ON HOMEOPATHS’ WORKLOADS – Peter Morrell

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“He became the director of a clinic where he taught medical
specialists how to analyze and choose the significant symptoms of a case rapidly. To give
some idea of his activity: in addition to his busy private practice, at his dispensary in
Philadelphia alone he and HIS PUPILS saw more than 18,800 patients in 1896 and 16,000 in
1897!” (Excerpt from: Biography of James Tyler Kent, by Pierre Schmidt MD)

Kent did NOT see 18900 patients in one year He obviously used 8 assis
ants, ‘pupils and medical specialists’ working alongside him. What is the underlying purpo e
of Pierre Schmidt making this claim about Kent’s workload?? The desire here is clearly to
brag to the homeopathic world and make some kind of maverick or Hercules out of Kent, to
heroise and mythologise him into something greater than he really was, that is the
underlying objective. The underlying aim of Pierre Schmidt is clearly mythological — how
can it be otherwise?

1 hour might be regarded as a good guide to the time a ‘decent’ homeopath
spends with a patient. A good homeopath might only take 20 minutes, while a poor one might
take 2 hours. Consultation time is not the only consideration. I did not claim that. It is
merely a good indicator of the quality of practice. We all know that some patients walk in
and the remedy is blindingly obvious in minutes. Others take a lot of frustrating time to
identify. There is a range; there is variability among patients and among homeopaths. But
that range does average about a point. And thus it is informative to know what that average
is. And to know the range.

If some homeopaths can do good work seeing 40-50 patients per day, then I
have no problem with that. It just moves upwards the annual total to something like 50 x 5 x
50 = 7500 patients per year. Yet I think such homeopaths are very atypical — they are
exceptional. And in any case, this is still a long way from 18,900, which is the ‘bullseye’
claim made by Pierre Schmidt in his biography of Kent. 7500 is still ~2.5 times too small a
figure.

Again, if some homeopaths can *routinely* see 100 patients per day, then
this pushes our annual total much closer to Kent’s. It is 15,000 patients per year.

But I think we should try and establish how long a homeopath can continue
to operate with such a heavy workload and still continue to do good work. Is it all solid
constitutional prescribing? How much of it is acute or first-aid work? How much of it is
just for 2-3 days per week? The fuller picture needs to be given if we are going to accept
as a possibility that ONE homeopath can see 100 patients per day every 5-day week for 50
weeks a year. Is that a wild exaggeration? Or is it very untypical?

I am just asking these questions because in order to put a maximum on the
estimated annual total, we must determine this with greater accuracy. I suspect that a
maximum of 5000-7000 patients per year is far more likely. And that is still, I suspect,
very atypical within the homeopathic world – 2000-3000 being a better average max for most
homeopaths. 7000 patients per year would be 28 patients per day for a 250 day working year.
I would suggest that is still on the high side for most homeopaths. Again, though, this
mainly applies to constitutional work – which necessarily takes longer.

I stress that these figures are not absolutes. But they give us a good
idea of the range that is occurring within the homeopathic world. That is not ‘massaging
figures’ but giving a good outline of some very useful information about how homeopathy is
practised. Let me just go further and explain two spin-offs from calculations of this kind.

If an average homeopath treats 10 patients per day in a village of 5000
people, then we can estimate how many patients they might see per year and how many
homeopaths that village might realistically need. That is a very useful datum. It is very
useful information for those bodies who are planning the expansion of homeopathy at village,
town or state level.

Secondly, these heavy workloads by homeopaths might also help to explain
why homeopathy is so popular in a country like India, with a high population of thinly
dispersed peoples. And again, we can learn from that and build it into programmes for the
expansion of homeopathy in such countries. I am thinking of Africa and South America in
particular as examples where this knowledge might be applied successfully in the near
future. It holds exciting possibilities for the future of homeopathy as a growing world
movement.

