Laying On of Hands? 1: Doctor and Patient

What’s missing in today’s medicine? — Danielle Ofri’s N.Y. Times article is a springboard for reflection:

When I was a child, doctors still came to the house when someone was ill armed with a black bag containing (in my memory) only a stethoscope, tongue depressers, and a thermometer.

And armed, if you’ll forgive the unintended pun, with their own two hands. The doctor came, he (there were very few women doctors in those days) sat down at your bedside,  took your hand in his, felt your pulse. He listened to your back and your chest with the stethoscope, felt your neck.

Whether or not you felt better right then, you felt a sense of confidence that you were in good hands (pun also unintended) and that you would be getting better. This was fortunate, as that black bag, until after the Second World War, contained no serious medicine, not even sulfanilamide, let alone the powerful antibiotics of today. The healing power of touch was of vital importance in those days.

Well, no one suggests returning to the bad old days of aspirin and iodine and  silver nitrate, and not much else. But has a precious baby been jettisoned with the bathwater? Maybe.

Danielle Ofri, MD., New York City internist, writes in “Not on the Doctor’s Checklist, but Touch Matters”:

“Despite the inroads of evidence-based medicine, MRI’s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.”

Dr. Ofri describes all the procedures she uses to examine a middle-aged woman on an initial visit, leading up tothe physical examination, which she has left for last.

“As I examine her abdomen, we continue to talk, but there is a perceptible shift in the tenor of our interaction. The polite but businesslike nature of our initial conversation has melted. No matter how we’ve come to this room, to these postures, to this connection, we are now more intimate.”

Her article is a strongly written account of the laying on of hands which “sets medical practitioners apart from their counterparts in the business world.” Or used to.

Books from some of today’s ablest physician-writers: Dr. Ofri herself, Jerome Groopman, Lisa Sanders, warn about an alarming decline in doctors’ skills at physical examination. Causes range from the misguided: narrow medical education based on machinery and medication and regarding physical touch as insignificant compared with the serious stuff; to the villainy (often unmentioned) of managed health care. In focusing on time as money, insurance companies have in effect declared that the laying on of hands is worthless. (After all, where’s the money to be made by it?) Consequently many physicians often find their patients’ appointments limited to fifteen minutes. And physical examination, like so many other things of importance, takes time.

When I was a child, and for all the decades of my life since, I thought of doctors as holding a privileged position. They have the potential and the mission to heal their fellow humans, and they carry it in many ways, in their knowledge, their white coats, their emblematic stethoscopes, and above all, in their hands. In their very presence. I have never changed my mind about that — But it seems that much of the medical world has.

Yes, we’ve gained immeasurably in medical matters since I was a child. But what have we lost?

Doctors out there? Patients? Anyone? Your thoughts?

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3 Responses to Laying On of Hands? 1: Doctor and Patient

  1. DJE says:

    There’s something to the saying, “Don’t just do something, sit there.” It’s a mantra for the doctor.
    I am reading a wonderful book now, “House Calls with John” by John Radebaugh, a pediatrician and family doctor. It’s a little gem and it addresses similar topics to Danielle Ofri’s article (and books).
    Great work, Judith!
    DJE

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    • Claudia Shuster says:

      In my work with child care providers, the best home provider I worked with suggested that when she was at her wits end about how to calm a baby or young child, she took off the child’s shirt and took off her own. Then she held the child against her chest, skin to skin.

      YES!! Touch has tremendous power. And I fear that in this media age, the AT&T slogan, “reach out and touch someone” represents how far we have come from understanding the power of REAL touch and what we may lose in this media mania!! – Claudia

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  2. Pam Maes says:

    What a vitally important subject to be addressed and readdressed in the emerging medical world of EMR, voice recognition dictation (adding hours to practitioner’s schedules and saving time for the business office). I am a Nurse Practitioner and when I was in training thirty years ago, an instructor said, Don’t forget to touch your patients when you’re listening to their heart and lungs. Give them eye contact when they tell you how they’re feeling, and listen to their stories!
    I work with a wonderful physician now, who, when I enter a patient’s exam room with a potential problem listed on their chart that I’m uneasy about, says, “Have you examined them yet?”…..
    That, without doubt, gets me more information and more understanding of what’s going on with the patient. Touching them, talking to them, and most importantly listening to them without a computer between us, we both feel more at ease. Yes, I may need to get a consult from the physician, but I have a better sense of what’s going on with my patient.
    Listening, touching, eye contact, observation: the very basic tools of medicine. When my pediatrician made house calls at our house, it was the most reassuring visit of all.You could hear her resounding voice yell, Dr. Clark here! and you knew all would be fine, even as a little girl. Those are still the valid tools of health care!!

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