Demonstration of Application of Case Taking techniques in Clinic, Ward, Community

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Demonstration of Application of Case Taking
techniques in Clinic, Ward, Community

• Dr. Shivaprasad K
• Professor and H.OD.
• Organon of Medicine and Homoeopathic Philosophy

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Demonstration Interpretation of Actions in
Clinic
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CASE TAKING 83-104

• Freedom from Prejudice 83
• ( Unprejudiced
  Observer )
• Sound Senses
• Attention in Observing
• Fidelity in tracing the picture of the disease

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CASE TAKING

• 84
• History of Suffering
• Opinion of People around him
• Physicians observations
• Without interruption Slowly F.N 81

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CASE TAKING

• Line by Line 85
• Precise Information questioning 86
• No leading questions 87 F.N. 82
• Dispositions of the mind 88.
• Special questions 89 F.N.83, 84
• Self observations 90 F.N.85
• Original unmodified picture Placebo 91
• Conjoint Malady 92
• Obvious cause 93 F.N.86
• Life style / Maintaining Cause 94 Female cases
  F.N.87

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CASE TAKING

• Lesser Accessory Symptoms 95
• Hypochondriacs 96 F.N.88
• Indolent patient 97
• Patients own expressions Special
  circumspection, tact, knowledge of Human nature,
  caution in conducting inquiry and patience in an
  eminent degree. 98
• Acute diseases fresh in memory Spontaneously
  detailed 99
• Case Taking in Epidemic and Sporadic Diseases
• 
  100,101,102 F.N.89 103
• Recording - disease accurately sketched 104
  F.N.90

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CASE TAKING

• How to apply Case Taking Techniques
• in
• Clinic, Ward and Community

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CASE TAKING

• Effective Case Taking Demands Disciplined,
  Well Planned Method
• An Observer present when the Case Taking Process
  is going on helps the Physician to realize his
  prejudices and make necessary changes in his
  approach so that the Patient as well as the
  Physician is benefited the most

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CASE TAKING OBSERVER THE ROLE

• OBSERVER IS AN EFFECTIVE LEARNING CIRCUMSTANCE
• KEY FACTOR IN EDUCATION AND TRAINING
• BECOMES AWARE OF PREJUDICES
• BRINGS NEARER TO UNPREJUDICED OBSERVER

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OBSERVER FUNCTIONS

• FORMULATE PROBLEM DEFINITION / PROBLEM RESOLUTION
  / INTERVIEW PLAN WITH THE CASE HISTORY
• BE SILENT . OBSERVE THE PROCEEDINGS
• AVOID UNNECESSARY MOVEMENTS OR EYE-TO-EYE CONTACT
• HAVE PLAIN PAPER SHEETS TO MAINTAIN TRANSACTION
  RECORD

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• RECORD / DOCUMENT THE COMMUNICATION BETWEEN
  PATIENT AND PHYSICIAN
• VERBAL INTERACTIONS AS WELL AS NON-VERBAL
  EXPRESSIONS LIKE FACIAL EXPRESSIONS, GESTURES,
  BODY MOVEMENTS, PERIODS OF SILENCE, ETC
• FIND OUT THE FACTORS THAT ALLOWED THE INTERVIEW
  TO DEVELOP
• SHOULD BE ABLE TO ANSWER QUESTIONS LIKE
  WHAT,HOW,WHEN AND WHY THE PHYSICIAN ASKED
  QUESTIONS AND THE PATIENT GAVE ANSWERS
• TRANSACTIONAL RECORD HELPS TO KNOW THE DYNAMICS
  OF THE CASE TAKING

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Environment Conducive to training of the Observer

• Trust
• Mutual love and respect
• Freedom of expression
• Discipline in action
• Absence of malice
• Earnest desire to improve self
• Respect Sensitivity to observations of others
• Absence of rigid, moralistic attitudes
• Mobility in role playing

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How to do Transactional Record

• Patients time of arrival, his appearance, dress,
  conduct in waiting room, people accompanying him
  etc..
• The time when the interview starts, initial
  greetings, initial reaction of the observer to
  the patient
• The opening question and the way it sets the tone
  of the entire interview
• The time spent in investigating different areas
• Various skills employed by the Physician during
  the main body of the interview

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How to do Transactional Record

• Relationship developing between patient and
  physician
• A special note of facial expressions, gestures,
  body movements, slips of the tongue, periods of
  silence, periods of free ventilation etc.
• The observers own internal states thinking,
  feeling at the appropriate place where they have
  been experienced
• Concluding question or answer with the manner of
  conclusion e.g. abrupt, gradual etc.
• Time taken for the entire transaction

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TRANSACTIONAL RECORD ANALYSIS

• TURMOIL OF EMOTIONS, ATTITUDES AND VALUES
• UNDERSTANDING OF TOTALITY EXPERIENCE OF PATIENT,
  PHYSICIAN, OBSERVER
• TRANSACTIONAL RECORD ANALYSIS GIVES PHYSICIAN
  OPPORTUNITY TO REEXPERIENCE THE INTERVIEW
• AT THE END OF THE ANALYSIS, PHYSICIAN DISCOVERS
  HIMSELF AND HIS PREJUDICES
• HE BECOMES UNPREJUDICED OBSERVER

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Operation Heal thyself

• Feedback
• Insight Pain/Pleasure
• Action Plan for purposeful modification
• Implementation
• Overcoming internal blocks to change
• Willingness to seek help

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Emotions weathered thru during training

• Admiration
• Contempt
• Impatience
• Helplessness
• Low self esteem

• Anger
• Sympathy
• Anxiety
• Happiness
• Sadness

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TRANSACTIONAL RECORD ANALYSIS