A Suggestion — A Question — and A Request:
Part 1 of Laying On of Hands focused on doctor and patient, the emblematic relationship of the healer and the one needing healing.
It seems to me, though, that all medical professionals who encounter their fellow humans at a time when those are weak and vulnerable have the potential to hold a privileged position. In varying degrees, that would include physician’s-assistants, nurses, and EMT’s, perhaps even medical technicians and many hospital staff, who may not ordinarily regard their position that way.
And what about the rest of us? Patients, broadly speaking: which ultimately includes everyone, because at one time or another all of us, whatever our profession, will be ailing, weak and vulnerable. Do patients have obligations, responsibilities, opportunities, as professionals do? Or are we simply to be passive and “done to”?
I conclude with a request from M, who relates a disconcerting experience she had while recently undergoing medical testing. It’s an ordinary enough situation which all of us have probably been in. Beneath the flurry of questions with which she ends, however, I sense one or more different, larger questions, for any of which she is looking for feedback. Or illumination. Or something. This is her story, in her own words.
The posture was uncomfortable: chin on a plastic tray, forehead pressed against the plate, patch over one eye, knees pressed uncomfortably against the machine. Two technicians were there, a trainee administering the exam, a more experienced one guiding, correcting, and readjusting tray, plate and eye patch. Once I was settled and pressing the remote to indicate my perception of various light flashes, the two began an animated discussion of office procedures, absent colleagues and the meanings of the “X’s” appearing on the screen.
I did my best to concentrate on my task, and when it was complete, they announced I had done well. I reproached both of them, saying that their chatter was disconcerting and unprofessional, and for all I knew might have invalidated the test, as I never knew whether I should just tune them out or listen for another instruction, which distracted my attention from the flashes.
They apologized, and said they never did that sort of thing without asking, but had simply forgotten in my case.
As the older technician (30, maybe 40 years younger than I) escorted me to the next waiting room, she reached behind me and rubbed my back in an uncomforting and ineffectual way, saying that it had been necessary to talk during the exam since she was training the other technician. The touch was unexpected, neutral, and I did not draw away. I simply commented that the technical direction was fine, office chatter was what I objected to. We left each other in silence.
As I waited for the next round of exams, I thought of her touch. Did she think I needed comforting? An old crotchety lady, perhaps? Was she asking forgiveness? Did this mean, please don’t tell the doctor what we did? We’re friends, right? Perhaps she needed to “touch” me in a way that her verbal communication was not accomplishing? I’ve been told that I can come across as very cold.
So. Over to readers. Feedback for M? Illumination? Or something?
And what do you think about the laying on of hands and the rest of us? Obligations? Responsibilities? Opportunities?
(Update: At the time, there was some discussion of this; but it is an open subject, an ongoing medical question, and all opinions are welcomed —)
Medical technicians are trained to operate complicated pieces of machinery. They are probably chosen for some demonstrated ability to learn how to do this. They are probably not chosen for their demonstrated excellent bedside manner. In the cases where getting a good result means putting a patient in an uncomfortable position, some technicians express concern that they must do this, while others do not. The ones that do probably concentrate on the patient and not on their partner operator. I think M had was dealing with two uncaring techs. They knew M was uncomfortable, and made no effort during that period of discomfort to reassure her, but rather talked to one another. I think that her objection to the chatter frightened them, and their apology and the touch were self serving.
As regards Part 2 of Laying On of Hands, ailing and weak we may be. We come to see a doctor whom we pay to make us less ailing and less weak. Is he or she also being paid to make us less vulnerable? If so, to what are we vulnerable, and how does the doctor help us deal with that vulnerability? I think not at all.
Sadly, perhaps, the gods of our childhood are no longer gods. Policemen were gods. Teachers were gods. Baseball players were gods. Doctors were gods. Now we read more about policemen who abuse their authority than we do about those who do not. Teachers are regularly villified as union members who work part of the year and expect a full year’s pay. Baseball players are multi-millionaires who misbehave off the field. As for doctors, they have far too many patients. They keep us waiting unconscionable amounts of time. They send us for tests they do not need for fear of a malpractice claim. They do not have the time to deal with our vulnerability, but only our illness. There is a shortage of nurses. Many are overworked. Do they care about our vulnerability? Technicians give the same tests over and over again each day. They may be polite and caring, but can we expect more?
I think we must adjust to the practice of medicine in 2011. We must ask questions. “Why is that test important? What will we learn from it? What is the course of treatment recommended, and are there other alternatives?” We must get second opinions. Yes, we have a responsibility. In the mass production-like factory that the practice of medicine has become, the patient has the responsibility to take charge, and to learn enough to be satisfied that it it the best course of treatment recommended is the best available.
Ah, you raise so many questions, Dick! I think perhaps you also point to the reason why there are so many questions being raised now: the practice of medicine in 2011 is a very different thing than it was even perhaps twenty years ago.
If any readers want to join in there could certainly be a lively discussion. For instance, about the reponsibility of patients to become knowledgeable and proactive — or not? — is this necessary, useful, possible at all? To what extent? Etc —-
What is especially poignant for me is what you say about the gods of our childhood, who are no longer gods.
Well, we needed to grow up, I suppose. And yet are we really surrounded by corruption on all fronts? Or is part of the sad decline due to my own favorite villains, the media. For those of us over 70, the media always wore rosy spectacles about our god-figures. I didn’t even realize Franklin Roosevelt was crippled and needed crutches. (There was no television to show us, and radio and newspapers were mum.) But now sometimes I think the media wears dark-colored glasses ALL the time and only points out defects, and so all we see around us is corruption and vileness. Surely the truth lies somewhere in between? But from a media standpoint, the place of reality is no-man’s-land, and is never shown.
