Repertorisation is not only a mechanical process of counting rubrics and totalling marks obtained by a medicine, it also includes the logical steps to reach the repertory proper and finally differentiating the remedies with the help of Materia Medica. Repertory follows the logic of Induction & Deduction. The steps to repertorisation start from case taking and end by finding out simillimum. They are:-
1) Case taking.
2) Recording and interpretation.
3) Defining the problem.
4) Classifications and evaluation of symptoms.
5) Erecting totality.
6) Selection of repertory and repertorisation proper.
7) Repertorial result.
8) Analysis and prescription.
Dr. Kent once mentioned to his followers, ‘There are a lot of symptoms, but there is no case’. What is the case then? A case comprises of symptoms which, gives the totality of a person’s suffering. The totality of symptoms, forms a case for the physician. In every event there exists a totality provided an expert can perceive it; likewise, in every alteration of state of health a totality exists which can be perceived by a physician.
Case taking is the first step, and the outcome of treatment entirely depends upon the success of this first step. Any mistake committed here would certainly interfere in the selection of drugs and planning of the treatment.
A physician should be clear about his job in the beginning itself and must possess a clear understanding about the case. For Homoeopathic physician, expressions at all levels, mental, physical, general and particular, are required to individualize the person as well as to diagnose the condition. If this is clear in the beginning, case taking will be on the right lines.
It is a unique art of getting into conversation, of serving and collecting data from patient as well as from the bystanders to define the patient as a person and disease. The purpose is to understand both the person and the disease. This particular method and approach is different from other systems of medicine
There has been much discussion on case taking by many stalwarts and this subject has been dealt-with at length but still many make mistakes while applying this art in practice. This being an art, the individual skill plays an important role in applying the rules of case taking. It is difficult to apply a uniform standard in all the cases and in respect of all physicians.
In case taking, physician applies his ability and skills of communication keeping in view his objective. As case taking is individualized in approach, there are several suggestions offered and numerous models of case taking forms are available to the practitioners. Some are in the form of questionnaires, some in the form of multiple choice questions, and so on. Dr Dhawale has devised a Standardized Case Record which has a fixed form, structure and function. It can be most useful to the profession if used properly.
Dr Hahnemann has described the necessary guidelines which should be taken into consideration while taking a case, in aphorisms 83-104 of Organon of Medicine. Throughout the process of case taking, the patient should be cooperative. He should be assured of the confidentiality of data. If patient narrates well and fully, the task becomes easier for the physician. Apart from the collection of data, case taking has got its own therapeutic value in certain type of cases, if not all.
Personal experience in certain cases has convinced the author about the therapeutic value of it. Many patients ventilate certain experiences unexpressed for years which keep on disturbing them and giving rise to very many physical and mental symptoms. Very often after the case taking, the patient says, “Doctor, I feel much relieved after talking to you”, and then a simillimum completes its job. It should be a free exchange between the patient and the physician. Both verbal and non-verbal communication of the physician can either encourage or discourage the patient in opening up various events and their effects on him.
It is a very delicate, yet dynamic situation, where the physician should remain attentive so that disclosures are properly received. Physician should be aware of is own problems of communication to gain more from this highly dynamic process. In some cases, even if one thread is missed, arriving at the totality would become difficult. Nothing else should keep the physician occupied other than the case taking. To understand the feelings properly, a physician should be expert in role playing.
He should acknowledge the feelings of the patient, but empathy should replace sympathy while dealing with sensitive cases. At the end of the interview with the patient, physician should have a clear definition of the problem. This is not always easy to achieve. If physician remains in confusion at the level of case taking, further steps in repertorisation would become intractable. A shaky foundation would certainly mar even the best of the superstructure.