Patients could use more group hugs from their doctors

Today, healthcare is criticized by the public as too high on technology and too low in touch.  Computers take patients histories, provide differential diagnoses, and even supply educational materials to patients. A new specialty, tele-medicine, offers healthcare services to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology.

A humorous story about technology occurred when a patient’s secretary called to say that her boss was too busy to come in for an appointment. However, the secretary would fax the doctor a list of her boss’s symptoms and asked if the doctor could just call in a prescription. Of course, that’s the extreme of high tech and no touch.

Let me relate a very moving experience I had with a patient who was having difficulty with urination associated with chronic low back pain. I asked if his urinary problem was improving and inquired about his back pain.

“Dr. Baum,” he said, “I have had a terrible 3 days, with such severe pain and discomfort in my back that I almost took out my pistol and ended it all.”

I completed my exam and stepped out of the room to alert the patient’s primary care physician of my findings. I was told that my patient was currently seening a psychiatrist and that his primary care physician would make sure that the psychiatrist was aware of the patient’s depression and suicidal comments. Then I asked the patient to accompany me to the reception area where I gathered my staff and the patient next to a prominently posted sign that says, “if you are feeling less than a B+, please let us know and we will give you a hug.” I whispered to my staff members that the patient needed a hug. When we hugged him, the patient’s had tears in his eyes because I believe we showed real concern for him and his well-being, which included his mental health as well as his urinary stream.

Later that day, my staff members wrote to the patient and expressing their concerns and saying that they look forward to seeing him at his next appointment. When the patient returned to my office several weeks later, he said that he had found my staff’s hugs were far more effective and far more encouraging than his psychotherapy sessions and the three  antidepressant medications.

This patient encounter remains one of the highlights of my medical career. The patient clearly demonstrates the power of high touch and that as long as physicians are willing to use high touch, they will never be replaced by high tech.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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  • WokenUP

    How much $ for the group hug? Would Medicare cover it?

  • http://secondbasedispatch.com Jackie Fox

    What a lovely post and so true. I’ll never forget when I saw my surgeon for the last time as a breast cancer patient. He wished me all the best and asked if he could give me a hug. Although he’s more given to handshakes, my oncologist also hugged me when I broke into tears after he recommended a mastectomy. Hugs are both powerful and healing. Look how much those hugs meant to you–imagine how much they meant to your patient!

  • Frank in L.A.

    If some people want a hug from their physician, that is fine with me.

    But I certainly do not see my physician to get a hug, and would not appreciate an atmosphere where the hug therapy were considered a normal part of medical care.

  • http://www.idealmedicalcare.org/blog/ Pamela Wible MD

    Neil, you are spot on! Great post. I have certainly found that human contact heals just as well and many time better than medications: http://www.youtube.com/watch?v=OlyXoIql9hY

    In addition to hugs, I give HUG coupons at the end of my office visits.

  • Kevin

    I felt this was a bit of a slight against the psychiatric treatment.
    Let me say that I fully appreciate the need for the expression of love, caring, empathy, etc. Completely normal to want that, and completely normal for the patient and the staff to have found this a rewarding experience.

    So, the patient expressed that these hugs were more “effective and far more encouraging” that his psychiatric treatment, then a lot of questions have to be answered. First of all, how did this patient define his expectations of his psychiatrist? To me, the need of a hug from the PCM’s staff to feel better is not a sign of mental health. If one can’t fulfill his/her need for object relations (warmth, empathy, trust, holding environment, closeness) within the boundaries of his own interpersonal relationships, then there’s a problem.
    The answer is NOT for the medical staff to provide this. (If the patient needed sexual fulfillment, would we provide that too?) My point is simply to state that there are BOUNDARIES to doctor-patient interactions, and good reasons for those boundaries.
    I don’t necessarily see harm in this simply hug. Doctors and other medical staff should certainly feel free to be humans, and I think we’re better for it. However, you can’t compare a hug to medical treatment. They’re not apples and oranges they’re apples and football stadiums. One is an expression of caring/love/empathy/etc. from one human to another; the other the delivery of competent medical care from a professional caregiver to a patient.
    And I’ll add this before getting off soap box…the fact that this interaction…this group hug…made the providers feel better….THAT concerns me. In psychotherapy training, we’re taught that…with any intervention…one should ask himself “Is this for me, or is this for the patient?” Sometimes the intervention makes both feel better, and that is fine. But it’s a slippery slope when we start doing things in practice because they make us feel better.
    I could write (well, probably plagiarize) a dissertation on the myriad of ways that hugs in the medical setting can go bad.
    Nothing wrong with hugs. I happen to love them. But it’s not why our patients come to us.

