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questionnaire for posting a case

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  • questionnaire for posting a case

    Member # 3746

    posted 22. July 2002 05:21

    1. What is your chief complaint (CC)? Tell as much about it as you can: the sensations, the kind of pain, the location, how your energy has been affected (for example, has the complaint made you restless, weak, nervous, anxious, irritable, hypersensitive, effected your thirst and appetite, your body temperature, and so on).
    2. When did this problem begin? What happened in
    your life around that time? What do you think
    caused it?
    3. What aggravates the CC? (for example, certain types of food or weather, movement, light, noise,
    heat/cold, or anything else that you can think
    of; please be specific) and what makes the CC better (for example hot or cold, massage, eating, lying still, music, company...)?
    4. At what time of the day or night is the CC the
    worst? Specify an hour if you can.
    5. What symptoms can you identify that accompany
    the CC (whether directly related or not; for example, headache with nausea; or menstrual cramps with diarrhea; a cold with irritability and anger)?

    6. Environment: With regard to the seasons, weather, outdoor temperature, indoor temperature, drafts, air quality, airconditioning, ocean air, mountain air, humidity, the sun/rain/thunderstorms/clouds/fog, etc.: what environmental factors give you comfort and relief, and which ones cause discomfort and distress? Try to give examples.

    7. What position is most uncomfortable for you?

    8. a)Do you tend to be chilly or warm? Are there parts of your body that are colder or warmer than the rest of you? Is there a special time of day or night when they are colder or warmer? b) Do you perspire a great deal? If so, when? And where on the body? (feet, head, hair, chest, armpits, etc) Does it leave a stain of a particular color? Is there a particular odor?
    9. Describe what your tongue looks like.

    10. What do you worry about? How do you deal with
    11. How do you keep your house/your desk/your room/your study/your bathroom?
    12. How easily do you cry? In what situations?
    13. When you are upset, what do you do to help yourself feel better?
    14. What makes you angry? What do you do when you're angry?
    15. Do you have an emotion that predominates; such as anger, depression, irritability, anxiety, jealousy, joy...or possibly two emotions that tend to alternate predictably?
    16. What fears do you have?
    17. What have been the most difficult circumstances in your life? How did you cope?
    18. What are the greatest joys you have had in
    your life?
    19. What was your childhood like?
    20. What bothers you most in other people? How,
    if at all, do you express it?
    21. What causes the most problems in your relationships?
    22. Do you have any recurring dreams? What are they about?
    23. What would you need to feel happy?
    24. What do you do for work? Ideally, what would
    you like to do?
    25. If you were made President for a day, what would you change?
    26. When people have criticized you, what were they complaining about? Similarly, when people have praised you, what did you receive praise for?
    27. What would you like to change most about

    28. How do you feel before, during and after
    meals? How do you feel if you go without a
    29. What would you most like to eat (if you did
    not have to consider calories, fat, anything
    you've read about the right way to eat)?
    30. What foods do you dislike and refuse to eat?
    What foods do you react badly to, and in what
    31. How much do you drink in a day? Include
    sodas, juice, coffee, tea, milk, and
    alcoholic beverages as well as water. How
    thirsty do you tend to get? What temperature would you like your drinks to be?

    32. How is your sleep?
    33. Do you do anything during sleep? (speak,
    laugh, shriek, toss about, grind your teeth, drool, snore, walk, talk, etc.)
    34. Do you have trouble falling asleep? What keeps you awake? Do you wake always at a certain time? What causes you to wake up? What position do you sleep in?

    35. Number of pregnancies, number of children,
    number of miscarriages, number of abortions
    36. At what age did your menses begin? If you
    have gone through menopause, at what age?
    37. How frequently do they (or did they) come?
    38. What about their duration, abundance, colour,
    time of day when flow is greatest; any odour
    or clots?
    39. How do you (did you) feel before, during and
    after menses?

    40. What medications are you taking at present?
    41. How frequently do you get colds and flus?
    42. Have you had any childhood illnesses twice,
    or in a very severe form, or after puberty?
    43. Have you had any vaccinations since the
    standard childhood ones? Have you ever had an
    adverse or unusual reaction to a vaccination?
    44. Have you had any surgery? What and when?
    45. Have you had at any time (mention year):
    warts, cysts, Polyps, or tumors? Where were they located? How were they treated?

