“The doctor did not even touch me,” a patient complains about a recent visit to an emergency room.
The diagnostic tool of the physical examination fades into the background as more modern diagnostic tools take over. In a strange paradox, technology allows the doctor to peer deep inside the body, but at the same time puts distance between the doctor and the patient. The distance becomes more apparent as consultations happen in the virtual world of telehealth. Today, the diagnostic tool of touch is not always necessary to connect to the patient.
In the late 1800’s, medicine was transformed by technology that allowed us to look inside the body. The technology of percussion (lightly tapping on the body) allowed us to use sound to determine what was inside — like an ancient form of ultrasound. Subsequently, the stethoscope brought the once silent sounds of the heart and lungs to the ears. Modern technology has brought us deeper into the living body with the diagnostic tools of xray, ultrasound, CT-scan, MRI, and the list continues to grow.
However, is there more to touch? Is touch more than just an outdated expectation between the patient and physician? We can argue that touch is the most economical diagnostic tool in the doctor’s tool bag. But does this ritual of the physical examination hold something more?
Even beyond the diagnostic power of touch is the healing power of someone witnessing your story and helping you to make sense of it. For the physician, this is listening not just with the ears, but also with the hands, and even the eyes. While the patient can tell their story verbally, sometimes part of the story can only be told through the physical examination. The physical examination is another way for the doctor to connect to the patient and the patient’s story.
“The emergency room’s job is to rule out an emergency,” I tell the patient. “They make sure you are stable enough to go home, and sometimes there is still work we need to do in the outpatient office.” I continue to listen to their story. I invite them to start at the beginning. We then move on to the ritual of the vital signs and physical examination. With this I am saying, “I hear you. I see you. I feel you. I’m here with you. We can do this together.”
As we determine what to let go of in modern medicine, we need to consciously decide what to hold on to and when.
What do we lose when the technology of the Doctor’s Touch is replaced?