  • http://www.myheartsisters.org Carolyn Thomas

    Wow, Dr. Baum – I’m of two minds about this story.

    On one hand, I love the poster idea, and the personal touch with that follow-up contact with your patient (saying “we look forward to seeing him at his next appointment”).

    But I would have been quite surprised (and maybe a wee bit freaked out) had my urologist and his staff gathered around me for a group hug like this UNLESS I had a longstanding relationship with all of them. I may have likely felt both touched (literally) and uncomfortable. In hospice palliative care, we’re taught that it can be inappropriate and even invasive to assume that our hug is what the patient wants or needs, for staff to go for the hug when WE feel an empathetic urge to do so, instead of respecting the individual’s personal preferences.

    Some people, in fact, are downright uncomfortable being hugged by strangers. We learn this by feeling them tense up during a hug!

  • Marina

    I think you overreacted about the comment that he wanted to shoot himself. It was an expression on how much suffering he was in. He was probably also tired, frustrated, and lonely in his skin. And if he truly needs anti-depressants I hope he received the right type, not SSRIs.

  • LisainKC

    I think that a hug can be very healing for most patients (if and when the patient agrees). My doctors work in a Christian practice and before I have any procedures done, my doctor asks if I want him to pray with me. I find THAT very comforting as well. I would be very happy to have any of my current doctors reach out with a hug. The healing spirit of touch is immense. Doctor’s forget that sometimes they just need to be Human along with their medical practice and treatment. In fact, some doctor’s are so gruff and uneasy with patient’s that we, as patient’s, are quite uncomfortable with them. Living with Chronic Pain, I would much rather have a doctor that offers a hug via a poster in a room than one who is standoffish or very matter-of-fact and acts like they are in too big of a hurry to care about me as a person. I would imagine that the over thousand people that I am ‘friends’ with would feel very similarly.

    • LisainKC

      I KNOW that my doctors work for a Christian practice and thus, when my doctor asked if he could pray with me, it was not an intrusion on my belief system. I could have easily said No if I did not want to. He is a kind man and would have easily taken ‘No’ without any belief against who I am as a person or patient. It is not like they say you have to be Christian for us to treat you!

  • Penny

    Wow, how clever. I once had a doctor who was always an hour or two behind in appointments because, instead of treating patients by the clock, each patient got the time needed. His patients realized that when their time came up they would receive personal attention as well.

    With a lot of ailments being caused by psychological problems, this doctor, unlike any other, was able to treat patients as a whole, so I doubt may of his patients became as physically sick as those of other doctors.

    Most people don’t have time to tell the doctor of their symptoms for months, (because they may have a few and there is only time for one), so he can’t treat their illness as a whole. He can only treat each part individually, which probably drives up health costs and requires both extensive and even incorrect treatment for smaller parts.

    Even the best doctors seem to not realize it, but most patients feel as though they are a “number” versus a person. Possibly this feeling of “isolation” and lack of connection is one of the key reasons doctors end up in lawsuits.

    There are so many cases of mental illness in society that I really do feel it’s not physical sickness that is the root of the nation’s greatest problem, but rather mental illness not being dealt with. I also think that mental illness can be much more effectively dealt with by “chat” than it can be by prescription.