As long as you do not consider numbers to be absolutes – as some poor
unfortunates clearly do – then these calculations provide some very useful data for use in
planning the future expansion of homeopathy.

I think the data presented on this topic has revealed some very useful and
informative aspects about current world practice. My other points about Kent’s workload
remain unchanged.

Finally, there is yet another point in all this. Is it possible to define
what an ‘optimum consultation time’ might be? The reason I ask this is that if we are not
careful then homeopathy might become so fast that it becomes as mechanised and uncaring as
allopathy has become. If you give a patient only 5-10 minutes of your time, then what use is
that? What healing benefit are they going to take away from that contact with you?

Dr Leopold Drexler of Austria once told me, in Stuttgart [april 1995] that
he always listens to the ‘patient’s story’ regardless of how long it takes. The stories of
illness are very important and patients must be allowed to tell their story. Just
prescribing based upon a face, a mentality or a tongue discolouration is surely homeopathy
of a very different order to a homeopathy that involves sitting and listening to the patient
and establishing a rapport with them?

Aren’t we in danger here of reducing homeopathy to a mechanistic and slick
method for quickly ‘finding the remedy’ and ignoring the patient as him/herself and the
wider social and psychological matrix in which they are embedded? If Drexler is right, then
it is not just ‘a remedy’ that a patient needs, but also that human contact, discussion,
etc.

If Kent saw 18900+ patients per year then it is just not possible to have
given them 1 hour consultations each! That is 50 patients per day; and so for a 6 hour
working day he was actually giving them a maximum of 7 minutes each! And therefore we should
perhaps question more deeply the effectiveness of THAT technique too.

In fact, a deeper analysis reveals that Kent’s position is even worse than
I have indicated above. If we divide 18,900 by 52 he was allegedly taking 364 patients per
week, for every week of the 52 week year! That means a staggering 73 patients per working
day of a 5-day week! If he had a 6 hour working day then that is 12 patients per hour,
continuously every hour, or one patient every 4.9 minutes!! I do not believe that he could
have done those patients much good at all – or indeed, himself!

Even an allopath spends more than 5 minutes with each patient on average.
It is surely quite ludicrous to believe that Kent was doing good classical homeopathy with
patients at that rate. It is just not possible – even with a computer it is not possible. So
a good dose of common sense is needed here So he was either plainly NOT seeing 18900
patients in one year and the figure was wildly exaggerated OR he was doing them no good at
all OR he was using assistants to do at least some of the spade-work on the cases. This is a
classic example of what I have said before – people being only too keen to believe
everything said about Kent while ignoring a simple commonsense interpretation of the facts!

Purely for mathematical purposes we can go further and estimate the
maximum number of patients any self-respecting homeopath (worthy of that title) can
realistically hope to treat in one year! If they see 8 patients a day, that is for 5 days
per week (=40) and for 50 weeks a year, the total is more like 40 x 50, ie 2000. Perhaps you
could see 10 patients a day giving an annual total of 2500 per year. This is useful
information, as it gives us a good estimate of the time being spent usefully with a
patient.I would suggest that it clearly reflects the quality of the technique being adopted.

A good classical hoemeoapth gets very little money from homeopathy and
takes 1-2 hrs per patient. But even with ~1 hour per patient and 2000 patients per year, as
calculated above, there is still a lot of your ‘spare time’ taken up reading up cases,
making notes and checking materia medica (especially those difficult cases), speaking to
patients by telephone How can Kent possibly have treated 9 TIMES that number in 1896?

You might claim that choice of potency does not necessarily indicate a
classical approach and there is more to Hahnemannian homeopathy than choice of potency. But
an assessemnt based upon the time spent with a patient is, I would say, a very good
indication of the quality of practice.

Good classical homeopathy is seriously economically uncompetitive when
compared both with allopathy and with the ‘mongrel forms’ of homeopathy. And that, in my
view, appears to have been one of the main reason for what I called the ‘corruption and
decline’ of US homeopathy 1890-1940.

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