...

And btw, Caroll Ann...I love your new avatar! Very nice!

Veterinary department Equine Colic. By H. Fischer. (The Homeopathic Recorder, 1889, No 2)

"The more one sees the more one learns of anatomical relations; and the better one learns to recognize and diagnose diseases, the easier will his practice become."

"We note that Hahnemann was criticized for "laying stress on securing the history of the patient." This is the only truly logical course of making a thorough diagnosis."

Hom. Rec., 1923, June, Vol. XXXVIII. A Critical Examination of Homoeopathy (A. Pulford)

Okay, Glen, you asked for it. As with any philosophical discussion, semantics plays a huge role. I am grateful to have a better understanding of where you are coming from in your use of the words "diagnosis" and "allopathic" ( I do know this is H's word but we have come to use it colloquially to mean conventional medicine and I tend to be a colloquial speaker/writer to keep things simple for conveying meaning).
And I should know by now that you are more literal than I am, Glen.

I hear you on the diagnosis...I completely agree. The word has been co-opted in the modern sense and certainly has a connotation other than the one we would use for our purposes as homeopaths. I love your dissertation on this and will retain it for my own reference. As well, I like to re-insert words that have been stolen or distorted back into everyday speech.

I babble more than you do, Glen, so don't take offense to what I use in my everyday speech, please. I am a straight talker. Nothing we talk about here is useless and I am didn't mean to imply that. You will learn my ways, eventually

I think the thing I want to zero in on here is the last thing you posted about "securing the history". I couldn't agree more on this point, in a couple of ways. To connect it with diagnosis seems a no-brainer but isn't it funny how when a medical doctor takes a history, or 5 minutes of one, the goal is one of diagnosis in their sense i.e. coming up with a category of disease, or battery of further testing, which looks like everyone else with that same collection of symptoms. Just barely touching the surface.

Second point: it dawns on me here that I have never considered my case-taking as diagnostic. That strikes me as funny now that I am truly thinking about this! We are painstaking in our case-taking and case analysis, truly, like no other profession. Of course this is diagnostic! We are looking for disease, altered feeling and function, homeostatic disturbance . The difference is that we work with "what is", the nature of the organism and are not out to further alter feeling and function, as in allopathic methods. I haven't given what we do with taking a case this kind of semantic though. In practice, it makes sense as this is where induction rests, eh? With our casetaking.

Allopathy is just a word Hahnemann used to describe a method of prescribing, not a method of practice, and I keep forgetting that too.

So, I suppose the conclusion here is that yes, indeed, we do need more path, phys exam, anatomy/physiology training. We do need to be unafraid to be as thorough with all of our tools as possible. We need to trust what we know and what we observe in our patients. We need to know when to tell a patient we want them to check with their doctor.

Do we need more education? Probably. Clinical education, for sure. We have really ramped it up here at TSHM but it still won't be enough.

Okay, back to work. I will think about this more. I am just babbling (yes, Glen, I babble more than you do! At least you think about what you say before you write it down...I think and write at the same time, like a conversation).

Andrea

Andrea, you know I’m always asking for it! That’s why I write so much. This is why the forum’s here…to yak it up and that’s why I’m always asking people to yak more!

And don’t worry…I never took offense to your words. I rarely take offense and if I ever do, I try and allow that knee-jerk conditioned behavioural reaction of mine to pass before I respond (just as I had to do when writing on that CBC article, esp. after being called a “scammer”). I try not to take offense because there’s no place for ego in medicine. I only brought up what you said because I wanted you to see that you were missing the point of my previous post. I think when we're at work, we sometimes read posts too quickly without reflecting on what we read and then rather than focus on what's there, we only see what were looking for. Joe spoke about this in his homeopathic thinking tools, i.e. foreground/background. If we're only looking for a quarter on the ground, then we're likely gonna miss a whole lot of what's in the background. But that said…let's continue speaking and babbling directly. I appreciate you speaking directly because I think it makes for better conversation rather than being too diplomatic and compromising what we really want to say.

