Monday, November 25, 2019

The Correct Touch Is Really Important

My patient said to me that she will never see that doctor again. She was annoyed that despite her complaining of pain in her knees, he did not even bother to examine her. There was no eye contact from him at all too. He told her brusquely that she had runner's knee and should not be running. The Sports Doctor then prescribed her some pain medication and referred her for physiotherapy.

She had gone to the physiotherapist referred but did not get better. Her friend suggested that she come to our clinic since the referred physiotherapist was not a runner as well. So here she was in our clinic.

Like I've written previously, I can never be totally sure of a patient's condition if I don't assess them properly. All patients need and deserve gentle and thoughtful treatment. However, healthcare is evolving and become more businesslike. However, that human touch is still really important.

We should never take for granted that our patients give us consent to touch them to be able to assess them. Especially now in an era of electronic medical records, doctors and other health care practitioners may spend most of the allocated appointment time staring at a computer screen, tablet or looking at MRI reports.

I'm so glad that Dr Abraham Verghese, a professor at Stanford University's School of Medicine still prefers "the bedside chat, the old fashioned physical exam and the power of informed observation".

In his 2011 TED Talk, he said that by shortening the physical examination, doctors will lose a ritual that is transformative, transcendent and at the heart of the physician patient relationship.

Of course there are instances when patients are in pain and/or anxious, they will be much more guarded. Definitely patients of sexual abuse or assault may cringe at the lightest touch.

I have on many different occasions seen a patient come in for say neck pain but had a worried look that seems disconnected from their physical problem. After assessing and/or treating them and asking them if they are alright they become tearful and mention a family death, possible relationship problems or financial difficulties. That placing of hands, that human touch was the catalyst that allowed the patient to open up and release the pent up emotions.

With that human touch, we can comfort, diagnose and bring about treatment.

Be careful with your touch. It can show gentleness, compassion and heal someone. Or it can show roughness, carelessness or even incompetence.

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