Evaluating the Appropriateness of Contact with Patients outside the Physical Exam

Otolaryngologists should be, or become, aware of certain circumstances that might be more nuanced than others with respect to physical contact with patients. For instance, some elderly women may not prefer a handshake of greeting, or if so, would prefer a light contact (not a very firm one). Some patients may have a fear of transmission of microbes from a physician’s hand to theirs, so many physicians may wash their hands in front of each patient or indicate that they have used sanitizer to cleanse their hands before initiating a handshake. It may be a bit awkward to wash, then shake hands, but this may be appreciated by more patients than we know.

Additionally, many, if not most, physicians will introduce themselves to family members in the room and may offer to shake their hands as well. Remember to inquire whether anyone in the room might not be listed on the HIPAA form, and have the patient add them to the form. As the husband of a female physician, the author is aware of additional concerns our female colleagues have to deal with, including unwanted physical contact from male patients that may well be worrisome enough to terminate the relationship. Female physicians may well need to be more constrained and careful about contact gestures with male patients than will male physicians.

There are a number of cultural considerations in giving contact gestures of welcome or support to patients, as many cultures vary in their receptivity to contact and opposite gender touch. Respect for other cultures, and observation of their mores, requires knowledge of the cultures and an appreciation of how best to accommodate the patient’s cultural or religious boundaries. The touching of a female—both married and unmarried—in some religious patients, especially Muslim, may be considered inappropriate. When entering the room, the male otolaryngologist must take in the gestalt of the situation, and, if in doubt, should not attempt to shake hands with the female patient, especially if they are in traditional dress.

Owing to the increase in medical mission trips by otolaryngologists in the past two decades, more otolaryngologists are becoming aware and knowledgeable of some of the restrictions on patient contact. One can rarely go wrong, if uncertain, by presenting a pleasant smile and proffering a polite greeting instead of a handshake. This author, even recognizing the presumed “assent” to a physical examination by being present in the examination room, has taken to always asking for permission to perform the physical examination. This sets the stage for beginning the professional contact for the head and neck examination. For female patients who have a covered head, one has to be a bit more specific about the examination requests, and be comfortable with performing the examination with the head covering on the patient—it can be done quite well, in fact. For a married woman who is covered, it may be appropriate to also request a head-nod assent from the husband or father of the female patient for good measure.