– BENERJEE.P,

Directions to the patient

Patients are almost always served with certain directions regarding diet and movements etc., and the object of these directions is always the same-namely facilitating the process of cure. In acute cases, the directions are almost automatically observed by all patients, because in course of their acute sufferings, the patients themselves grow to have an aversion to things that aggravate their sufferings, e. g., a patient suffering from fever, of himself and naturally avoids taking rice or a bath or an exposure to cold. There is, therefore, not much difficulty in respect of acute cases. But, such is however not the case with chronic patients. On account of their long courses of sufferings, the patients gradually cease to have very much of an immediate aggravation from non-observance of directions regarding diet and movements. Besides, they grow callous about the benefit of these directions. They gradually find that they hardly get any improvement even by observing them. This sort of disregard and callousness for directions are however always to the detriment of the patient.

 As however it is not naturally very easy for chronic patients to follow directions in respect of diet and movements, the physician should prescribe his directions with great care and consideration, and also see to it that his patient’s freedom is not unnecessarily and avoidably interfered with. He should therefore give such directions only as are really necessary for helping the process of cure and not embarrass the poor patient with all sorts of silly instructions like this and that. It is not unoften that patients are served with a multiplicity of directions which unnecessarily subject them to a lot of avoidable inconveniences and hardships. This should never be done. Our object must ever be the good of the patient and we must ever give such directions only as would lead to his good. In respect of directions, we should and must studiously avoid the dictates of whim as also the tendency to pose as learned.
 Let us see if there is any method for prescribing our directions for chronic patients: Such diets as are likely to aggravate the suffering should always be stopped, e.g. , pepper and chillies for patients having burning while urinating; ghee and things difficult to digest, for patients suffering from dyspepsia and liver troubles. It will be found that there will not be much difficulty for the patient to obey such directions. He himself avoids these as they aggravate his sufferings. It will be seen in chronic cases that the modalities of the patient are exactly like the modalities of the medicine prescribed, if of course the medicine has been prescribed correctly. This should give some indication as to what the directions in the case should be. Those things that aggravate the condition as you find it in the medicine will most probably aggravate the patient’s sufferings. For example, if you have selected Lachesis for a certain patient, then the condition of that patient must be aggravated by acid food and drink; if you have selected Arsenicum for a certain patient, then the condition of that patient must be aggravated by milk. Because Lachesis and Arsenicum have aggravation from acid and milk respectively. Therefore, patients for whom Lachesis and Arsenicum have been prescribed must be instructed to avoid acid and milk respectively. Similarly, the Lycopodium patient must take no food in the afternoon and no acid food even, and so on. Thus, it appears that the patient should be asked to avoid such things, such food, diet and drinks and such movements as aggravate the condition of the medicine prescribed for him.

 Besides the above, things and habits of luxury should also be stopped, as for example, drinking and opium habit etc. Of course, there should not be any unnecessary interference with the freedom of the patient. We have seen that, some physicians even direct the stoppage of smoking etc, during the course of treatment, and I am afraid this is going too far. Such directions only put the patient to a large amount of trouble and privations while they serve no useful purpose. I have seen a case in which a pneumonia patient requiring Pulsatilla was dragged to death’s door by the use of hot antiphlogistine on his chest. I have seen another case of Phosphorus in which the patient was rendered insane by having been made to stop bath. All these unmistakably suggest that the directions to be prescribed in each case should always be in accordance with the modality of the remedy selected. If the remedy has been correctly selected and if the directions regarding food, diet and movements etc. are in keeping with that, the object of the directions-namely cure-will have been served, while there would be no risk either of giving a wrong direction or of an undue interference with the patient’s freedom.

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