A Doctor's Touch

Touching a patient is one important act which a physician can perform. Although it is no longer performed in the manner pictured in the medical textbooks graphics of the 19th century (see Addendum below), it is an act which we teach our medical students all about as they learn to first experience the relationship with a patient previously unknown to them.

Touching the patient, perhaps at first as a handshake, provides the first connection with the patient. It can be represented as the marking of a beginning doctor-patient relationship which is hopefully to continue to the benefit of the patient. The quality of the handshake tells each party, at the onset, something about the other. As the patient relates the history of illness and his or her life experiences, the physician’s touch at a moment the patient demonstrates emotional distress, a touch of the physician’s hand on the patient’s arm or shoulder shows the physician is aware of the distress and is present to be supportive.

The act of touching continues into the physical examination where touching is termed palpation. Usually, the first touching in the physical exam occurs if the doctor, not the nurse, takes the patient’s vital signs blood pressure and pulse where touching is involved. It also may be the first time that the physician and patient are physically close to each other over a period of time and becomes a marker for what will continue throughout the examination to a more intimate professional relationship. Palpation is used extensively in the physical examination. Students are taught that it is important to attempt to create a warm hand to examine the patient, since the results of touch with a cold hand can be that of patient discomfort and erroneous findings. The doctor’s touch during the exam not only discovers areas of the body which are painful to touch but also the doctor learns about the warmth of the patient’s skin, its texture, moisture and elasticity. In addition, the touch can reveal whether there is crepitation or crackling of the tissues under the skin or in the joints which may represent pathology. Touch also reveals sound vibrations from the lungs or heart or masses within the patient’s skin, below the skin, in the boney skeleton and within the cavities of the body. A doctor’s touch continues throughout the physical exam and shouldn’t stop when the exam is over and a discussion of the findings and conclusion occurs. Here the light but continuing touch of a patient’s arm or hand, particularly while conclusions upsetting to the patient must be presented, can represent that the physician intends to remain in contact and supportive for the patient as the medical care begins or continues.

Simple touching can be emotionally touching for both the patient and even occasionally for the physician, however touching should be part of the entire professional actions where the intent by the physician is solely for the benefit of the patient. The issue of hugging is a more controversial aspect of touching and I have already devoted another thread to this subject.

In conclusion, as you can see, a doctor’s touch is an action which, if used wisely and professionally can provide a variety of benefits from psychological to diagnostic. Also, you can see that touch is missing when the doctor-patient relationship involves phone, video or e-mail communication. It is understandable why we who teach medical students stress touch as an important medical tool in its many ways. ..Maurice.

ADDENDUM: Graphic above and text below from Victoriana

Medicine in the 19th Century: The Touch

Classic illustration of a woman's medical exam by her doctor. Many 19th century medical textbooks used this illustration to show the proper manner to examine a female patient. The physician's eyes are diverted so he will not violate the woman's "modesty."