For new PA and medical students, touching patients is just plain awkward at first, which is why medical programs get students in close contact with patients early on - to make them swim in that discomfort so they’ll get over it quickly. You may recall that my first real patient experience as a PA student was to conduct all of the most sensitive exams - breast, prostate, testicular, and pelvic. Touching a patient’s shoulder or feet was simple after that. But the health care as an industry is slowly becoming less interested in touching patients, and it may be up to our generation of clinicians set things right.
Touching Patients
I was completely taken by the following video talk by Abraham Vergese, MD on the importance of touching patients as part of the physical examination. Vergese’s argument that touching patients is a sacred and rapidly disappearing skill in medicine is beautifully told, and I encourage anyone considering a career in medicine to watch it and think long and hard about what matters most to them in their work. I would love to hear your comments on the topic - it’s something I’ve become very passionate about.
Enjoy.
[subscribe2]
I can relate to what you write, though I’m still only in the seriously-considering-PA-school phase, because I work in massage therapy. In addition to the admonition to swim in the discomfort of such close contact, I’d argue that because the very nature of the medical practitioner/patient relationship is a professional one, there is a pre-established framework within which one can navigate such situations more easily. If a patient (or client in my case) shows body language or verbally says that they’re uncomfortable, giving an overview of what will happen, as well as explaining during the exam step-by-step what will happen next could help. Personally, I prefer using abstracted language to enforce the professional nature of the treatment, and give some subtle evidence of boundaries. For example, “the left knee” instead of “your left knee.” There are other areas in which one can be a friendly, caring, and personable MT, PA, etc., so I don’t feel this makes things impersonal or cold.
For me, the training to set up a caring, respectful, professional relationship with a massage client gave me the confidence to define and enforce boundaries both for myself and the client, which allowed me to become more comfortable with touch and its proper applications. When respected and used properly, touch is a powerful tool to assist in assessment and treatment.
I gotta say, that while I agree with Dr. Vergese on most everything, and while his speaking tone was calm and appealing, he seemed to be so serious-to have little to no sense of humor during that talk. That said, I think one of the most useful aspects of his talk overall is he illustrates how the medical relationship can be meaningful, caring, and extraordinarily effective while still being a (uniquely?) professional one.
P.S. I am very grateful for both this blog and the podcasts, because your approach shows the humane side of medical training. Or your humane take on it (due to your therapy training?). Also, your work here is one of the main factors which led me to seriously consider the profession. Many thanks, and best wishes with the final stretch of school!
Incredible lecture! Physicians who value the ritual of touch are far and few. Thank you for the video!