What are some things that we can regularly do to improve our connections with our patients and improve their health through empathetic activities?
The Medical Board of California has some recommendations when touching our patients.
A Few Rules of the Road:
- Use social touch cautiously. While touch is part of the human experience, patients can feel particularly vulnerable in the exam room and can easily misinterpret your best intentions.
- Separate your social and procedural touch in the visit. Apply the procedural touch needed to complete your exam, and save the social touch for a more appropriate time.
- Before procedural touch, explain what you will be doing and remember that silence is not consent. While you may have done this exam five times that day, your patient may not know what lies ahead. Let them know, and be certain they understand before beginning.
- During procedural touch, continue to augment with a verbal explanation of what you are doing and why. By sharing your knowledge, you can increase a patient's comfort level and enhance their trust in your expertise.
The profession of Physical Therapy is very 'hands on'. At Cornerstone our entire treatment approach is based on touch. While I do not phrase my approach to procedural touch by asking direct permission. "I am going to touch you now." (Personally I think this would create an awkward situation.) I use language like "lets take a look and tell me if we touch your pain." I continually ask how someone is feeling during the exam and treatment and get constant feedback. I will also start by asking them "can you show me where it hurts?" People love to communicate how they are feeling and want to show you where they feel the problem is.
Separating the procedural touch from the caring, empathetic touch is important. I leave empathetic touch for the end and it will depend on whether I felt a connection and what 'vibe' I received from them. Not everyone will take empathetic touch well. In the literature we do not find any body part that everyone feels that empathetic touch is ok all of the time. The shoulder, upper back, forearm and hand seem to be the most acceptable areas.
The thigh is NEVER a good place for empathetic touch. Not sure we needed research to tell us that one but patient surveys are clear that this area is not a good place to build rapport.
“There are other ways to show that you're connecting as human beings, such as eye contact, smiles, [or] touching the patient's shoulder, that are overlooked in the fast-paced ways medicine has evolved" Mark S. Sklansky, MD
(Chief of the division of pediatric cardiology, medical director of the UCLA Children's Heart Center, and professor of clinical pediatrics at Mattel Children's Hospital UCLA and the David Geffen School of Medicine at UCLA.)
I once had a patient stop the initial evaluation as we were taking our history and thank me for not typing on my computer while he was talking. He had not experienced that in all his prior encounters with the numerous medical specialists and past physical therapists.
Listen to your patient first, then let them know that you will document what they have said because it is important.
REMOVE THE COMPUTER FROM BETWEEN YOU AND YOUR PATIENT
Still not convinced? Look through the links we have provided through this post and check out some of the references. There are some good thoughts on improving our care through listening, taking our time and through touch. I was surprised to see the studies myself on the impact of compassion on health. Who knew? This is what I call common sense medicine.
Here is a book by Joel Manby on love in the workplace. If you own your business this is a great book to look at principles that can help you improve your workplace.