I have three kids — all with very different temperaments and different personalities. Sometimes I use the term superpower to identify and cultivate their strengths and greatest attributes. I have always believed that my superpower is connection. It is a value I hold dear and a quality that has allowed for authentic alignment in my work as a physician. Connection underlies the strength of a secure therapeutic relationship and enhances my ability to inspire healthy change in my patients. I employ all my senses to create connection with my patients including listening deeply, compassionate gaze, unassuming body language and — the power of touch.
Many years ago when I was a medical student, we participated in a patient simulation. An actor would present with a chief complaint, and we would be observed and graded for bedside manner, physical exam and diagnostic skills. One memorable patient was a soft-spoken senior man who presented with chest pain, weakness and shortness of breath. In general, I was having trouble engaging in this exercise knowing that these were not real patients and the interaction was being recorded, but something about this man moved me. I felt empathy for him and wondered if he really suffered from the heart condition he acted so well. When the time came to examine him, I placed my left hand on his shoulder while I auscultated his heart with my right. When the exercise was over, and I had seen all five patients, this senior man was the one that stayed in mind.
Several weeks later, we met with an instructor to review the recording and receive our evaluation. It was then that I heard the critique that has stayed with me nearly two decades later, regarding my soft-spoken elderly patient. My evaluator had noted, in fact, failed me, for inappropriately touching him. “Inappropriate?” I thought, as I frantically wracked my brain for how I could have both inappropriately touched and yet swiftly forgotten. The instructor continued that unnecessarily placing my hand on the man’s shoulder “could be taken the wrong way especially from a pretty girl” and that “I should refrain from touching my patients inappropriately in this way.”
I will never forget the surprise and the shame with which I received that critique. I would have never thought that my desire to show empathy with a gentle touch on the shoulder could be perceived as a violation. This feeling of shame stayed with me for many years and informed my bedside manner as a result. It took a long time to discredit his reproach. Many years of being afraid of misrepresenting my intentions and many years before I dared to question that I could use the power of touch to console and connect.
Not every encounter and not every patient is the same. Certainly, we must be mindful of how touch is received and be cognizant of when it might not be welcome. But when did touch become so sexualized, reserved only for intimacy of an erotic nature?
The truth is that there is an intimacy between doctor and patient that should be acknowledged and honored. Is it not intimate when a patient shares the untimely death of a mother or a personal history of abuse? Is it not intimate when we relay news of illness or hear of their pain. And what could be more intimate than hearing their life force, the sound of their beating heart? Whether we chose to recognize it or not, the doctor/patient relationship is intimate, and one could argue that not acknowledging that intimacy is the true violation.
Many of us have gone into medicine for all the right reasons. Many of us chose medicine because of our love of people and the aspiration to help others. We have studied long and hard while our friends were out to play. We ignored relationships and ignored ourselves. We have endured 36-hour shifts while our children’s care was relegated to nannies and other caretakers. Most of us have done this unconditionally and if asked would do it all over again. Yet, the perception of physicians does not reflect this level of commitment. Physicians are increasingly seen as apathetic or aloof as our role as healer has been relegated to other professions that appear to care more.
Yet, I sense that collectively we seem to be awakening to the elemental and innate need for connection. We crave connection. Our patients crave connection. And studies are increasingly demonstrating the negative effects of leading a disconnected and isolated life. Lack of connection has been linked to professional burnout, reduced productivity, poor mental health and greater disease leading to higher mortality. It has become apparent that connection is needed to survive, to thrive and to engage wholeheartedly in our lives. It is time that we reclaim our role as healer, to reclaim our power and privilege to connect — and perhaps the first step is to reclaim the power of touch.
Adrienne Youdim is an internal medicine physician.
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