Today, the public has criticized health care as too high in technology and too low in touching. Computers take patients’ histories, provide a differential diagnosis, supply educational materials and even submit a bill for the services that we render. A new specialty — telemedicine — offers health care service to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology. Telemedicine, a technology in its infancy, offers improved access to care, greater efficiency in diagnosis and treatment, improvement in productivity. Although telemedicine technology is accepted by patients, one of its drawbacks is the inability to have any physical interaction with the patient, such as being able to touch the patient or to examine the patient.
One humorous story about technology concerns a patient whose secretary called a doctor 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 would call in a prescription. Of course, that’s the extreme of high tech and low or no-touch.
A few years ago, I saw Jim (not his real name) for a problem of difficulty with urination associated with low back pain. I asked Jim if his urinary problem was improving and inquired about his back pain.
“Dr. Baum,” he said, “I have had a terrible three days, with such severe pain and discomfort that I almost took my pistol and ended it all.”
I completed my exam and stepped out of the exam room to alert Jim’s primary care physician of my findings and that Jim may be suicidal. His PCP informed me that Jim was seeing a psychiatrist and that the PCP would make sure that the psychiatrist was aware of Jim’s depression and suicidal comments. Then I asked Jim to accompany me to the reception area, where I gathered my staff around Jim 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 Jim needed a hug. When we all congregated around Jim for a large group hug, Jim 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 genito-urinary system.
Later, all of my staff wrote to Jim expressing their concern and letting Jim know that they looked forward to seeing him at his next appointment. When Jim returned to my office several weeks later, he said that he found my staff’s hugs and note far more encouraging and helpful than his all of psychotherapy sessions and all of the three antidepressant drugs he was taking.
This story remains one of the highlights of my four-decade medical career. This story 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!
Today, there is such trepidation to talk to patients and staff for fear of being charged with harassment. Recently, I was in the exam room with my medical assistant, and I was speaking to the patient. I said, “Ms. Smith, you look terrific. I can tell you have lost weight. I’m so impressed with your progress. Keep it up.” Ms. Smith smiled and favorably acknowledged my compliment. When I left the room my medical assistant pulled me aside and said that my comment was “inappropriate and could be considered harassment.” I was dumbfounded. Do we live in a world that a physician can no longer offer a compliment to a patient? I hope not. I would feel terribly constrained if that was the situation regarding communication with patients. I am fully aware of the sexual line and the harassment boundary that shouldn’t be crossed. However, I believe that if you can ask a patient about their bowel habits, their menstrual history, and their sexual activity, then certainly you can offer a constructive comment on their healthy lifestyle activities and behaviors.
Next, let’s discuss tactful touching the patient. During several doctor’s lounge discussions with colleagues, I often hear that doctors are fearful of touching a patient or even shaking the hand of a patient of the opposite sex. Again, this seems antithetical to enhancing the doctor-patient relationship. I strongly believe, and there is evidence that supports this belief, that tactful touching has a medicinal value. My standard approach to a new patient or an existing patient is to enter the exam room with a chaperone if the patient is a female, I make a point of smiling, then reaching out and shaking her right hand and use my left hand to gently cup her elbow as I state her last name preceded by Miss, Mrs., Ms. I believe that this tactful touching starts off the patient encounter in a positive fashion. After 41 years in practice, I have never had a negative reaction or response from a patient with this approach.
Has political correctness (PC) gone too far? I hope not. I think that using compliments and tactfully touching a patient has a place in contemporary medicine. Because of the rash of accusations that have received media attention in the recent past, the response of not being nice, not being complementary and failing to touch our patients is a jackhammer response in the wrong direction, and we will lose one of the unique and special aspects of being a doctor. As for me, I am going to continue to say nice comments to patients when appropriate and to continue to shake their hands. Please don’t report me to the PC police.
Neil Baum is a urologist and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MD, or on Facebook and Twitter.
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