Doctor-Patient Relationship: Should Doctors Hug Their Patients?

The Pros and Cons of Hugging Patients

The physician/patient relationship is intrinsically intimate. During the course of clinical exams, doctors may touch and palpate their patients, ask sensitive personal questions, and sometimes present them with gut-wrenching news. Despite all of that—or perhaps because of it—doctors still debate a simple question.

Is it okay to hug your patients? The answer: It depends.

Given recent months’ numerous accusations leveled at prominent people for alleged sexual harassment and inappropriate behavior, there is a new tone affecting personal interactions. While instances of assault are pretty clear, it’s important to note that behavior which one person considers innocent could be distressing to someone else. More self-scrutiny is required now than in the past.

Doctors care about their patients. A hug is a fundamental physical expression of caring. Ergo it can be appropriate to offer a hug. That’s the opinion of Dr Lucy Hornstein, a family physician in Phoenixville, Pennsylvania.

“How much more viscerally and subliminally can you express that you care about someone?” asks Dr Hornstein. “You can say, ‘I care about you,’ and touch them on the arm or shake their hand, but that’s not the same as putting your arms around someone. It’s the most primal way of expressing care.”

Arguments on the con side of the debate are far more varied. Some worry that a gesture of caring might be misconstrued as a romantic overture or sexual advance, exposing them to charges of harassment or misconduct. Others say that it’s unprofessional, may be culturally offensive to some patients, or may be damaging to those who have suffered trauma or abuse. Many of these arguments nibble around the edges of a core objection: Hugging violates the patient’s right to not want such contact.

“I guess I’m always the Grinch on this,” says Mark Kuczewski, director of the Neiswanger Institute of Bioethics at Loyola University in Chicago, “but it’s really a question of thinking about the normal standards of informed consent.”

Patients Want to Please Their Doctors

In a clinical exam, patients consent to being touched. They haven’t consented to any other intimate contact, however. Although some patients might welcome a hug, others might consider it an invasion of their personal space or a sign of attraction. Despite their discomfort, they’re likely to submit to the embrace.

“There’s a power imbalance,” Kuczewski says. “Patients want to please their doctors. A patient is not going to say, ‘Please don’t do that.’ They are going to go along with it.”

Doctors who advocate hugging are aware of the arguments against it, but insist that common sense can alleviate the risk that the gesture might be unwelcome or misconstrued.

“I have been seeing some of my patients for 20-plus years,” says Dr Robert Lee, a family physician in Johnston, Iowa. “It would be odd to see someone you’ve known for 20 years and not give some sort of embrace.”

Although Dr Lee says he generally offers a side-by-side shoulder hug, an arm squeeze, or a simple pat on the knee rather than a full embrace, he’s conscious about being sure to touch a patient in some way.

Common Sense, Compassion, and Conservatism

“I can’t tell you the number of time that patients have come back to me after seeing a doctor I’ve referred them to and said, ‘They didn’t even touch me,'” Dr Lee continued. “The patient may not have needed to be touched. They just needed the doctor’s opinion, but the patient wasn’t satisfied. I firmly believe in the power of touch. Patients expect and appreciate it.”

And sometimes, he says, there is just no substitute for a hug.

“It’s usually appropriate when there’s been a death,” he says. “I think one of the fears physicians have is that it’s hard to extricate yourself in those situations. Once you give that hug, that may not add an extra 3 minutes or 5 minutes to the visit, but an extra 20 minutes. A patient may want to talk, and you are not trained in being a therapist.”

But even doctors who say hugging can be acceptable are quick to point out that there is no blanket rule or policy that can cover every situation.

Dr Hornstein, who generally offers hugs to her patients, says the appropriateness of the gesture depends on a laundry list of variables. Whereas a longtime patient might welcome a hug from a familiar family physician, they certainly wouldn’t expect it from a podiatrist or gynecologist they’d just met.

“It’s going to depend on your specialty, the clinical scenario, how long has the doctor/patient relationship been established, the doctor’s and the patient’s preferences, and cultural issues,” she says. “A given doctor has to decide whether it’s okay in a given situation.”

Navigating the Landscape

Fairly or not, age and gender come into play as well. Whereas a young patient might find the prospect of a hug unsettling coming from a young male physician, she might welcome a hug from his more mature, female colleague.

“I’m going to call it female privilege. A man is absolutely putting himself more at risk than I am. Getting a hug from me is like getting a hug from your mother or your aunt,” Dr Hornstein says. “The older I get, the more I fall into one of those ‘safe’ categories.”

So how do you navigate the landscape? Folks on both sides of the debate offer a little guidance:

• Don’t try to be something you are not, says Dr Lee. If you don’t like to be hugged, don’t start hugging your patients.
• Read the patient. When talking with a patient, Dr Lee might touch them on the shoulder or knee so they know they have his full attention. “If I see a pull-back, I understand that that is something they don’t want.”
• Be patient-centered. “The patient’s culture is the one we want to take into account,” says Kuczewski.
• Ask permission. Using a neutral tone and body language, Dr Hornstein asks, “Do you need a hug?” and is perfectly comfortable accepting “no” for an answer.
• Remember, relationships change over time. Little Julie or Johnny might have jumped off the table to hug you when they were toddlers, but they’re likely to feel differently as teenagers. Respect their space.
• Never hug a patient unless they are fully clothed, says Dr Hornstein. “That goes without saying.”
• “Be flexible with your support,” Kuczewski says. Just as doctors need to know how to respond when patients ask them to join them in prayer, so too doctors need to learn how to deal with situations where a patient may need a little extra emotional support. “Responding appropriately is what we are after here. We don’t want to put the burden on doctors to be mind-readers. Simply asking, ‘I think you could use a hug. Would you like that?’ gives the patient a chance to say, ‘I’m not a hugger,’ if they want to.”

Recognizing that the interaction is about the patient and what they need is critical, says Dr Hornstein. “As doctors, it’s our responsibility to read the nuances of a situation and err on the conservative side,” she says.

Source:Shelly Reese. Should Doctors Hug Their Patients? – Medscape – Jan 03, 2018.