Why long-term follow-ups?

Intro to long-term contacts with patients

The following discussion will probably only make sense to other homeopaths. If you a not a homeopath, and are curious about the professional technical concerns of homeopaths, keep reading and feel free to comment.

In-depth interviewing

In-depth interviewing provides very important information about our remedies.  Information about remedies is not only from testing (proving).  When remedies have clear evidence of long-term curative value,  they give us information that we could not find from testing.   Information from poisonings and the medical or herbal history of the substance of the remedy are among the important other sources of information.  Aside from testing data, the most informative source of information is the clinical history of remedy use.  Because we use sources other than testing data, there are many common remedy conditions of patients that are not found in our testing database. 

Why a complex database?

In general, symptoms are collected under one heading (a rubric), but the meaning for each individual remedy within that rubric may vary widely.  Of course, looking up a symptom in this dictionary-like database is only a first step, so homeopaths are trained to research the specific meanings of each individual rubric.  That is, if they do not already know the differences between those remedies, they have learned methods to compare the remedies in a rubric.  The much more narrow reason for superficial descriptions of remedies concerns criterion for selecting symptoms worthy of inclusion in the repertory has changed with computerized databases.

Superficial interviewing

But the other problem of these generalized rubrics is deeper.  To many homeopaths, many of the social, psychological and even physical conditions of the patient are considered insignificant or even non-medical.  In fact, for practical purposes, the amount of information needed to find a curative remedy is usually much less than an excellent in-depth description of a case. However, this repertory-based need for such generalized rubrics is a problem in some difficult cases. Furthermore, full descriptions of remedies are also artificially limited by the efficiency needs of practical clinical homeopathy.

Why fuller descriptions  

Why would fuller descriptions of remedies be useful?  Below I will describe only one use, but note that there are many other uses for full descriptions of remedies.  

Non-pathological stress

Occasionally, I have patients who lead healthy lives. They have a distressing problem, and when I talk to them in depth, their lives are filled with stress.  This stress is part of who they are, but it is not pathological in a medical sense.  In these cases, I am often helped by knowing the non-medical circumstances of remedies that are particularly evident information based on in-depth case taking.  Even if the problem is clearly medical, the non-pathological descriptions are important to find a curative remedy, but in cases of clear pathology, at least I will find many symptoms our literature. I am less likely get help from our traditional database when the patient is leading a healthy lifestyle and his symptoms are distressing, but not pathological. But, the problem is that even the most common remedies are not described in the detail that I discover when talking with patients.  Because I spent the time and effort to understand patients in some depth, I know many factors that are not symptoms found in the repertory or even in the traditional clinical literature.  So, how are these deeper, but often non-pathological symptoms related to why long-term follow up is so important from a homeopaths perspective?

Valuable results from in-depth interviewing

As my answer to this question, let me start with my conclusion: When I know that a remedy worked over the long term, and I am clear about the patient's conditions are based on an in-depth interview, I have reason to believe that even those non-pathological conditions can describe the curative remedy. This is a valuable result.

Mangialavori's answer

Massimo Mangialavori describes the philosophy behind in-depth interviewing and long-term follow-up in great detail.   (See https://www.mangialavori.eu/complessita/ for more information.) His clinical cases also illustrate the results of in-depth interviewing and long-term follow-up.  He is an expert at describing these results, so sometimes I use his work to solve my cases. I employ not only his interview style and way of studying cases, but also his descriptions of remedies and case studies are very helpful to find curative remedies.  Subtle social/psychological/physical conditions of the patient may not be completely reported in our literature, but for some cases, they are significant in understanding remedies and patients. Following this method, I am building more of an intuitive understanding than what is supported by more traditional methods.

Less explicit standards

A number of modern authors contribute nuanced clinical cases and analysis. My only caveat concerning such descriptions is "how long is the follow-up and how many cases have the homeopath seen that support this remedy description?"  I have followed these authors many years, so I intuitively trust their judgment.  I think that instinctively, good homeopaths evaluate cases results based on such criterion.  However, in general, the validity of cases would be much higher if editor and publishers automatically required 2-5 years of documented follow up. These criteria should be explicit.

Implementation

But, homeopathic record keeping can become as complex as accounting.  Unless the homeopath sets up his practice and his record management for long-term follow-up, the first step to this high ideal cannot be taken.

Use in difficult cases

Furthermore, I think that there could be great variation among homeopaths in such clinical descriptions.  So, in many more traditional schools of thought, such full descriptions do not carry the definitive weight of tested (proving) symptoms.  A lesser demand for information is of course quite practical in very straightforward cases.  Nevertheless, I have found that full descriptions serve as sufficient guideposts for difficult cases, especially where repertorization is not confirming even a small set of remedies, or the symptoms described by the patient are not fully covered in the repertorization or even in the traditional remedy descriptions.