I am a geriatric psychiatrist and am an osteopathic physician. The art of touch is a major part of my practice. I am the medical director of an inpatient geriatric facility. The patients that I see on the unit are typically suffering from dementia with behavioral disturbance. They are often agitated and anxious. For me, touch is an integral part of their care and healing.
I find that when interviewing these types of patients, they are calmer and are much more trusting when I simply hold their hand as we speak, rub their forearm, or pat their backs. It is a reassurance that they can trust me and that I will take care of them. I also make what are known as “fidget sleeves” to help relieve their anxiety. These are crocheted forearm sleeves that are adorned with “fidgets” which are items of different color, texture, and sounds that are soothing to patients with dementia when they fiddle with them. It has been through these interactions that I truly realized how important the art of touch is to quality medical care. Touch not only plays a vital role in soothing patients but in diagnosing and treating them as well.
I am also an osteopathic physician, and my training was heavily dependent on touch. We osteopathic physicians are taught the practice of manual manipulation. Being able to place hands on the patient’s vertebrae, ribs, pelvis, etc. guides us to the malfunction and subsequent treatment. But it’s not just osteopathic physicians who are taught the importance of touch, but allopathic physicians are as well. We are both taught during our extensive training that besides gathering history, the physical exam is the most important part of evaluating the patient. Just simply by placing hands on the body and using percussion, physicians are able to determine the size and border of organs. We can also percuss to determine the presence or absence of fluid in an area. Touch alerts us to the probability of appendicitis, ovarian mass, hernia, and much more pathology. Quality care simply cannot happen without the art of touch.
But frighteningly, care is now given in rapidly increasing those who were trained in the complete absence of touch. There are now numerous programs that offer advance practice degrees solely online. And one may say, “but these are nurses who have touched patients throughout their career and do not need to learn the art of touch.” However, sadly, this is untrue. There are now programs that not only allow for online-only training but also do not require an RN degree. And what is even scarier is that the acceptance rate to these programs is nearly 100 percent.
Without mincing words, these degrees are bought and not earned. How can you learn to perform a quality physical exam online? How can you know that your patient has an enlarged spleen if you have never felt the border of a normal-sized spleen? The crucial art of touch cannot be taught online. It just simply cannot. There is a national push by the American Academy of Nurse Practitioners to not only diagnose and treat patients but also to do this independently, even if this means getting their degree solely online. And this makes me terrified and sad for patients. No one should be able to provide care to any patient without extensive training in touch. For without the art of touch, there is no true quality care.
Katherine Gantz Pannel is a psychiatrist.
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