Wednesday, April 21, 2010

Let Your Fingers Do the Talking

I'd like to elaborate on something I said yesterday, if that's okay with you (how would I know if it wasn't? Beats me, but I wanted to be polite and include you, anyway). I mentioned that, as osteopathic medical students, we're trained to use touch in the promotion of wellness and well-being. What I didn't mention are the risks involved, not for the patient so much as for the practitioner, and this is where the water gets murky.

I can't produce the data offhand -- must have left it in my other shirt -- but satisfaction surveys consistently report that patients like working with their osteopathic physicians because of the personal attention they receive. I can't prove what I'm about to say, but I believe this is due, in no small measure, to the fact that we touch our patients. You may not realize it, but when we stand behind you and palpate the lymph nodes along the sides of your neck, for example, then run our hands across your shoulders, we're evaluating muscle tone and thus, gathering information about your emotional, as well as physical, condition.

At the same time, we're also telling you about ours -- the communication goes both ways. You might notice that we seem (feel) hurried, upset, happy, or sad by the character of our palpation, the tension in our fingers or their pressure on your skin. As much as we try to maintain an appropriate professional distance, information passes through our fingers that we can't hide. For the most part, we aren't consciously aware of what we're "saying." Nevertheless, you come away with a deeper understanding of us than either you or we realize at the time and this is reflected in the quality of our relationship.

One of my most favorite authors, Dr. Harold Searles, has written about a fascinating dynamic that can take place between patients and their doctors. He says patients have an uncanny ability to sense when, and in what ways, their doctor is in need and often endeavor to help by bringing up similar concerns in their own lives. Patient and doctor cooperate to heal the patient and in the process, heal the doctor as well. I mention this because it points out how the relationship between us, between doctor and patient, can never be entirely one-way. The element of mutual self-revelation -- conscious and unconscious -- is always present.

It is the acceptance of this risk, that some knowledge of us will be accessible to patients, that renders osteopathic interaction so very real and personal. I can imagine some of my medical school colleagues asking, what about psychiatry, isn't that the one specialty where touching patients is prohibited? Yes, it is, and for that reason we must be very good at using our other senses to reach the same goal. But Searles was writing about psychiatry, so the matter of self-revelation isn't eliminated by restricting physical contact to a handshake. The point is, using touch to evaluate and treat patients inserts another piece into the relationship puzzle and it's one of which we need to be aware.

Returning to the theme of rites of passage, OMM takes us past the obvious issue about touching another human being and into the realms of relationship and personhood. We don't dwell on what it means, this kind of contact we have with patients and one another while in training, nor should we have to. The take-home message is we're creating a relationship that goes deeper than we think, and whether we're budding psychiatrists, internists, gynecologists, or surgeons, we're actively relating even when our mouths are shut and our fingers are doing all the talking.

(Creative Commons Image by
Archie McPhee Seattle via Flickr)
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