How to be an Authentic Doctor #10: Touch the Patient

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I remember going on an interview, after graduating residency about 20 years ago, in a small town in Virginia where one doctor in the group took me aside as I was leaving and told me to always “do an exam and touch the patient”.  I blew it off then because I was thinking about finding a job and finally making some money and not interested in another tip on being a good doctor.   But for some reason I never forgot what he said.  It seems such a simple thing to do, touching the patient, but it isn’t.   It also doesn’t seem that important but it is.

It is my opinion that there is an expectation by almost every patient that they will be physically examined during the appointment.  Nonsense, you say!  Trust me on this one.  That is one of the biggest complaints I have heard from patients about “other” doctors they have seen over the years. “He didn’t even touch me!” they would complain.  That being said, I am not perfect on this one.  Far from it.  I mean, if you come in to go over a cholesterol result after a recent complete physical a week ago then what sense does it make to do an exam all over again? None.  But I try.

From a study in 1978:

The quality of health care depends not only on how well physicians and other health professionals perform their tasks and the reliability of the technologies they use, but also on their ability to be human. To touch and be touched is part of the process of staying well or getting well.

Patients seem to need that human touch.  It’s understandable.  Sometimes shaking hands in and out of the visit is helpful but it does not cover you 100%.  They expect to be touched via an exam. There may be more to it as well.  Patients need to have closure or a grounding to signify that something was done in the visit.  I don’t know why but it is in our nature.   You would think  that by you saying, “Is there anything I didn’t answer for you today” would give closure that but there is an expectation that still exists that you will touch the patient.  In other words, it confuses them when they are waiting on the exam and you don’t do it and then you end the visit.  Examining the patient is part of the ritual of the office visit so when you break that routine patients will feel uncomfortable.

This does still not mean every visit needs an exam.   For the purists and the doctor I met 20 years ago, I am sorry.  Due to the brutal time constraints put on me by the need to bill correctly, type, and do endless clicks on the ERM, there are some times I cannot get an exam done.  But I try.  And I think about it.  And I do more touching of the patient than I would have if it had not been brought to my attention.  And now I am bringing it to yours.

  4 comments for “How to be an Authentic Doctor #10: Touch the Patient

  1. Hueydoc
    April 13, 2014 at 11:08 pm

    How can I touch the patient when I am typing like hell on EPIC !!!???!!!

  2. Pat
    April 13, 2014 at 1:22 am

    No matter what one’s profession, we all go into marketing.

  3. Dave Mittman, LELT
    April 12, 2014 at 8:31 pm

    Chiropractors learned this long ago and it has served them well . Too bad they don’t drum it into medical practitioners.
    Dave

  4. Sir Lance-a-lot
    April 12, 2014 at 8:06 am

    Absolutely right, Doug.

    Although I myself do fall down in one area: Conjunctivitis. I will walk in, look at the red, gooey eye and say, “Sorry, that’s really contagious, I think I’ll just stay over here where I’m safe.”

    Other than that, I touch everyone (MRSA patients with gloves on, sorry), though I don’t do exams on psych patients in the urgent care.

    The other aspect of this is that people want the stethoscope. I read about this in local caribbean populations in the 1930s once in a memoir called “Out-Island Doctor” or something like that, and it stuck with me. If there’s any way I can squeak the stethoscope in, I do (sorry, sprained ankles are SOL).

    And, yes, I do get the “That other doctor didn’t even touch me” comment a lot, including from patients whose problem is essentially a history-only visit (whom I examine).

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