A caring hand can touch our patients in many ways

Commentary. By Eric Anderson, MD, amednews contributor. Dec. 10, 2001.

COMMENTARY

Observations on the state of medical practice and medical life

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I was a speaker at the annual meeting of the American Pharmaceutical Assn. in Montreal about 18 or so years ago. I don't recall the details of my subject much, but what I do remember is that one of the other speakers was a corner-store pharmacist from the Los Angeles area who enjoyed being called "the Hugging Druggist."

This was in the days when a pharmacist's job seemed to be merely to deliver a bottle of the designated dose of the correct medication. But his style, he said, was to fill the prescription, hand it to the customer, then come around his counter and embrace the patient. He called his hugs "Vitamin H." Customers, he told me, would drive all across L.A. just to get his personal service and his hugs. "I can't understand why so many doctors are so standoffish with their patients," he told me, "Why they don't show their interest in their patients more. Why they don't lay on hands more and give more comfort."

I don't understand it either.

Oh sure. Lots of doctors are friendly. And it's not every patient who enjoys being touched. Said a young male physician to me once: "I'm really careful about not giving an encouraging pat to any female patient, especially if she's a young career woman. I reckon if they don't want me holding doors open for them they sure as heck don't want me patting them on the shoulder -- or anywhere else."

Understood. And we've learned, furthermore, that the paternalistic approach is no longer appropriate (it would be as much in style these days as bloodletting), and that it's safer legally to give more choices to patients and let them decide because after all, we are told, they are our partners in health, But that said, why are so many of us so distant when we deal with our patients?

Some young doctors say they have to stay distant. That's the professional approach of the 21st century. They would lose their value to patients if they became too involved. And they find it has never been easier to be uninvolved than today: Group practices with 9-to-5 hours. Off-call protocols. Telecommuting. Today's doctors take to this detached service easily. The reason, famously given, is that the warm, comforting, empathetic personality could never make it through med school; only the type A's could survive, and the selection process accepts that premise. And that's why, so it goes, the schools churn out such clever, farseeing, technically brilliant, cold-fish physicians.

I was talking to recently qualified physicians about this not long ago. Said one to me, "Sure, when we're medical students we fantasize about healing the sick with our touch. We see ourselves in a magical biblical way saying, 'Pick up your futon and walk,' but then we finish our residencies and know there aren't any shortcuts. Lab tests give answers; touching doesn't!" Said another, "Therapeutic touch is bunk. Didn't you see the experiment published at a science fair by a mere high school kid? She surely showed us all something!"

She probably did, but I'm not talking here about claims that a hand held over a patent's body creates electromagnetic fields, and so cures. I'm talking about a hand that just touches a patient, establishes empathy and comforts. Is it so hard, even when we're running late, to greet everyone in the examining room when we enter, shake the hands of all the adults when we introduce ourselves, listen more than we talk, and make an exclamation of sympathy when we hear a tale of woe? And touch the afflicted part even when we know the history may well be more important? And maybe pat the pediatric patient on the head or give him a hug, or help the elderly man to his feet, or escort the older woman to the door? And before they leave just pat a hand and smile encouragingly?

Can we get back to basics? Does it matter? Can we change? Should we? We may have to. Or our patients' tentative, toe-in-the-water experimentation away from impersonal medicine, all of which is based on science, to comforting concepts like alternative medicine, some of which border on quackery, could become a tidal wave. Know this: Many of our patients are willing to switch to the other side.

Dr. Anderson is a semiretired family physician in San Diego.