Can You Ever Be Too Close to Your Patients?

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As a member of a patient and advisory council at a major Boston hospital where I resided for several months during a complex liver transplant in 2005, a topic of ethics came up recently. The subject was "To Hug or Not?" The conversation was framed with a story about a physician whose human instinct tells him to offer a hug to his patients when they become upset, but in the current cultural climate, he has found himself holding back, unsure of what the patient wants and needs in that situation, and what the perception will be if he offers a hug.

A panel composed of an advisor, a palliative care doctor, a director of spiritual care, and a patient relations representative provided their perspectives on providers hugging or not hugging patients who become emotional. Clearly, there is no easy answer to this, so it is a conversation worth continuing as doctors seek guidance.

Imagine that you have just received upsetting information from your/your family member's doctor, and become emotional. Under what circumstances, if any, would it be ok for the doctor to comfort you with a hug? What might you say to a classroom full of doctors-in-training about "the right way" to comfort a patient when the patient is emotional?

A person on the advisory council that I belong to said this: “I have several doctors that end and start visits with hugs. They read me. They know I accept them.”

She continued, “I’ve been hugged by my oncologist who I’ve known for 15 years. But, an RT (who I had never met before) ended a very recent biopsy with a hug. Both were welcomed and comforting. There are several doctors I have that, if they offered a hug, would not be comforting. It’s just the connection two people have.”

There is no easy answer. Or a black and white formula. While we can’t easily explain or teach body language, I would start there. It’s a fine line, isn’t it? Offering what feels like natural comfort (which may be received as comfort) versus initiating potentially threatening behavior. My guess is to err on the side of caution and to not offer physical contact will be the preferred method encouraged to doctors. 

Personally, I feel very connected to my medical team and would in no way be put off by it, but I realize I'm probably not the norm. I do remember more than a year ago when I was told I needed to have both hips replaced (eventually) but one immediately. My liver doctor (who didn't make this diagnosis, but knew of it) sat on a small rolling chair and came very close to me and took both of my hands and looked into my eyes and said, "Nancy, this should NOT have happened to you. You were on very low doses of prednisone (I had two organ rejections early on after my liver transplant). We just don't see this happening to people that often." I became more emotional but so appreciated his warmth, concern, and compassion. I also feel that people will either tell you they're not comfortable -- or you can sense it right away. It's not a cookie cutter situation – and one should probably take the patient (personality, demeanor, culture/ethnicity, etc.) into consideration before offering touch.


NancyMichaels 21 highres 
Nancy Michaels is a speaker and consultant on effective communication techniques for medical professionals. She can be reached via her website at www.nancymichaels.com

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