Such was the advice from a family physician's lecture during our first week in medical school. At the time, I heard the literal meaning of his message: physicians show concern for a patient's ailment by touching him where he hurts. We palpate the aching abdomen, manipulate the injured joint, and run our hands over the skin rash. To a new medical student, it was welcome advice that gave some direction to my very limited patient contact.
Now, though, as a psychiatry resident navigating the myriad clinical experiences required in my internship, I find myself reflecting on that family doctor's advice and wondering what role, if any, it should play in my patient interactions. Certainly in my medicine rotations I am able to follow his direction in a literal sense. But what about psychiatric patients?
This issue is one with which many of my colleagues and I have struggled as we attempt to establish a foundation on which to build our professional careers. For many of us, the natural instinct when confronted with a patient in pain is to reach out (literally) to offer comfort and support. However, one advisor in my program for whom I have great respect has emphasized the potential for a psychiatric patient to misinterpret the intent behind a physician's seemingly innocuous actions like patting a patient's shoulder or holding her hand. Indeed, literal touching is an instinctive reaction that may actually complicate matters rather than alleviate pain. I recognize that potential on an intellectual level, but I still catch myself fighting the urge to reach out to a patient in distress. I imagine that internal drive comes from a feeling of helplessness, of wanting to help relieve suffering but being unsure how best to do so.
Perhaps the answer to the dilemma can be inferred by reframing that advice in a more metaphorical way. In other words, perhaps "touch where it hurts" really means that a physician should seek to connect with his patient and to attempt to alleviate his pain. This is, of course, one particularly challenging aspect of mental health: to understand a patient's mental anguish. It is an elusive skill that I hope to gain during the course of my training.
Connecting with a patient's psychic pain can be done without literal hand-holding. Instead, empathic listening may be used to acknowledge pain and suffering, and supportive comments may help to alleviate that pain. Knowing what to say and when to say it may be, in fact, the psychiatrist's version of "touch where it hurts." Thus, we use our time in residency to learn the healing effects of language.
I know that a part of me will miss the physical contact associated with caring for the medically ill. However, I am very much looking forward to putting that family physician's advice into practice—just in a more metaphorical manner.