    • LisainKC

      Penny,
      I agree that most patients do feel that we are a number versus a person. That is what healthcare has turned into. There is, indeed, a feeling of isolation and disconnection between patients and their physicians. Now if only the doctors would realize this and not only the patients!!! They spend so little time with the patient treating the (as you said) one issue instead of the body as a whole. Once you have been hit with a chronic illness it is so very easy to see how your body does indeed work as a whole. It is no longer just this symptom or that symptom – it is indeed how that symptom affects this other part of the body as well. Sometimes I feel that we know as much or more that the physician’s do about our bodies!

      • Penny

        LisainKC, I do have to tell you that I did get a hug from a doctor once and immediately I saw him in different eye –like he was human versus just a wound treater.

        But I think hugs could be dangerous sometimes. What if some woman took that wrong and started stalking him, or a man-hater took it wrong and made a complaint against him? Doctors may not always understand their patients.

        They can give me a hug anytime, I’ve even been tempted to hug my doctor when he looked like he had a really bad depressed day.

        But today society makes all good things look bad it seems. We have to be scared of and distrust everyone. How awful.

        It’s for this reason that I thought a chat would be safer for most doctors who would likely feel their greatest sympathy for young attractive women. A young person often looks cute to an older one but the reverse is often not true.

        When I walk into a doctor’s office and he’s sitting at a desk, where the patient bed also is, I immediately feel the doctor is warmer and kinder than one who walks in with running shoes and one hand on the doorknob. I’m sure that if they ever did surveys with doctors who were sued, they would find out that the majority of these doctors were either doorknob hangers or womanizers.

        Hugs y’all.

  • http://www.myheartsisters.org Carolyn Thomas

    Interesting flurry of stereotypes flying around here. It seems that female patients should be viewed as either potential “stalkers” or “man-haters”. But that’s not the reason hugs should be very cautiously distributed in medical practice.

    As Kevin writes: “…the fact that this interaction – group hug – made the providers feel better….THAT concerns me.” I agree.

    Generally speaking, every patient and every situation is different, and health care professionals are better off not making these ASSUMPTIONS about what patients need or don’t need in the way of hugs, prayers, or other actions that feel good to the providers, but may NOT be so to the recipients. That doc, for example, who wants to pray with his patients might very well receive a “yes” response from some patients (even those who do not feel comfortable about the offer) simply because of the inherent power imbalance between patients and their health care providers.

    We can’t always assume that everybody is just like us.

  • LisainKC

    I think that if someone is against prayer, they are not going to let a doctor pray with them. Period. People are strong in their convictions. To say that women are “man-haters” or “stalkers” is not accurate in my books. I think that just the fact of giving or receiving a hug can make a person feel good might be what the doctor was trying to express. Not that it made him feel “gooooddd” like in some sick way. Just that a hug made him feel good. Of course, I am not that doctor but he only had so much room to express himself. And there are only so many ways to express the word “good”. Some people I believe are blowing this way out of proportion. I think the doctor is on a good path and that he can help a lot of people with his good old fashioned hugs. Go for it Doc!

  • Penny

    Here’s an amusing article that will make you think on one hand that this is progress and on the other smile. They are trying a new service in Calgary whereby patients may be treated as a whole (in a hospital that is), although I believe it’s only for those with mental illness. While that will probably relieve doctors of some of the double problems, I’m sure those with no “recorded” mentally ill problems might be somewhat envious they will still be treated as a part.

    http://calgary.ctv.ca/servlet/an/local/CTVNews/20110615/CGY_unit_plc_110615/20110615?hub=CalgaryHome

  • LisainKC

    Just wanted to add that last week, after all these conversations, I went to the doctor and asked him what his feelings are on all of this. He said that he gives patient’s hugs at least once a day. Jokingly, he said “Here, I’ll prove it” and reached out and gave me a hug. This is a doctor that is my primary physician – a D.O. I have been going through a lot of medical problems and I do have to say it made me feel like I had been heard, ‘validated’, at some level. It made me feel like my doctor is human. He stated his reason for giving a hug is that there is “only so much an anti-biotic can do” and that the human touch of a hug can give a different healing than a medicine can do. I totally agree with him. I left the office that day feeling in a stronger position to fight what I needed to fight.. which is no small stuff medically. Just wanted to share that.

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