Let's face it—no one says I had a wonderful experience getting a CT scan today. But they do say, I had a great doc take care of me today; she shook my hand firmly, looked me in the eye, and really listened without interrupting me; she did a thorough heart exam and explained what was going on in plain language so I could understand it. Listening, examining, and connecting.
I wrote “The Power of a Handshake” (Spring 2015 Intima) because as a teacher of the physical exam, I think the exam is an essential component of what we offer as physicians. There are so many important aspects to our physical connection with patients. For me—it all begins with a handshake. My handshake initiates contact between me and the scared or nervous patient. It breaks the ice and also offers respect. It is the beginning of the rituals we offer that helps with making a connection that will hopefully lead us to a diagnosis and a therapeutic relationship with patient.
I was taught 80 percent of diagnosis comes from history (which is why we have to listen), 15 percent from our exam, and the multitude of tests we over-order helps with only 5 percent. However, the physical exam and a simple handshake do more than contribute to a diagnosis. It is how we bond and offer healing. In Abraham Verghese's wonderful TED talk entitled "A Doctor's Touch," he describes a woman who is disappointed in the care she receives for her breast cancer at a world class institution because "no one ever touched me; no one examined me."
In John Berens’s "Healing Hands" from the Spring 2014 Intima, he captures this so well in his descriptive poem. I love his realization that the healing in his hands was likely there long before he completed his training. I was moved by his reflection that a wise elderly lady saw this before he did. How true that our patients need us to offer touch and healing, so it is not surprising they often can see things before we do. We use our hands for greeting patients, for examining and connecting with patients, and ultimately as Berens points out—for healing. Let us not take our hands and our simple gestures for granted. Surely our patients do not.
Hugh Silk is a member of the UMass Medical School Humanities in Medicine Committee and oversees the medical humanities teaching of the family medicine residents. Read “The Power of a Handshake” in the Spring 2015 Intima.
© 2015 Intima: A Journal of Narrative Medicine