Title: The Art of Follow Up
Author: Dr. Rajan Sankaran, MD
Published by: Homeopathic Medical Publishers, Mumbai, India
First Edition, 2018
172 pages, paperback, black and white
Reviewed by: Dr. Vatsala Sperling, MS, PhD, PDHom, CCH, RSHom
As I steep myself further into homeopathy, I find the idea quite convincing that for something as intangible and non-material like homeopathy to work, it has to be a scientifically performed work of art. Though the old masters like Kent, H. A. Roberts and George Vithoulkas have written volumes about what to look for in a follow up, it is refreshing to read Dr. Sankaran’s take on this subject. The very title of Dr. Sankaran’s latest book “The Art of Follow Up” suggests that there is an art angle to the technique of follow up.
A follow up cannot simply be a robotically executed heartless inquiry into the symptoms before and after the remedy, a soul-less review of checklist of symptoms that have gone away, improved, remained the same or gotten worse. In writing an introduction to Dr. Sankaran’s book, Bob Blair brings out his own experience of watching Dr. Sankaran conducting follow ups and assures the readers that the book contains pointers and insights that could be useful for follow up and case management in our daily practice. On reading the book further, I find that Bob Blair’s assurance is solid.
Dr. Sankaran’s book addresses simple questions like what to look for in a follow up, whether or not the patient requires the same remedy, how much time should be devoted to follow up and how frequently follow up should be done. The chapter on clinical possibilities in the follow up addresses a total of thirteen scenarios. An equal number of mini-chapters elaborate these scenarios in just a few paragraphs. Sixteen cases are used to illustrate these scenarios.
The chapter on clinical possibilities in acute situations begins with five scenarios and again five cases are presented to show how a particular decision is made for further course of action.
Dr. Sankaran has deftly handled the ever-elusive question of potency and dosage and he has tied it neatly to the level of experience that he teaches as part of the Sensation Method. Using just one case, Dr. Sankaran has written about remedy relationship, complementary remedies, antidotes and cyclical remedy sequences.
The role of care-givers, family as well as friends, the value of their close day to day observation and feedback are highlighted in a chapter, and the case of a 19 year old girl with psychiatric problems is used as an example. This chapter is particularly useful for the practitioners who routinely see non-communicative patients brought in by the care-givers.
Referring the case to other practitioners is recommended if we find ourselves stuck in a particular point of view and our assessment of the patient is not yielding a remedy that makes any difference to the patient. There is no harm in tapping into the brilliance of our peers, mentors, teachers and even competitors, after all, if we hold on to the position that our practice is not about our ego, but about our patients and their access to successful treatment. Two cases clarify Dr. Sankaran’s take on this issue.
A tiny chapter on emotional adjustment is from Dr. P Sankaran, the author’s father. This chapter has a depth and philosophical quality that a father would use while teaching his child about how to make sense of ambition, efforts, imagination and the realities of life. It occurs to me that as each of us grow as human beings and acquire a certain depth and maturity in our life, our understanding of homeopathy and our practice, we will all reinvent the truth contained in this chapter and experience this truth as our own.
No matter how mature we become, chances are we will continue to encounter “complicated cases” that are heavily medicated and have deep pathologies. In this situation, Dr. Sankaran reminds us to be aware of the potentials and limitations of homeopathy as well as our remedies and he prompts us to keep the welfare of our patients in mind before we ask them to change, stop or reduce their medications.
With increasing global awareness about alternative healing modalities, homeopaths in the western countries routinely see patients who continue to consult with and follow advice from a big team of care-providers that might include traditional Chinese medicine and acupuncture, Ayurveda, chakra and kundalini healers, yoga instructors, psychotherapists, energy healers, spirit and dream counselors, chiropractors, osteopaths, naturopaths, nutrition advisors….and so on.
Besides visiting these healers on a regular basis, our patients also see their MD doctors regularly. It is possible that many of these practitioners are ok with homeopathy being in the picture as well, but the chances are that some of them might actively discourage our patients from using homeopathy. What is the place of a homeopath in this assembly of alternative health practitioners? As homeopaths, are we supposed to encourage the patients to use any modality they feel comfortable with? Or should we say to them, ‘Just stay with homeopathy.’
I am not alone in running into this situation with my patients and certainly other homeopaths share this same experience. As I mull over this subject, I find that Dr. Sankaran has kept his focus on alternative healing modalities like diet, lifestyle, music, art, sharing, meditation, mindfulness, and finally spiritual orientation.
From the perspective of homeopaths based in the US, where patients come to a homeopath and also visit 20 other alternative practitioners, I am very keen to learn what Dr. Sankaran has to say and how he would train us to clearly perceive and understand what our remedies are doing alongside the treatment protocols of other healing modalities that our patients are currently using. On page 161, Dr. Sankaran gives a brief hint, “Work with and as a team. Include all who are willing to help the patient get better.”
This little nugget of practical wisdom is really nice. In the end whatever modality and ‘pathy’ we happen to be practicing, it has to be for the patient – for his or her betterment and relief from suffering. It is not about us and what we are good at or not.
Ending the treatment is an issue that I think about frequently. Dr. Sankaran says that no patient is totally free of symptoms, both physically and mentally. Does it mean that patients sign in to our practice and remain with us for the rest of their lives? Practically, this is impossible and the chapter on end of treatment is where we can read about what to do and how and when to bring the treatment to a closure.
The most appealing aspect of this book, “The Art of Follow Up” is its slender physique, crispness of content, and its’ ability to get to a point in direct, brief and sharp manner. Dr. Sankaran has written in an engaging and succinct style. The illustrative cases spread across the book are to the point.
Note: the cases are not a literal and verbatim transcript of every Oh and Ah uttered by the patients during case taking that can sometimes go well over two hours. Dr. Sankaran has dived deep into the treasure trove of his cases, pulled out little gems, chiseled and polished them to remove all fluff and then presented them in a form and size that succeed in giving an example of the point he is trying to make.
These ultra-brief illustrative cases have added enormous practical value to this book and the reader can quickly learn why and how a decision is made during follow up. I have very much enjoyed reading this latest book by our beloved teacher and writer, Dr. Sankaran, and it is my hope that you will enjoy it too.