Touch and Trust

For a physician, the sense of touch is closely entwined with the treatment of a patient. We learn the physical exam maneuvers that help us demystify the internal workings of the human body, at least enough to glean more precise information about the person’s ailment. We press on the sinuses to gauge whether a sinus infection may be present. We pull on the earlobe to distinguish external otitis from middle ear otitis. We feel the pulse of life between our fingertips and their neck, wrist, foot. We feel the vibration of fremitus as we cup our hands over the site of their pneumonia. We feel an enlarged and hardened liver in the right upper quadrant, a firm spleen in the left. We tap at an ascites-filled abdomen and listen for dullness versus resonance. We feel the sphincter tone, or lack thereof in a patient with spinal damage. We feel the heat of cellulitis or a swollen, angry joint and compare it to the relative coolness of the other limb. We palpate up and down the vertebrae searching for point tenderness in a person who has bony metastases from cancer. We feel loose, rubbery lymph nodes reassuring us of a benign infection versus the hard, fixed stones pointing us toward a more malignant etiology. We feel the snap-crackle-pop of ‘Rice Crispies knees afflicted by osteoarthritis. We feel the thrill of a loud heart murmur under our flat palm on their sternum. We feel the bruit of a dialysis access fistula.

But of these, perhaps the most important is the feel of a patient’s hand wrapping around your own in a silent moment of trust — trust that everything you have said, done, and felt to this point has been noticed, and you are being looked at to guide them forward in their health, wherever that may lead. The power of touch is such that it can build this level of understanding between two strangers, in one of the most intimate and vulnerable experiences of their lives: this is the essence of the patient-doctor encounter.

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