BrazJOtorhinolaryngol.2015;81(3):229---230
www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
EDITORIAL
‘‘Until
Mary
Ellen
held
my
hand
.
.
.
’’
The
critical
importance
of
touch
in
medicine
夽
‘‘Até
que
Mary
Ellen
segurou
a
minha
mão...’’
A
importância
vital
do
toque
na
medicina
Sittingunnoticed onmy officedesk,and constantly grow-inginheight,residesastackofletters---differentsizesand shapes,inhandwritingandletterheadsofalldescriptions, distinguishedbytherepetitiousthemeconstantinthemall: ‘‘...Iwassoveryfrightenedwhenyouwereaboutto
per-formmysurgery...untilMaryEllenheldmyhand.’’ IntheearlyyearsofthepracticeofmedicineIassumed thesefrequenttestimonialsweresimplyaccoladestargeted towards a splendid and unique surgical nurse, my long term partner in patient care, whose talents and caring interactionswithpatients in myexperienceis equaledby none.Quitesoon,however,Icametorealizethatthe tac-tilecourtesiesmyteamreligiouslypracticedwithpatients
− those of providing a soothing touch, a gentle grasp
of the hand, even a slight hug − were not only
surpris-ingly effective in reducing patient anxiety, but gradually cametobeamajorexpectedfactorinourdoctor---patient relationships.
Istillbelievethatmoststudentschoosetostudymedicine in order to experience the unique bonds that develop between patients and doctors. In this high-tech era of medicine, daily accounts are chronicled about patient annoyanceanddissatisfactionwithphysicianswhoavoideye contact,spendthe majority ofthe patientvisit recording dataonaniPad,attempttodiagnosebyorderingan increas-ingarrayoflabtests,andtoooftenfailtoexamine,connect with,andtruly‘‘touch’’thepatient.Mypersonalinternist, amiddle-agedrelicoftheOslerianagewhenstudents gath-ered around the hospitalbed with amentor whoreveled in thedelights of thestrength of abounding pulse, seek-ingapalpableliveredgeanddecipheringatypicalcardiac murmur,inevitablypercussesmychestoneachvisitwiththe
夽
Pleasecitethisarticleas:TardyJr.ME.‘‘UntilMaryEllenheld myhand...’’Thecriticalimportanceoftouchinmedicine.BrazJ
Otorhinolaryngol.2015;81:229---30.
‘‘thump-thump-thump’’ofapracticedfingerandhand.Both heandI understand theunlikelihood ofrevealing a chest problemundiscoveredbyradiographicimagingor somnogra-phy,butwemutuallyappreciatethetouchandthevaluable timeitaffordsforfurtherhistory-taking.
InthefifthcenturyBC,Hippocrates,theacknowledged fatherofmedicine,wrote: ‘‘Itisbelieved byexperienced doctorsthattheheatwhichoozedoutofthehand,onbeing appliedtothesick,ishighlysalutary.Ithasoftenappeared, whileIhave been soothing mypatients,asiftherewasa singularpropertyin myhandstopullanddrawawayfrom theaffectedpartsachesand diverseimpurities,by laying myhandupontheplace,andextendingmyfingerstoward it. Thus it is known to some of the learned that health maybeimplanted in thesick bycertain gestures, andby contact,assomediseasesmaybecommunicatedfromoneto another.’’
By no means doI suggest that cure of disease derives singularlyfromthetouchofahand,butexperienceteaches thatgentletouchduringexaminationandinteractionwith patientsyields,attheveryleast,emotionalwell-being.
Otolaryngologistsinparticularareaffordedthe opportu-nitywitheverypatientexaminationoftheheadandneckto putintopracticegentletouchmaneuvers.Anotoscopeheld deftlyinthetipsofthefingers,paralleltothefloor,provides aglimpseoftheauditorycanalandeardrumfarmoregently thanwhentheinstrumentisgraspedlikeathreatening ham-mer.Theexploringtonguedepressor,providingaccesstothe oralcavity,servesbestwhenaconsciouseffortisexpended togentlydeflectthetongueandlips.Indirectmirror laryn-goscopyandnasopharyngoscopybothpossessthepotential for discomfort ifthe tongue is grasped in an unduly firm manner.Patientsareacutelyawareof thevast difference betweenaroughmanipulationandpalpationoftheneckand thedeftfingertipexplorationfornodes,glandsandpulses. Thesemanipulations areexamination touches,asopposed toreassuringtouches.
http://dx.doi.org/10.1016/j.bjorl.2015.03.001
230 EDITORIAL
Eyecontact,listening,touching,andobservationarethe
hallmarks of traditional medicine, and establish the vast
difference between the ‘‘health care provider’’ and the
physician.
Touching, after all, is an effective, inexpensive, and
easily-administeredmedicationtoemployinboththe sick
and those who simply experience foreboding in medical
interactions.
SomeyearsagoIlosta youngerbrothertotheravages
ofmetastaticcancer, despite the veryfinest of care bya
legendaryoncologist.Asmybrothercametotheendofhis
courageousbattlewithanincurabledisease,withhisentire
familygatheredaroundhim, hisphysiciansatonthebed,
liftedhispatientintohisarms,andmurmured‘‘I’msosorry
Icouldnothavedone morefor you.’’More thanatouch,
thatsingular gesturespoke volumesabout the humanistic
qualitiesofacaringphysician.
Patientsdesire,expect,andbenefitfromthereassuring
gentle touch of theirphysicians. It representsa powerful
tool,essentialinthephysician’sbag.
Andearlyinhisorhercareer,mayeachphysiciandiscover
aMary Ellenasavaluedandessentialpartofthemedical
team.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
M.EugeneTardyJr.