Now about speaking colloquially or literally…we’re medical practitioners…scientists…we experiment in our labs daily to confirm the Law of Similars. It's demanded that we be literal and exact. In the sense that you're “speaking colloquially”, the true meaning of the word is altered and as a result mistakes are made with real consequences. Have a look at this to see what I mean, you said:

“I do know [allopathy] is H's word but we have come to use it colloquially to mean conventional medicine.”

…pure and simple, the “colloquial” use of allopathy, though commonly used, is wrong. Now let’s change the word “allopathy” to “homeopathy” and see what happens:

“I do know “homeopathy” is H's word but we have come to use it colloquially to mean any type of prescribing that uses homeopathically prepared Rx’s.”

You see the slippery slope that happens? This is how pseudo-homeopaths have been "speaking colloquially" and justifying their deviations from Hahnemann for centuries and still today. Sankaran, Scholten, Scherr, Dr. Aconite, Dr. Swan (tissue Rx’s), some students at TSHM, OHA, CCNM...the list goes on. How many others have used misused the word homeopathy and gone on to deviate from its principles? According to that world congress of homeopaths in 2007, about 90% of modern practitioners. As we haven't been semantic enough in the history of homeopathy, the climb back is a steep one as we see now with the current state of our education and success of practitioners. I hope you can now see why we need to exact and unambiguous in our language.


re: “…it dawns on me here that I have never considered my case-taking as diagnostic. That strikes me as funny now that I am truly thinking about this!”

And it should! Doesn't it also disturb you a whole lot? What does it say about the quality of our education when we've never realized that we were diagnosticians ourselves? I never knew that I was diagnosing until I heard Andre say it 2 years ago. Up to that point, I had been studying and practicing homeopathy for 6 years and I didn’t even know what it was that I was doing! Andrea, you’ve been graduated for a few years now, practicing for a few years now and you’re the administrator and face of a homeopathic school and you, too, didn’t realize that you were diagnosing till this week! Isn’t this a little unsettling? The old Hahnemannians must be rolling and groaning in their graves knowing that we didn't even know we're diagnosticians.

As you said, “we do need more path, phys exam, anatomy/physiology training.” When you ask, “Do we need more education?” I think the fact that we don't even understand thoroughly what we're doing in our profession should compel us to change your answer from "Probably" to “Without a doubt.” We have a long way to go. (And, btw, it's great to see that TSHM is in good hands like yours and the profs to put it on the right course.)

Points taken Glen.

Andrea

From Carol Ann:

Dr. Veronika Zhmurko on diagnosing:

“As a MD, I take a case a little differently with the focus on physical examination in order to determine and localize pathology.”
“I found that it is very important to understand actual medical diagnosis in addition to just gathering totality of sx. In my opinion, Homeopaths need to be able to differentiate between sx of disease and sx of the patient. All old masters actually were good in diagnosis in additional knowledge of MM. They recognized disease during examination and by knowing common sx, particular ds is could find peculiarity. They all emphasized that disease not important, but peculiarity is important. I found it useful in practice.”

Hey, All,

So as we’ve established that diagnosis is fundamental to what we do, I think it would now be good for us to identify when it is that we diagnose specifically.

In previous posts, Joe gave his view point on the subject and I added what I’ve learned so far. If we combine both posts, there’s a total of 7 clinically applicable diagnostic situations (and perhaps more).

I was going to post the 7 points here now but I decided to do it in a separate post following this one because I’d like to first ask you to challenge yourself and see how many of the 7 points you can identify. Why? Deliberate practice.

From the article, Expertise - The Making of an Expert, (let me know if you want a copy): “You need a particular kind of practice -- deliberate practice -- to develop expertise. When most people practice, they focus on the things they already know how to do. Deliberate practice is different. It entails considerable, specific, and sustained efforts to do something you can't do well -- or even at all. Research across domains shows that it is only by working at what you can't do that you turn into the expert you want to become.”

If we want to be expert homeopaths, then here’s a simple opportunity to do 5-10 min. of deliberate practice now or to mull over during the course of our day while we work. Deliberate practice activates and gives weight to the neural connections that hold info. (If you come up with any diagnostic situations not already mentioned, then please kindly share.) If we're unable to identify all the clinical diagnostic situations where we should be diagnosing, then we have to consider that some skills basic to being a homeopathic physician are not being taught and more importantly for us, we know that we need to learn them.

Cheers