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Prescribing Online – A Perspective

Prescribing Online – A Perspective

Prescribing online over the last 3 years has been a very exciting experience for me. I’m a mother of 3 children (5.5, 3.5 and 1 yrs) which makes having a regular practice near impossible. And with my husband constantly being transferred in his Job, I restarted and discontinued my private practice 3 times over the last 12 years!! I had to send my patients away to my homeopathic colleagues for continued treatment which was demoralizing for them as well as for me.

Then, I had the opportunity to keep in touch with my subject (homeopathy) online through two bulletin boards. That is how David Johnson and I met and worked on a few cases, which resulted in us starting the internet practice together, working as a team.

It was a learning experience the first year, where we were seeking to obtain a precise and complete history from our patients in order to make accurate prescriptions right from the first prescription onwards. Then, began the careful monitoring of each case as we were keen to avoid keeping people on un-indicated remedies for a long period of time as well as provide them early relief. We realized how much empathy as well as intuition played a part, not only in remedy choice but in case management as well, particularly in difficult cases that required both an understanding of the pathological process, and a miasmatic interpretation of what was happening.

Below are a few pointers I’d like to share with young homeopaths interested in practicing online.I think any responsible homeopath would strive to work at these as they form the basis of an Internet practice, without which it could be a serious mistake to take on people online for chronic treatment.

1. The Organon of Medicine by Dr. Samuel Hahnemann details in Para 3 – 6 the qualities that are expected of any homeopathic practitioner re: knowledge of what is disease, knowledge of the remedies, knowing what is to be cured, obtaining a good history to form a “portrait of disease” and practicing with an unprejudiced mind.

For practicing online, this strong knowledge base has to be supported by adequate experience in clinical practice of following patients for at least 5 years. It allows for patient confidence in homeopathy as well as in the homeopath, when the patient realises that we understand what we are doing. It helps us to deal with difficult clinical situations where decisions of posology and management have to be made.

2. Always strive to take a complete and detailed history before making a prescription. It concerns me that I am putting my patient on a remedy that could affect his health for the long term. So, adequate maturity and responsibility has to be attached to a remedy suggestion. A detailed questionnaire suited to ones approach and understanding of homeopathic practice is hence the first step to obtaining this history. Due to wide differences in styles and methods of analysis, someone else’s questionnaire is not the answer – its best to frame your own!
I have found that getting to the right remedy at the beginning will afford less work later on – and if one has a talent for that, I thank God for it!! For online cases the physician needs a great deal of insight, empathy and intuition to understand what the written word of the patient seeks to convey. We do not have the luxury of facial expressions, hand gestures or observing the pathology.

3. Strive to keep complete records of the patients’ history as well as follow ups. My experience is that follow-ups need to be regular one a week or once a fortnight.This allows for a deeper understanding of the case, accurate analysisof the sequence of events – of symptoms as well as of remedy’s prescribed –  in order to clearly perceivewhether the patient is moving towards cure, based on Hering’s ‘Nature’s Law of cure’ and  Miasmatic interpretations. Suppressionsand temporary palliations then can be clearly observedby the trained eye both in acute cases as well as chronic conditions. At no point can one be complacent about ones choice of remedy, however confident one is of that choice.
But if we wish to professionally take on a person’s life online, we need to be diligent about our commitment to their welfare.

4. In all serious, deep cases (not life threatening) it is very helpful that the patient has a regular family physician giving a diagnosis of the condition, an unprejudiced objective assessment of clinical signs, and do relevant laboratory investigations that help us to make ‘clinical’ judgments of the progress of the case. Remember, subjective expressions of the patient are not always dependable and something superficial may look terrible to a lay person but in reality may be a harmless progression with deep internal improvement.

Now that I have detailed the important requirements, let me talk about some of the “fun” aspects we experienced in our internet practice. Choosing an appropriate remedy (or series of remedies), ‘seeing’ the case move in the right direction according to the Law of Cure, and finally observing the patient in a balanced state of health in every aspect of his life, is what the ‘fun” is all about!

One of our first cases was a young man of 28 who was prescribed Thuja based on the most relevant characteristic physical symptoms and his state of mind – which resulted in him being unable to be in a stable relationship, unable to complete his studies to qualify and so unable to find a job. He was dependant on his parents’ financial support. His physical symptoms were clearly in a sycotic expression – recurrent purulent conjunctival inflammation with chronic swelling of lower lid conjunctiva (Basically diagnosed as Allergic Follicular Conjunctivitis). Similarly his mental sate reflected this sycotic expression typical of Thuja. He had taken so much of suppressive allopathic medicines (anti-inflammatory, antibiotics, steroids in eye drops, nasal sprays, oral pills, etc), that they had given up promising him any improvement as now even steroid eye drops were not working anymore.

He also had a history of eczema from childhood which had been suppressed with steroids, but recurrently flared up on his thighs, legs and arms. He had a host of other associated complaints (headaches, Marfanoid syndrome, allergic rhinitis, occasional episodes of asthma), besides being very sensitive to homeopathic remedies – which I believe was directly a result of suppressive treatment. He would aggravate even on 1 drop of Thuja in LM, second dilution, for 3-4 days before he would see improvement.

