The patient–physician relationship is perhaps a singularly unique one with respect to physical contact, given the importance of the physical examination and the physician’s responsibility to understand and connect with the patient as a “person,” and not just a body of anatomy and cellular physiology.
Explore this issue:July 2018
Human touch can be a form of body language not dissimilar to a smile or a head nod—it can convey a sense of understanding and connection. However, depending on the patient, the strength of the mutual patient–physician relationship, and the context of the particular encounter, one must consider the important elements of proper, ethical, and professional physical contact with the patient outside the conduct of the diagnostic physical examination. If one considers the fundamental concept of physician physical contact to be respectful, comforting, and appropriate, these three guidelines can be considered prior to initiating a gesture that involves touching the patient.
There are two other, equally important, principles to be considered: respecting the patient’s person and self-determination. Given the complexity of the human psyche and personality, patient acceptance of a contact gesture from a physician depends a great deal on their definitions of personal space, their view of the professional relationship, the power differential perceived in the relationship, and their need for comfort or friendliness demonstrated by a gesture contact. Most physicians, through intrinsic and experiential awareness, insight, and understanding, should be able to discern when an empathetic or friendly gesture would be appreciated by the patient and, perhaps more importantly, when it might not be appreciated.
Given the above considerations, an otolaryngologist may wish to exhibit caution and temperateness by asking the patient if she would appreciate and agree to a contact gesture of support and empathy, and inquire what would be an acceptable gesture to the patient, if the patient agreed. A light touch on the arm or shoulder, held for a short time, might be a simple way to convey one’s professional empathy and an understanding of her anxiety and worry. Conversely, it is almost always acceptable to express your concern to the patient through appropriate words and an encouraging and hopeful facial expression.
Of greater ambiguity is whether or not to initiate or accept a “hug” with the patient. Since this is more contact than a touch on the arm or shoulder, it should be considered with greater discretion, and more often is a product of a solid, long-standing patient–physician relationship, in which a clear understanding of the intent, purpose, and propriety of the gesture has been affirmed by both patient and physician. Another word of caution: Regardless of the gender of the patient and of the otolaryngologist, if there are only two persons in the examining room, with the door shut for privacy, a misstep could come down to patient versus physician, and the differential of power may not favor the physician in this situation. If one is considering offering or extending a contact gesture of support or empathy, it might be better delivered in an environment where other, non-biased individuals are present. Unfortunately, the medical profession is at some risk for scrutiny regarding physical contact considered to be inappropriate, so a heightened sense of propriety must be exerted at all times.