ARTICLE may not be too impatient with us in realising their agenda - of wanting to be better by yesterday . These professional performance pressures combined with astute business issues may well distract us from our best efforts , as we may frequently wobble , improvise and grope for direction as we assist our patient along their journey of a return to good health .
Attitude Formation
Assuming that you have already selected the simillimum medicine , let us start this quest for the optimum potency and dose regimen by first individualising some qualities about the patient before us . This is done by making an assessment informed by the subjective intuition that comes from clinical practice - the artistic aspect of practising medicine - about each of the following six points .
1 . How vital is this patient ? Observation is the first essential skill in examining a patient , from the sparkle in their eyes and the stride in their step , through to taking their vital signs , as all these help you assess their vitality . The higher their vitality , the more liberal your potency and dose regimen choices may be .
2 . To what degree , and on which plane , 5 is the patient ’ s suffering mostly biased ? Chronic and acute prescribing are managed differently , as complex psychiatric conditions are likely to require a different potency and dose regimen than simple physical trauma cases . The more chronic the problem and the more centrally the disease is biased , the more liberal your potency and dose regimen choices are likely to need to be .
3 . How robust is the patient ? Age , body size and sensitivity differences will cause considerable variations among patients ’ potential responses to potencies and dose regimens . The more robust the patient , the more liberal your potency and dose regimen choices can probably be .
4 . How complicated are the obstacles to cure , and any other maintaining factors , from the relative simplicity of problematic diet and lifestyle choices , through to iatrogenesis arising from complications caused by compliance with pharmaceutical procedures . Composing a timeline of past neverwell-since scenarios will reveal the hierarchical and sequential nature of how the Direction of Cure will be seen to unfold . The more obstacles to cure and maintaining factors there are , the more liberal your potency and dose regimen may need to be .
5 How confident are you about the medicine that you have selected as the simillimum ? Humility derived from past errors hopefully chastens the overconfident prescriber , inspiring increased prudence . Genuine confidence can be matched to a more liberal potency and dose regimen .
6 What idiosyncrasies are there about this chosen medicine ? Factors ranging from the differences in the noted potential duration of action 6 to the implications invoked by the use of medicines from different kingdoms 7 all make a difference to how liberal your potency and dose regimen can or cannot be . For example , Silica and Hepar both have the reputation of potentially expelling ( or resorbing ) foreign objects at different potencies , which could be heaven , or hell . Sulphur has the reputation of being the most potentially dangerous medicine in our Materia Medica due to its centrifugal action in discharging retained bodily wastes . Having favourite and unfavourite medicines ( and potencies ) is unfortunately a common trap in practice .
For simplicity , your summative and concluding position on an individualised application to your patient ’ s full prescription , derived from the above analysis of their qualities , could be reduced to one of three : Conservative , Moderate or Liberal . Clearly , a spectrum of hybrids of these three primary attitude options is always possible , from Extremely Conservative , through Moderately Conservative , to Moderately Liberal , and finally to Extremely Liberal .
Application of Attitude
Once you have determined , on the basis of your practised art , the ideal individualised attitude you will take , let ’ s briefly review the six potency and dose options that are now available for its application .
1 . Which potency scale ? Quinquaginta millesimal ( Q or LM ); Centesimal ( C ); Decimal ( X or D ).
2 . Where within this scale shall I begin ? At or near the beginning ; somewhere around the middle ; at or near the end ?
3 . How shall I have the patient dispense their medicine to themself ? By olfaction 8 ( sniff the medicine ); by taking some liquid ( drops , sprays , teaspoonfuls ) into their mouth ; by taking some solids ( pillules , granules , globules , powders ) into their mouth ? Maybe even by rubbing the medicine ( creams , ointments , lotions , soaps ) onto their skin ?
4 . How many doses should the patient take ? One dose once ; once daily for a few days only ; a good number of doses per day for a good number of days ?
5 . If more than one dose is to be taken of a liquid medicine , how many succussions of the medicine bottle would be recommended before the next dose is taken ? Perhaps 2 succussions ; maybe 5 succussions ; possibly 10 succussions , or even none ( if it is a solid medicine )?
6 . What would be the optimum time interval before the next health review for patient feedback ? Later on that same first day of dosing ; in a few days after the last dose ; in a few weeks , or even months ?
JATMS | Autumn 2021 | 15