COMMENTARY

Is Hugging Patients Appropriate?

Brandon Cohen

Disclosures

June 25, 2014

How important is a physician's touch? In a recent all-physician discussion on Medscape Connect, the question of when and how to touch patients yielded insights on physical exams, handshakes, and hugs.

"Do you make a point of touching your patients? Do you hear about it when you don't?" asked a primary care physician, beginning the discussion.

Right away, several doctors spoke up in favor of frequent and meaningful touch. An internist clearly had thought it through:

[Touch] is a social expectation; it is an integral component of the patient-physician relationship. I have had new patients tell me that they left the previous practice for a variety of reasons, but lack of examination in general and lack of focused exam leads the list.

A neurologist agreed:

Every new patient I see gets a nearly complete physical exam and a complete neurological examination. As for subsequent visits, the examination, if indicated, is a focused one. But it's not just touching a patient, but how you touch. I've always auscultated with my right hand and use my left hand to cradle their upper back and pull the patient close to me. This intimate sharing of interpersonal space in a safe environment does a lot to win trust.

A dermatologist also saw great benefit in the hands-on approach and mourned the lack of touch in colleagues:

Unfortunately, many dermatologists (I guess up to half) do not touch patients. They learn diagnosis by pictures and photos and do not combine sight and touch... I can't do my job without my fingers... Am I stupid? I don't think so.

"I've always been convinced that the popularity of chiropractic is solely due to the fact that chiropractors actually touch their marks -- excuse me -- patients," added the neurologist.

An internist also had strong feelings on the topic:

There is a tremendous symbolic value of touch as a healing power. Patients often feel better after a routine physical examination: a key part of how to establish an environment of trust. Other tips on the Art of Medicine: Smile -- you cannot convey a sense of warmth without a smile; learn to appear relaxed, as an aura of calmness builds confidence and shows you care.

But touching outside of the formal examination process was also up for discussion.

"Does shaking hands count?" inquired a curious internist. Shaking hands most definitely did count. Several colleagues swore by the handshake as a simple way to develop strong bonds with patients.

A neurologist described a useful technique in detail:

When I shake hands with most patients, as our right hands grasp, I place my left hand on the dorsum of their hand and squeeze their right hand between both of my hands. It's a less formal, less standoffish, and more intimate way of greeting someone. Body language and touch have a large impact on how comfortable another person feels when they are consulting with you.

A pediatrician advocated a gentle touch when shaking hands. "My neurologist made me want to cry out in pain this week when he squeezed my painfully arthritic hand hard while shaking hands!"

An internist then took the discussion past handshakes and on to the delicate issue of hugs.

I shake hands with males. But females quite often want a hug, especially the young ones. I bet they feel like daughters or granddaughters, being my patients for years."

A pediatrician quickly piped up with a warning:

Hug a female? I wouldn't dare! At warp speed I'd be before the board. Some mothers don't even want me hugging their kids. I feel it's safer to keep a professional distance.

But a neurologist was undeterred and advocated the healing powers of the embrace:

It's tragic that we have to think twice about hugging patients. That said, for many of my long-term patients, a hug is usually expected. In neurology, as in much of medicine, there are times that the patient in front of you may have a diagnosis where a hug is the most human of all therapeutic interventions.

A primary care physician largely agreed but had developed a system to avoid misunderstandings:

I do lots of hugging (usually older ladies), and they typically appreciate it. Occasionally I misread a person and hug someone who doesn't seem to appreciate the kindness. I write "No hugs" on the chart to avoid making the mistake again.

An internist had more of a wait-and-see approach:

I will hug back if someone initiates a hug, and occasionally initiate if body language and previous relationship suggest appropriateness. A hand on a shoulder, holding another's hand clasped with both of my hands, other small gestures as part of a gentle conversation that validates feelings and is direct and honest.

A cardiologist seemed a bit bemused by all of this in-office cuddling:

I can recall no occasion in many years when I have embraced a patient of either gender, or wanted to, or expected to be embraced. Maybe I have been much too cautious, but none has ever complained that I neglected them by not laying on of hands.

The final word goes to an internist who provided a comical take on a doctor's touch: "Ew! Isn't that how you pass on germs?"

The full discussion of this topic is available online. Please note that this is open to physicians only.

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