The human touch in medicine: good or bad?

Humans need human touch

Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level.

However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that’s when the popular adage can be beneficially carried out in its literal sense.

Medicine as art

Enter the art of medical caregiving, stage left. I refer to it as art because it is exactly this — rather than a method set in stone, it is malleable, changing with interpretation and need. Much like other abilities, which get better with time, caregiving, too, can be improved on through practice.

Some may argue that, much like with Dali and art, or Einstein and math, people can possess an innate ability to excel in it.

Similarly, some doctors are inherently more gifted in their ability to “feel” their way to patients hearts — and I don’t mean that term in the inappropriate sense, but as in possessing a natural proclivity for achieving the perfect emotion-to-touch ratio, when pursuing therapeutic breakthrough.

I grew up watching others around me use this instinctive ability — a form of “schmoozing” — to foster relationships, get better grades, and even optimally place into coveted positions. I wasn’t born with the gene for it, nor handed the tools needed to explore that skillset, as I got older. I grew resentful, quite honestly, when doing “the right thing” didn’t land me where I wanted to be, like those who were gifted with the talent.

But that changed. Or maybe I just grew up and learned to take responsibility for my own fate in life.

Either way, when it comes to caregiving, years of one-on-one patient interactions gave me the experiences needed to improve my own communication abilities. My newly honed skills served as proof that Malcolm Gladwell’s “10,000 Hour Rule” truly could materialize when applied.

Touch: good vs. bad

If you think of the concept of “touch” in medicine as having a negative connotation, or if that concept makes you uncomfortable in any way, it’s time to consider why.

Why do we, as a society, think of touch in such a negative light, when there’s so much good in it? Why is it negative at all, in fact, when its definition reads “to affect someone emotionally,” and often ends in significant impact?

Has touch always been wrong in medicine, or has the latest rise in touch-awareness shaken our confidence? Should we completely prohibit engagement, in any form of touch, even if it comes from a genuinely good place and is delivered tactfully, and in good judgment? Should we restrict this powerful means of making a difference, simply because we fear misinterpretation?

The idea of experiencing anxiety about wanting to deliver quality care is familiar to me, as a physician, from a litigious perspective. It reminds me of the common medical practice of defensive medicine, where one holds back, or adds otherwise irrelevant, even lengthy, steps to the delivery of medical care, simply because of the fear of legal backlash. It is one of the biggest issues dragging down health care today. I cover this ad nauseam in an upcoming article, aptly called, “Playing Hide and Seek-Damages With Our Degree: The Need for Tort Reform in Health care.” Stay tuned for that.

Infusing human touch into medical practice

Back in 2011, the Washington Post addressed the issue of touch in their article, “Doctors Often Struggle to Show Compassion While Dealing with Patients,” where the author, a physician himself, discussed his own struggle with showing compassion and learning the importance of its presence in patient interactions. He says, in reference to teaching students:

A good technique for showing compassion, I told the students, is simple: 3 T’s. Talk or listen, take time and touch. Merely taking the time to talk and listen to patients is comforting, as is a doctor’s touch.

His method, however, is not necessarily what we’re taught in training. Established medical guidelines often preach that you keep these very emotions out of the patient-physician interaction. You’re told this early on in medical school, where students are, by nature, in hypnotic states of sleeplessness. It becomes almost like a mantra — a yogic chant of so-called truth: resist the temptation of letting yourself into the patient’s world and becoming too emotionally invested.

The concept is then further solidified into residency training, where there, quite honestly, may not even be time in the day for emotion of any sort to materialize. Sure, you’re moving through the motions, but you’re also doing it all on little sleep, with poor health and hygiene, and, frankly, somewhat in a daze. Someone should really do something about that.

Using our hindsight to better our foresight

It seems hypocritical, in hindsight, to have emotional detachment stressed while emphasizing the importance of bond formation with these very same patients. I may not have been comfortable saying this as a student, but I say it proudly as an attending now.

The Journal of General Internal Medicine covers the need for emotional bonding in What is Clinical Empathy, in which Jodi Halpern, MD, writes:

“Outside the field of medicine, empathy is a mode of understanding that specifically involves emotional resonance. In contrast, leading physician educators define empathy as a form of detached cognition.. This article argues that physicians’ emotional attunement greatly serves the cognitive goal of understanding patients’ emotions. This has important implications for teaching empathy.”

We need more empathy in the field of medicine. And more touch. Schools need to teach it in class and residency programs need to teach it on the wards, and in clinics, instead of telling students to detach.

Empathetic human touch

I challenge the concept of “emotional detachment,” as I grow into an experienced physician, much in the same way that I challenge the “touch detachment” we’re increasingly told to practice within this day and age.

In the context of medicine and in healing, emotions and touch are not always mutually exclusive. We can combine the two concepts, in fact, and deliver them in the form of empathetic human touch. They fit together so well, like a hand in (latex) glove.

What you get is a valuable tool, with potential for explosive results. When I discovered that power — the magic created with this powerful tool, I made a decision to use it. The next time someone needs a “shoulder,” I’ll let them cry on mine.

Dana Corriel is an internal medicine physician who blogs at drcorriel.

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