The Power of Therapeutic Touch in Healthcare

Dr. Abraham Verghese, renowned physician author and infectious disease expert, writes about the account of a woman seen at his tertiary care hospital with advanced breast cancer. Her electronic record contained volumes of detailed medical records, imaging, laboratory, and genetic analysis studies. She had been attended by a number of expert oncologists and radiation therapists at several hospitals and clinics. Yet the irony stated by this patient was that of all of the subspecialists who saw her, not one had bothered to examine her cancerous breast. Unfortunately, this woman’s plight is not an unusual occurrence in the healthcare system today. Amidst a technology driven healthcare system boasting of advances in medical knowledge ranging from miraculous medications, unparalleled diagnostic imaging, and the unleashed power of mapping the human genome, the physical examination seems a mundane sometimes meaningless routine. This was not always the case.

Dr.Verghese describes the physical examination as a ritual transformation bonding healthcare provider to the patient in an intimate manner incomparable to any other professional activity. We as healthcare providers are ‘licensed to therapeutically touch’, as no other profession, however powerful and skilled. In fact, the touch related to a proper physical examination has a powerful therapeutic property. Physicians of old understood this in a way that seems underemphasized today. My medical training as a physician assistant took place in the late 1970’s. I remember my textbook, DeGowan and DeGowan’s Bedside Diagnostic Examination. We were taught the fine art of percussing the lungs for fluid accumulation, and to smell the fruity breath of a diabetic in ketoacidosis. We spent hours in small groups practicing this fine art on one another, and back in those days, the medical license still required an observed physical examination to be performed properly. Today, while physical examination is still taught, students rarely observe their preceptors performing the traditional skills cursorily mentioned in their clinical skills classes.

The COVID-19 pandemic has not helped. Virtual visits by telehealth have increased by 78X, producing a quarter trillion dollar industry, and spawning a host of startup companies in the area of digital health. As convenient as these visits have become, it is impossible to do a complete physical examination using this technology. Providers now treat talking heads instead of warm bodies. Of course, there are many routine conditions and visits that do not require a physical presence to deliver care. Nonetheless, we have lost a great deal of the connection which is only possible in the physical presence of a doctor’s office or a hospital bed, or a home visit for that matter.

The disconnection of living in an internet virtual world has affected health care as much as it has our social outlets. It is a rich paradox that amidst the epidemic of mental health maladies, many exacerbated by the social disconnection we are all experiencing, virtual counseling is now offered as a therapeutic solution. We have lost an underappreciated therapy: physical touch. We are greeted with virtual hugs and instagram posts, but what happened to physically being present for and with each other.

While I cannot significantly change the relentless domination of technology at the sacrifice of physical touch in the healthcare system today, I can teach my students that when they lay hands on a patient or listen attentively to the distress and concerns of their patient, they are making a difference that matters, in addition to participating in the highest privilege granted to a fellow human being: therapeutic touch.

The views of the author shared here are those of my own and not the University of Nebraska Medical Center.

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