    46. Do you tend to have any discharges (nasal,
    vaginal, etc.)? What is the color, consistency?

    47. a) Do you tend to need a smaller dose of
    medications than most other people?
    b) Do you need less anaesthesia than others,
    or have a hard time coming out of it?
    c) Do you tend to react to vitamins and herbs
    and/or need hypoallergenic vitamins?
    d) Are you sensitive to paint fumes, exhuast,
    dry cleaning fluid, fragrances etc.?

    48. Family history: Mention diseases, causes
    and ages of deaths of father, mother,
    sisters, brothers and grandparents on both

    49. Construct a time line: Mention from birth
    on to the present day, all IMPORTANT events
    (emotional and physical traumas,
    heartbreaks, divorces, work-related events,
    diseases or traumas your mother had while
    being pregnant with you, family stress,
    death in the family or of friends,
    disappointment, etc.) Mention the symptoms
    experienced at those moments or which you
    can date to those traumas.
    50. When you stand in line at the bank or supermarket, how do you feel?
    51. When your family member was last sick, what did you do?
    52. How is your sexual energy?
    53. How do you react to consolation
    54. What part of your life do you have the most difficulty coping with.
    55. What are your hobbies?

    [ 24. August 2002, 14:57: Message edited by: Barb ]
    Man, do not pride yourself on your superiority to animals. For they are without sin and you in your greatness defile the earth by your appearance on it and leave traces of you foulness after you. Dostoyevsky

  • #2
    Jonh - is there a way to keep this as the first post? I'm sure there is. DOes anyone object to doing so?
    Man, do not pride yourself on your superiority to animals. For they are without sin and you in your greatness defile the earth by your appearance on it and leave traces of you foulness after you. Dostoyevsky


    • #3
      I'd love to know if it were possible.



      • #4
        My commons sense says that it should be detained in FAQ and not as first post.

        When a new comer will come over to BB. He or she will first read FAQ. Because it is general rule to visit any site.

        Keeping this post at top does not full fill this object. It is not in the sense of new comer to read first post first and then send his her post.

        FAQ is specially meant for this purpose.

        Secondly, improve this questionaire before putting in FAQ.

        My suggestion is to design a simplest questionair and place under a new button and name it QUESTIONARE. Also write in pop up menu. "Before sending any medical problem to this forum. Members are requested to get help from this questionaire."
        <b>With warmest regards<br />Q.T</b>


        • #5
          It is very very very complicated questionaire for new comer. The members who are coming here, are not homeopaths. They are layman. So it is very difficult to answer all these questions specially for their general symptoms / complains. I don't think so. it is always necessary to answer all these questions first before sending post.

          Secondly, they dont have much time to anwer all these questions.

          Thirdly, If they don't understand any question, then where they will go? To whom they will ask or consult for clarification of questions. .

          Forthly, generally new comer have not much time to read so many detail before sending his/er problem.

          Is it not ridiculous to write answers of so many mmany questions in just simple acute fever or cold.


          • #6
            I think if someone writes in with an acute, we can say, "Go to the questionnaire and just answer the questions about the chief complaint."



            • #7
              The best way to do it would be to have a separate Forum named 'Questionnaire', with the one Topic and one post, the questionnaire - no posting would be allowed to the Forum.

              Someone would have to be 'moderator', to update the questionnaire as necessary - he/she would be the only one with access to the message.

              You could, I suppose have two - a 'simple' and a 'thorough' questionnaire.

              I want this to be done by general consensus, if not acclaim - so private emails to me please at &lt;; 1) offering to do it; or 2)saying who you think should be in charge of it.
              No such mails will be published, and my decision on 'moderator' will be final - what fun

              [ 26. August 2002, 17:09: Message edited by: jonh ]


              • #8


                • #9

                  Please give us time to write questionnaire. It will take some time to write simple but comprehensive questionnaire. I will contact you privately.

                  [ 27. August 2002, 11:05: Message edited by: jonh ]
                  <b>Dr. M Iqbal (Classical Homeopath)<br />Iqbal Poly Clinic, Main Market, Kharian<br />Phone Clinic: 05771-511337, Residence: 05771-533737 </b>