The polarization tearing apart our beloved country begins with the simple fact that it’s conflict that sells newspapers (updated, increases ratings). And however much we know this in our hands, that which is always before our eyes is absorbed willy-nilly, so we too begin seeing only the dark. Or maybe that’s just me —
There was a piece on NPR about this a while ago – about how the ‘art of touch’ as a diagnostic tool is being lost within the medical community. I.e., a truly skilled doctor can feel (and more importantly, discern) between different types of bumps and lumps and nodes and whatnot beneath the skin, invisible to the eye but crystal clear to a trained set of skilled hands. Yes, machines can be helpful (clearly) – but we have almost given up and surrendered our own POWERFUL skills and human abilities in deference to cold, ‘exact’ machines. (Which also mess up – we just don’t bother to question them.)
I saw somewhere that most lumps in the breast are still found by women themselves, and that one can develop one’s own sense of touch for monthly self-examination —
We’re big fans of the DVD Great Courses, and are currently watching one of Dr. Sherwin Nuland on Doctors: The History of Scientific Medicine through Biography, absolutely fascinating. It was hundreds of years (thousands, if you start, as he does, with Hippocrates) before the Science and Art of touch became central to medicine. It wasn’t until early 19th century France that a physician named Laennec invented the stethoscope and systemized the skills of looking, listening, feeling, and percussion (tapping) — To give you an idea, it’s in lecture 7 out of 12 —
(Anesthesia as we know it appeared in 1846 — so be grateful you’re around now, not earlier!)
I am VERY grateful to be born at this time in history, where so many advances have been made, and so many resources are available to me. I definitely appreciate the innovation of anesthesia! 🙂
Huge questions raised here. There are major disconnects between patients and health care professionals. This is a small one — but significant. This kind of discussion between health care professionals in the presence of patients is really common — The patient becomes a thing worked on. In the final analysis it should be all about the patient. The field of “patient-cantered care” addresses this. The institute of healthcare improvement ( http://www.ihi.org/Pages/default.aspx ) addresses many of these issues.
An interesting link, David. Thank you!
What should become a mantra is what you say: “In the final analysis it should be all about the patient.”
Public touch is a difficult topic for me – for precisely the questions posed by M. Unless I know the person well (and sometimes even when I *do* know the ‘toucher’ well), I don’t quite know what to make of their touch. Are they meaning to support, or to coddle? To show solidarity in our humanness, or to pander? To equalize power, or to regain/reassert it?
For me personally, I don’t touch someone unless I first have their permission. Even with a friend who is clearly upset, I will nearly always first say, “I feel a lot of empathy with you right now, and would love to give you a hug. But is that something you want?” I then wait for their head to nod or shake, and then act accordingly. If I genuinely want to offer help, I will ultimately respect the needs, wants, wishes, and desires of the person I wish to aid. I don’t get to comfort myself at their ‘expense’.
Obviously someone who chooses the name Touch2Touch for their blog has one set of attitudes about this subject. For instance, a massage is my idea of heaven!
But of course you are right, Stef — for many people touch may be intrusive, unwelcome, threatening. So it’s wise to ask, to be respectful — In any counseling course I know of, that is a big topic.
For me personally — coming from a non-hugging, non-touching background, and marrying into quite an opposite family — I’ve done a 180 on the subject.
I’ve watched the video Free Hugs umpty-ump times and get emotional every single time, at the initial wariness and mistrust of most people toward an embrace, at the responses of those who break through it, perhaps even at the wistfulness of those who cannot, but look on longingly (or am I making this up?) — so complex, so amazing.
(I certainly understand the trauma of anyone abused in even the slightest way and the relation of touch and power — What startled me, though, were the words “coddle” and “pander” — not terms I can readily associate with touching.)
Because touch *is* so powerful, people who are aware of this can (unfortunately) choose to exploit it and use it as a manipulation tactic (i.e., think of sales people who gently touch a customer’s sleeve – b/c this action is one of ‘bonding’, and increases the odds of a sale…) – so this is the general arena where the terms “coddle” and “pander” sprang from…
Hmmm, never thought of this. Thanks for the explanation.
If I’d been in the chair I would have mentioned my inability to concentrate the moment the conversation started – maybe with a little humor about my eye-ear coordination (or lack thereof), so they’d know I was having difficulty. I’ve found that if i don’t speak up about any discomfort or disagreement immediately, my point of view gets less consideration. And I’ve always found humor to be a good foot in the door technique, even when a situation is sticky, maybe especially then. From M’s description of the touch, I’d say the tech was giving a double message, one verbally (“we aren’t usually this chatty”), and another physically. If it was indeed a “neutral” touch, I’d interpret it as a kind of apology, a look-I’m-sorry-I-didn’t-mean-to-irritate-you kind of reassurance that didn’t come across in her words. Any kind of touch conveys a message. We must have a kind of body-located touch interpreter. We might have to learn to consciously pay attention to it the way we do to our gut…
Very interesting to compare your comment here, Pauline, with Stef’s (which will follow) —
Touch is a complex thing, then, meaning different things to different people. Perhaps we need to pay attention, as you say, to the messages coming IN, and also to the messages we may be sending OUT —
I think it was patronizing, and I’m surprised you were able to tolerate it. I know people with jobs are still people and they have needs as well, but you’re right that in the medical industry a lot is at stake. It’s a calling.
Thanks for your comment, Christine. The incident — and the account — belong to my friend Meg who, by serendipity, is arriving here to visit from Arizona next week. She eagerly reads all responses on the subject, so thanks from her as well!