The Importance of Touch

Do healing hands belong in cancer care?

This blog is stimulated by a recent essay in The New York Times about the importance of medical touch.

It is the story of the writer’s experience of a mammogram, her breast cancer diagnosis, and the ongoing diagnosis and treatment that involved a lot of touching.

With the prominence of the #MeToo movement, and our national conversation on touch and consent, this seems an especially relevant topic. Most women have a personal experience of some sort with unwanted touch, and we bring our histories into every exam room. Thoughtful clinicians, like thoughtful people doing all kinds of jobs, consider how best to proceed. Does a doctor need to ask permission to do an exam? Does the mammography tech need to ask permission to handle and position our breasts? Does a doctor need to ask permission to hug or even place a comforting hand on a patient? Clearly a male doctor performing an internal GYN exam needs to have a female nurse or assistant in the room; does a female doctor need to follow this same rule?

When I was in training, there was a frequently told story about patients’ perceptions of how long a physician stayed in their hospital room. Half of the doctors had been told to remain standing, and half were told to sit; they all stayed for five minutes. Not surprisingly, patients guessed that the sitters were there longer. The question of where to sit is also important. Whenever I visit a patient who is hospitalized, I ask what is most comfortable? Sometimes it is clearly the bedside chair, and sometimes sitting closer, on the side or the foot of the bed, would be better. I learned to never sit down without clearing it with the patient. The advantage of sometimes sitting on the bed is being closer and being able to touch. Again, with permission, a hand on a blanket-covered knee or holding a hand is comforting.

Touch has always been part of healing. Worldwide, all healing traditions  include some kind of touch. I often hear complaints from people who meet with a doctor who never touches them. The complaints are stronger when the doctor does not maintain eye contact and may even sit facing the computer, typing in all answers rather than engaging in a connected, face-to-face conversation. It is hard to feel heard and cared about when the doctor is intent only on the keyboard.

Since I believe that all human interactions, let alone ones that are focused on healing, require personal connection, I firmly believe that competent, careful touch is part of a medical visit. Like all cancer patients and survivors, I have been examined by a lot of doctors, and a few stand out for their remarkable exams and care. The best physical exam I have had was from an endocrinologist whose hands were warm and careful and who was thoroughly engaged with me, the patient, during the exam. No one else has ever noticed or commented on small details the way she does.

The laying on of hands is healing in and of itself.

Touch is so important that at the Cancer Center at Beth Israel Deaconess Medical Center, we created a Reiki program in which trained volunteers offer cancer patients hands-on healing with the palms of their hands. The impact of this metaphysical approach has not been proved by science, but many patients find a great deal of comfort in it.