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Monday Feb 26, 2018

Healing or Harassment: Is It OK to Hug a Patient?

Editor's Note: Medscape recently posed the question, "Should doctors hug their patients?"(www.medscape.com) The article drew more than 300 comments with a wide range of responses. We asked our new physician bloggers to answer the same question.

[hands reaching across word hug]

Compassion and Connection

I often don't have to write a prescription for stress, anxiety or abdominal pain because I have already figured out and provided the desired "treatment" to the patient during the visit. Sometimes all people want is to be heard, to be seen or to be touched by another human.

The decision to touch or hug takes a certain level of discernment by the physician. This skill is often referred to as emotional intelligence, and it can enhance one's ability to read the emotional energy of another human being and determine whether touch is appropriate, warranted and welcome. From this information-gathering, a physician can determine whether there are any potential conflicts (such as age, gender, culture, familiarity level, etc.) that would increase the chance that an innocent physical representation of kindness could be misinterpreted.

I recently had distinctly different encounters with two male patients on the same day. One patient was upset about a miscarriage he and his wife had just experienced. I opened my arms, and he stepped into my embrace, looking for comfort. An hour later, another patient seemed uncomfortable simply by my proximity to him during a physical exam. His comments of discomfort during his skin examination, referencing the current climate of sexual misconduct allegations, further confirmed my intuition. This is a patient I would likely never hug.

It is true that each individual's ability to read people and read situations can vary greatly. Therefore, if unsure, the best thing for a physician to do is to ask the patient for permission. This authentic inquiry can itself demonstrate empathy, compassion and connection.

Venis Wilder, M.D., New York

Small-town Perspective

I live and practice in a rural area, and the relationships I have with my patients often extend beyond my clinic's walls. I see them as their physician during home visits and at the nursing home, but I also see them as a member of a small, close-knit community when I go to my daughter's school (where many of them expect hugs), the grocery store, the gas station, sporting events and more.

I would like to think that I can read my patients well. After all, looking for nonverbal cues can add much to our understanding of a situation as physicians. There are patients I have never hugged because it is not something they seem to need or want. However, there are other patients who would be offended if I did not hug them at every visit. There are patients of all ages who approach me for hugs when they see me in public.

I have never felt uncomfortable or concerned about blowback or litigation from this practice. I've always been a hugger and came from a family where physical affection was routine, so to me it just seems natural.

Sometimes touch is as healing as anything else we can offer in an exam room. Indeed, sometimes it is all we can offer.

Beth Oller, M.D., Stockton, Kan.

Finding Balance

I admit it. I'm a hugger, and there's no getting around that fact. Maybe it's my Italian heritage, or it could be the two years I lived in Mexico, where a peck on the cheek was a common greeting. Still, I am careful to limit these greetings to close friends and family.

When I was first asked to write down my thoughts on this issue, I had reservations. With all the sexual misconduct scandals in the news, I think the topic of appropriate physical, interpersonal contact is a tough, hot-button issue, and no one wants to come down on the wrong side. In general, I think we should avoid any unnecessary, nonclinical contact, and it is advisable to have a nurse or scribe in the room whenever possible. Without exception, a chaperone should be present during breast, genital and rectal exams.

That being said, there are certainly occasions where a hug may be warranted. I have had times when a brief, gentle hug helped console a long-established, grieving patient who was in tears because of a recent loss or a bad report. I also have had cases in which geriatric patients hugged me in greeting or to express gratitude. Such instances are few and far between, but it is important not to negate the benefit of the benign, well-placed hug if the situation calls for it.

Knowing when and where it is appropriate is the difficult part, and it takes a great deal of tact, experience and skill in reading social cues. Because of this, I generally try to limit my nonclinical contact to a warm handshake or pat on the shoulder. It is always best to err on the side of caution and keep patient encounters as professional as possible, thus avoiding any unnecessary personal liability.

However, it seems that to be successful in primary care, one must find the balance between the sterile, rehearsed clinician that medical training produced and the warm, trusted family friend that patients often expect their family physician to be.

Kurt Bravata, M.D., Buffalo, Mo.

Posted at 08:53AM Feb 26, 2018 by Venis Wilder, M.D.

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