Part III Healing
Touch
We all are
quite familiar with the physical exam, and what would a doctor’s visit be
without a proper physical? The problem comes; however, when 1) we forget
entirely about doing any form of physical exam and simply stick to questions
regarding history and presenting symptoms 2) we walk through the motions,
simply engaging the patient in what we may feel is only a necessity in terms of
charting for the EMR or 3) (more relevant to healers in training like myself)
in the midst of being so concerned about acquiring and practicing a “skill” we entirely
remove ourselves from the reality that we are a human touching another human,
whether it is for a specific purpose or not. While these 3 reasons are not
exhaustive, they readily come to mind when I think about the pitfalls when
approaching a physical exam within the context of the medical encounter.
In the
spirit of adapting language to modify our intentions and overcome cognitive
biases, this is where I suggest replacing
“Physical Exam” with “Healing Touch.” Simply taking a moment to pause,
breath and re-center myself with the intention of not only eliciting a
potential sign towards pathology, but providing a healing human connection
through touch has been critical for me during my medical school training. If
anything, I realize that my actual physical exam technique is certainly not of
the caliber of a family doctor with 30 years experience listening to hearts and
lungs, so why not take the opportunity to truly provide a soothing touch? With
both a resident and attending physician also conducting a physical exam on
nearly all patients that I see in the hospital, I am not overly concerned that
the patient is being inadequately cared for in terms of the physical
examination. Now, while I have
specifically pointed out encounters from the medical student perspective, the
truth is that all healers, those training and who have practiced for numerous
years can stand to benefit from reframing their intentions when it comes to
patient contact.
Danielle
Ofri of NYU School of Medicine and Bellevue Hospital has become one of my
favorite authors and speakers within the medical field and it is no surprise
that in July 2014 she wrote an article for the NY Times entitled “The Physical Exam as Refuge” that got more than
a few gears churning in my head when it came to changing my approach to the
physical exam. To put it succinctly, her article is pure magic, and I suggest
to anyone willing to change his or her perspective on the physical exam to
follow the link below to read her piece.
Ofri “The Physical
Exam as Refuge”
Her primary point in the conclusion
sums it up perfectly, “So while the utility of the physical
exam for diagnosing illness may not be quite as refined as it once was (though
certainly still quite useful), it has become a tool of a different sort, a
refuge from the intrusion of technology, a moment of only touching and
talking.” Ask anyone in medicine today and the first thing that most will
complain about are EMR’s and the amount of time spent dictating notes or typing
and sitting in front of a computer monster. Just this past week, during
Pediatric Grand Rounds at UVa, our speaker spent the entire 60 minute lecture
discussing how to go about tackling the monster that is EMR and modify our
hospital workflows such that we can actually be more efficient and improve
patient care. While this post is not focused on the technological modifications
that we could implement to allow us to operate outside of the “monolithic EMR
system,” we must realize and take any opportunity to engage our patients
without involving a computer screen.
To
wrap up and bring this post to a hopefully cheery and more practical ending, I
will share with you a recent patient encounter of mine that was precisely what
I think of when it comes to “Healing Touch”. I was seeing a young 7 year old
boy with Type 1 Diabetes in our Pediatric Endocrine/Diabetes clinic. The boy
had some serious energy, yet was polite beyond imagination. It became quite
clear as I started talking to this young boy that his enthusiasm for life was
certainly not restrained by his chronic illness. From baseball to swimming, to
playing adventure games outdoors, this little guy was living life to the
fullest. In addition, he told me in the most genuine manner I have heard to
date- including adolescents and young adults, that he wanted to be a doctor and
go the UVa School of Medicine. So I said, “Well, if you want to be a doctor,
how about we start your training right now?” I had already seen him playing
with the otoscope and ophthalmoscope on the wall and clearly he wanted to have
these tools of the trade in his hands. So I started with him and said, “We are
going to do a head to toe exam and after I do each of my parts of the exam on
you, you will get a chance to do some of the same things on me, how does that
sound? Eager beyond belief, he was already lying upright on the table ready for
me to look at his eyes, feel his neck and listen to his heart. Step by step, I
went from looking at his pupils to shining a light up his nose and in his mouth
to listening to his heart and lungs, and finally gently pressing to feel the
pulses in his arms and legs. While I explained to him that he would have to
have more training to look at someone’s ears and at the back of the eye, he was
overjoyed to listen to my heart beat, feel my pulses and watch my pupils dilate
with a shining light. It was by the far the most enjoyable “Physical Exam” I
have performed during my training up to this point, and amazingly enough,
likely the most accurate and effective. My heart had be stolen by this one
little boy, and through the course of the visit, with the attending speaking
with the mother and I engaging with the 7 year old patient, we had broken down,
together, the barriers of EMR and the temptation to simply go through the
motions of a physical or type endlessly into the computer aka: the pit of
despair. “Healing Touch” is not just an optimistic expression for an approach
to human contact, it is truly a manner of providing therapeutic relief to our
patients that goes far beyond diagnostic relevance. And in the end, we all
might find that, as doctors and medical students, we might just benefit from a
little “Healing Touch” ourselves.
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