IT took 6 months for him to show clear response to the remedy though it was evident that Thuja was working with old suppressed symptoms expressing themselves. This is because he continued to use antibiotics or suppressive medications during acute flare ups – as he couldn’t bear people to look at him and think he was deformed! So we just had to be patient with him till he decided to stop them.  But even after that, he continued to believe that he needed at least supplementary therapy to help with his healing. He would browse the internet and buy supplements like flaxseed oil, enzymes, etc. and whenever there was clear improvement he would attribute it to these supplements and not the remedy!! It took a lot of work to educate him and convince him about capability of the homeopathic remedy to cure him.

Finally he accepted that it did, and began to stop all the supplements when he realized that his symptoms showed no improvement when he took them. Instead they produced new symptoms of their own!

After a year and a half on Thuja repeated very infrequently, a deeper state surfaced, which existed before but was not so clear in his initial history. His eye improved about 90% with mild inflammations and redness that disappeared in a few hours but his eczema increased during that period and the flare up would not subside. He developed different fears of the dark and being alone, more similar to his childhood and on repertorizing the present symptoms – physical as well as mental, Calcarea sulph was the remedy.

Here we can see that he had moved from the stuck sycotic state into a psoric state and the skin symptoms were typical of Sulphur. He had Calcarea sulph over the next 6 months infrequently and the eczema completely disappeared. The eye redness only came up very occasionally when he was stressed out with work (mainly in front of a computer screen). All his other associated complaints improved as well and hardly troubled him anymore. His mental state improved so much that he was now able to complete his training, be in a stable relationship and work in a stable job, which he was unable to do for the last 5 years.

He is still on very occasional doses of Calcarea sulph 30C (once in 3 months or so) if the eye redness or eczema express themselves and do not subside on their own when he’s under stress. And as you can imagine he’s very grateful to homeopathy saving his life!

I presented this case for a variety of reasons as it exemplifies how important it is to keep in touch with the progress of ones online patient, especially in these types of cases. There is only so much they can tell you in a follow up and a lot may be left unsaid, that one only discovers due to regular updates:

1. His excessive sensitivity to remedies would have made us give up on Thuja thinking it was the incorrect remedy earlier on. But subtle changes in symptoms in line with Hering’s ‘Natures Law of Cure’ inspite of his suppressive intervention were evident to me, and made me persist with it.

2. It helped me to realize how many suppressive treatments he continued to use with the homeopathy as well the supplements he was depending on. It allowed me an opportunity to educate him on how each of these drugs and supplements were contributing to his condition instead of helping and were also interfering with the action of the similimum remedy.

3. The updates gave him encouragement to stick with homeopathy as that was his only hope at this point – and he trusted my instinct. At the point of his life when he was very depressed and thought there was nothing going for him in his education, work and relationships – regular updates helped him to see a ray of hope that he would one day be well.  I consider this all very important in the management of a chronic homeopathic case of this type. Just the remedy and manipulation of the doses alone could not do this. At the most he would have been totally frustrated and given up on this remedy as it continued to aggravate his symptoms, and he would have insisted on continuing his suppressive medications.

4. Making a choice of remedy is not necessarily difficult in chronic cases even if suppressive medications are going on. Having the perception and capability to analyze the mental state of the patient to decide on remedy selection helps overcome the possibility of physical modalities and concomitants of the chief complaint being masked.
Assessment of the case though, requires a little more insight than just knowing homeopathic principles of remedy response. Understanding the action of allopathic remedies and experience of knowing their palliative effects as well as suppressive pathological long term effects in clinical situations, allows the trained eye to sift out symptoms and deviations in the progress of the case that are not from the homeopathic remedy. This is where an experience of the present clinical status of disease in our clinics and hospitals (here I mainly include those of modern medicine) proves to be of immense help in case management.

We have had any number of cases like this including those that just needed a single remedy to cure them. Some complicated cases, some simple cases, a mix of everything to make life very interesting! The case analyses and remedy choices were exciting (thanks to David Johnson’s deep perception), and the management was fun. I have met beautiful people the world over. It has been a wonderful learning process and I can say I have grown as a person and as a homeopath to feel fulfilled that I am learning and moving towards the calling God has set for me for my life.

About the author

Leela D'Souza

Leela D'Souza

Leela D'Souza-Francisco, MD (Hom), CIH (Cardiology) is a Mumbai-based homeopathic professional whose experience includes intensive graduate medical training at India's leading homeopathic medical institution in Mumbai, completed in 1990. She completed her MD (Hom) from MUHS, Nashik in 2008 with a Dissertation entitled "Emergency Management in Homeopathy". She obtained a post graduate MSc (Homeopathy) degree from UCLAN, UK in 2009 with a Dissertation entitled "How Can We Develop Suitable Clinical Trials for Research in Classical Homeopathy". Her present interests include management of in-patients in homeopathic hospitals, and clinical research in classical homeopathy. She has been in practice for over 20 years and is online at www.homeopathy2health.com for the last 15 years. Presently she is Consulting Homeopathic Physician, with specialization in Cardiology at Holy Family Hospital, Bandra, Mumbai.
Visit Dr. Leela D'Souza at her website : http://www.homeopathy2health.com/member.htm
and contact her at: [email protected]

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