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Human Touch: Does It Belong In Medicine?

Doctor holding patient's handThe New York Times asks: “Should the doctor hold a patient’s hand” during emotional times? The comments that follow the short article are the most interesting. Most readers say this question shouldn’t even be asked and that human compassion should always win out. Touch is a human gesture of comfort and understanding.

But some readers disagree. One said she recoiled when the doctor reached out to touch her hand after telling her that her cancer had returned. It felt really creepy to her. Another asked: “What if the physician is also a Catholic priest or a pediatrician and a priest?” Whoa. It becomes more complex when you get into the psyche of the abused.

I have often thought that one of the appeals of chiropractors is that they “lay on hands” and touch and manipulate patients. With 21st century modern medicine, physicians can treat entire episodes of illness with tests, scans and robots and never actually touch the patient. No wonder people feel “dehumanized” and wonder if doctors really care. Touch and compassion are part of the entire human experience and the physician is present during a patient’s most stressful time. But wait, there’s another side. Read more »

*This blog post was originally published at EverythingHealth*

Silence: The Value of Listening

Between what is said and what is not, the truth lies in waiting. Palpate the silence. Hear the double meaning. Smell the hesitation. See the nostrils flare. Watch the direction of the gaze. Feel the tension.

The truth vibrates in myriad ways. It is deep, below the surface. Frank Herbert’s novel Dune illustrates the concept with fascinating fiction. Imagine a people –the Bene Gesserit –  genetically bred and trained as seers into the unconsciousness, sensors of the truth, like breathing lie detectors. Little did I know that such truth seers are not just a part of fiction, and although a rarity, live and walk amongst us.

I have met such a seer. Towards the end of my residency training, a gifted psychologist was assigned to follow me as a routine part of our training. I’d become competent and efficient in administering my craft. “My doctoring will impress her,” I thought with some pomp.

Right before the first person we saw, she told me, “Pretend I’m not in the room.”  Then, for the duration of the morning, she silently observed the patients I saw and my interaction all while in the back of the room.

After seeing a few patients, we’d break and talk. The patients I saw, I felt, were representative of standard primary care issues: Joe forgets to take his medication. Susan can’t quit smoking. Elaine has unexplained abdominal pain. My medical paradigm explained that Joe, like most people,  can’t comply taking continuous medications.  Susan is addicted, not interested in quitting smoking until she’s good and ready. Elaine’s pelvic pain is mysterious but not worrisome.

I’m stunned when, after my medical analysis, the psychologist paused, emitting a rueful smile. She sighed knowingly and responded, “Actually, Joe is angry at his wife and defies her by refusing to comply. Susan has unresolved issues with her father who’s probably an alcoholic. Elaine’s pain suggests sexual molestation.”

“Give me a break!” cried a voice from inside of me. And as the days rolled along there were other voices too.  “I am a family doctor. This is not medicine! I don’t have time for this! Just what you’d expect from a psychologist; too much Freud!”

As the weeks turned, I reluctantly see her hit nail after nail on the head. She saw complex patterns in people’s behaviors and complaints that I’m too blind, and too unwilling, to see.

With this new, almost astonishing, dimension to medicine, I see, for the first time, art, compassion, insight, and intuition as equal partners to the formulas of science. I slowly wonder what it truly means to be called “a doctor,” when so much is missed in the science of “performance.”  I am captivated, begging to know: How does she see? Can I learn? Is she gifted or crazy?

We are in the final days of my tutelage when we meet an enraged Sharon, in follow-up from the emergency room after a miscarriage. She didn’t know she was pregnant, began to bleed, and ended-up in the ER. She was pushed into a back room, left alone for a long time, bleeding heavily. She felt abandoned, angry, and humiliated. The ER attending staff, she insists to me, made her feel like a “slut.” I listen and then promise to investigate and call her back.

In the post-patient meeting I explained to the Bene Gesserit (as I now secretly called my psychologist mentor), “Delays occurred in the ER’s treatment of Sharon and she was over reacting but never in danger.”

“Right about the danger,” the Bene Gesserit concedes, “Wrong about what happened. Sharon had an affair her husband found out about it through the miscarriage.”

Having been humbled too many times, my resistance drops. “What did I miss can you show me?” I beg.

“You sense her over-reaction, her anger, yet dismissed it. Something else fuels her rage. Close your eyes. Pretend to be having a miscarriage right now. I’ll coach you through it.”

“This will be tough.”  I think, “I am a man and can’t really miscarry and am sitting in the doctor’s lounge with plenty of colleagues enjoying this play acting.” I close my eyes and settle into a foreign reality. It doesn’t take long to be guided to bells ringing in my head. “I don’t feel like a slut.”

The Bene ignores me and continues, “The vibrations are always there if you tune your antenna to the right frequency. People are pools of water with surface and depth. Illness arises within a context. Ripples on the surface are the symptoms caused from objects thrown-in or vibrations from the past arising to the surface. To reveal this union between the physical and emotional bodies is a unique potential of a healer. “

Sharon’s husband visited my office three days later, chief complaint chest pain. The betrayal was written all through him and verified as forecasted by my mentor. Unnerved I began in earnest to train my own antenna as to reach my fullest possible potential as a healer, a potential only realized by committing the time to listen comprehensively, intuitively, respectfully needed to do so.

Medical care today is all about the quantitative: 10-minute office visits, performance-based measurements, and only the facts.  Medical problems are often not simple algebra formulas where the sum equals its parts. Many times healing requires the art of listening, intuition, trust,  insight, empathy, grace and even spirituality. It’s not neat, nor quantifiable, but many have journeyed through life enough to know it’s true. Even after all the science has spoken, the art hides itself in myriad ways, patiently waiting.

Until next week, I remain yours in primary care,

Alan Dappen, MD

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