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Recent Newspaper & Online Columns by Kate Scannell MD

Can you be a doctor without ever touching a patient?

By Dr. Kate Scannell, Syndicated columnist
First publised in print: 11/12/2011

I was checking out the broccoli at the local grocery store when an ex-patient tapped me on the shoulder and began a conversation. I was relieved that he found me in the fresh produce section rather than the wine or bakery aisles.

Naturally, he updated me about his chronic medical problems. I was sorry to hear that his diabetes had become difficult to control, all the while registering the high-calorie, processed foods in his shopping cart -- along with the discounted post-Halloween candy.

Nonetheless, he started complaining about his current doctor -- her "uncaring nature." He was annoyed by her slowness in responding to his recent request for a prescription. He was frustrated with her for "looking at the computer screen all the time" they were together in clinic. And after reciting a sad litany of further grievances, he paused dramatically for a moment before asking, "But you know what irks me the most about her?"

He stared intensely at me and waited, with an expectant smile on his face. Not knowing the answer, I began to wilt faster than the broccoli in my sweaty hands. The "doctor in me" wanted to answer his question correctly and assuredly, because he seemed to be suffering such estrangement from his current physician. He needed a healing dose of connection with an MD, I thought.

Luckily, a grocery clerk appeared and asked whether she could help us. My ex-patient instantly replied, "No. I'm just telling my old doctor here how my new doctor has never examined me."

"Tell me about it," she replied. "I don't think mine has touched me in -- gosh, years, actually."

So there we three stood, amid the melons and tomatoes, touching on the topic of not touching. The clerk eagerly told a story about having a swollen knee last year which her doctor didn't touch. "Not only that," she added, "but when I began pulling up my pant leg to show my knee, he said it wasn't necessary. He didn't even want to see it! He just told me to take some anti-inflammatory -- over-the-counter, mind you -- and get an X-ray."

My ex-patient lamented, "Yeah, the docs don't even do their own blood pressure measurements now. And a machine takes my pulse. Such basic contact with a doctor, someone I'm supposed to trust with my entire body -- it's missing!" He then turned to me with a puzzled expression on his face and solemnly asked, "Can you be a doctor without ever touching a patient?"

I would like to claim that, this time, I answered my ex-patient's question in a helpful, decisive and reassuring manner. And I would like to claim that the three of us ultimately left the produce aisle nourished from our commiseration, fortified with supportive mutual sentiment. But none of that happened. Rather, it seemed that we departed in gloomy resignation.

I realize that the skillful physical examination of patients' bodies has become an antiquated art within my profession. Studies reflect a progressive decline in our hands-on clinical skills which parallels our increasing reliance upon medical tests and technology to "examine" patients and diagnose their illnesses. Most of us doctors now probably touch a computer keyboard at least a thousand times more often than we touch a patient throughout the course of a workday.

But there was a time in the not-so-distant past when the measure of a good doctor depended upon his or her ability to walk into a patient's room -- armed with a mere pocketful of medical instruments -- and diagnose a patient's illness using touch, visual inspection and auditory clues offered by the body. These diagnostic encounters entailed intimate, multi-sensory and mutual human contact between patients and doctors. Patients' fates often depended upon them, and even those with incurable diseases sometimes spoke of a doctor's mere touch as "therapeutic."

That same fully-embodied contact was regularly sustained even when patients felt well, during their periodic "checkups" or "annual examinations." Hearts were heard, skin was inspected, pulses were palpated, livers were percussed. Your physician literally "had a hand" in keeping you healthy. And by repeatedly performing these routine examinations, physicians maintained and perfected their clinical skills.

The point is that the sustained and intimate contact was an intrinsic feature of the doctor-patient relationship, independent of sickness or health. Anyone who thinks that such embodied connection between doctors and patients was irrelevant to mutual trust and good medical care needs to have his head examined.

Yet somewhere along the way, fundamental aspects of the contact changed, associated with tectonic shifts in our identities and allegiances to each other. Hospital-based physicians called "hospitalists" newly stepped into the relationship and took over care when patients were hospitalized. The "annual examination" and "periodic checkup" went the way of the iron lung. Physicians and medical schools paid less attention to honing physical examination skills, while we increasingly prioritized technology over clinical acumen to not only direct medical decisions but define diseases as well.

And we are paying dearly for the cost of estrangement between doctors and patients. Lack of relatedness and trust translates into poorer medical outcomes, patient dissatisfaction, treatment noncompliance, doctor shopping, pursuit of non-beneficial treatments, lawsuits, physician burnout, and greater reliance upon costly arbiters of health care like medical specialists and technology.

Surely, not everyone is dissatisfied with the status quo. And our problems of estrangement won't neatly resolve by reinstituting the annual wellness exam or resurrecting the primacy of physicians' clinical skills. But overall, we patients and doctors are losing touch, and we are suffering the consequences.
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Kate Scannell is a Bay Area physician and the author of the novel "Flood Stage."
© Copyright 2011, Kate Scannell