Monday, November 30, 2020

The practice of touch in the days of telemedicine

The Practice of Touch

The pandemic has forced me to realize the value of touch and presence in my roles as a doctor and a father. Where I went to medical school, all students took a course called The Practice of Medicine. It wasn’t about anatomy or disease; instead it taught students how to approach patients and slowly introduce physical contact in order to perform a physical exam. Touch is an intimate contract between doctor and patient. It tells them what they feel in their bodies is real and can be examined, and it symbolizes their doctor’s commitment to helping them heal. When I was a resident on rotation in the intensive-care unit, I learned that even terminally ill patients felt reassured by daily examinations. Their families, too, found comfort in witnessing the ritual and the bond it created.

The Practice Of Touch by Timothy Gallagher, The Sun Magazine, December, 2020, pg. 21

As a psychotherapist when patients come to the office and I invite them into the consultation room, they want to shake my hand. I back up, bow, hands in a praying posture, and say quietly, “Namaste.” They then laugh, knowingly, and sometimes say “Namaste” back or also bow.

They then ask if they need to keep their mask on or if they can take it off. I say, “As long as we are six feet apart you can take it off. Would you like me to put one on?” They invariably take their mask off and say, “No, that’s okay.”

It is so good to see their full face and they are relieved to see mine even though we don’t touch by shaking hands. Psychotherapists usually don’t touch their clients anyway or if they do only with great circumspection and permission from the client.

I keep my window open a bit even when it’s cold out and run the electric heater. Ventilation gives me some sense of security..

Before COVID, when I came home from work, my two-year-old daughter would sometimes yell, “Papa!” and run and tackle me. These days I return home and go directly to the shower without hugging my eager daughter or touching anything. Physical touch is integral to her development: nestling into my side while drinking a bottle of milk or receiving kisses on her booboos. But now touch is also the feeling of my hands incessantly washing hers, and kissing with face masks on in public. There is a new absence of touch when I keep her six feet away from neighbors, when she has to play virtually with friends, and on video calls with Grammy. I wonder what touch will be like for her in a year, or when she is my age. How will this restraint from contact affect her sense of family and community? Ibid p .23

The big fear nowadays is what we might bring home from the outside or what might be brought home to us. Do these fears enhance our mindfulness and gratitude for the social connections we used to take for granted? Might these fears and precautions in the long run make us more appreciative and attentive? I value my time with my family and clients more. It seems more precious. Less like work, obligation, and responsibility and more like blessing.

I will never know if our physical contact helped Pamela heal. If I were her telemedicine doctor, I would have ordered the same tests: a CT scan of her head and face, to assess for internal bleeding, and an X-ray of her knee. The information I gathered would have been the same. Would the outcome have been any different? Ibid. p.23

I don’t know if the outcome would have been different but the experience is certainly different. The mirror neurons don’t fire the same with digital media as they do face to face. When prospective clients call for an appointment they always ask if I am seeing patients in the office. I say, “In the office, on the phone, and on Zoom whichever you prefer. So far 98 out of 100 want face to face. Many have told me they are “zoomed out.”

While the research is yet to be done, I am hypothesizing that there is a difference in outcome between telemedicine and the laying on of hands. The first is technical manipulation based on data accumulation, the second is healing. 

Healing, I am thinking, takes touch.

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