My wife has two world-class oncologists who help her manage her Stage 4 Lung Cancer. Both are excellent clinicians. Yet their skills differ in one very important way. Her radiation oncologist physically touches her a lot (in a good way of course!). There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam. Her medical oncologist not so much.
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We all recognize the therapeutic value of touch. Dr. Abraham Verghese, a Stanford Physician and Professor, at the 2011 Med2.0 Conference, described the power of touch associated with the physical exam. In the following scenario he describes an interaction with a chronic fatigue patient who came to him after being seen by many other physicians.
The patient was very voluble and kept talking as I began the physical. I always begin my routine, my ritual with the patient’s hands…it seems natural to hold the hands. I slip my figure to the radial pulse and then examine the fingers looking for cyanosis and clubbing…. As I began my routine, this talkative patient began to quiet down. I had an eerie sense that the patient and I had slipped back into a primitive ritual…one in which I had a role and the patient had a role.
When I was done the patient said to me with some awe…I have never been examined like this before. If this were true that was unfortunate since this patient had been examined by other physicians many times before. Following the exam, I told the patient the same thing he had been told by other physicians, I don’t know what the problem is …but here’s what we will do. I had earned the right to tell the patient this because of the examination.
Verghese believed that, unlike the other physicians seen by the patient, he had earned the right to diagnose the patient and expect the patient to accept and act on his findings. Why? Because of the patient trust he had earned in part through the power of touch.
Turns out that there is scientific research to back up Verghese’s claim. According to researchers, people are able to more accurately discern a wider range of feelings and emotion from touch than from gestures, expressions, and sometimes even words. That’s because touch is the first language we learn. Tiffany Field, PhD of the Touch Research Institute in Miami has found that benefits of touch seem to stem largely from its ability to reduce levels of cortisol, a stress hormone manufactured by the body.
Given the high degree of personal stress associated with a trip to the doctor, a lab test, or hospital visit, I suspect we could use a whole lot more touching…not less as is the trend. Verghese has a name for this trend – you know where clinicians gather around the computer and not the patient. He calls it iMedicine….and it’s not a good thing.
That’s my opinion…what’s yours?
Keltner, D. Born To Be Good: The Science of a Meaningful Life” (Norton, 2009)