Hugging your patients: Is it empathetic—or crossing a line?

While the physician-patient relationship requires a certain level of intimacy, doctors are divided as to whether it is appropriate to hug their patients—particularly given the recent attention on harassment and sexual misconduct, Shelly Reese writes for Medscape.

5 myths physicians believe about patient experience

The arguments in favor of hugging

Proponents of hugging patients—such as Lucy Hornstein, a physician in Pennsylvania—believe that hugging is the most effective and humane way to show a patient support and care. "How much more viscerally and subliminally can you express that you care about someone?" Hornstein said. "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."

In fact, Robert Lee, a family physician in Iowa, said in some scenarios, not giving a hug could make a patient feel uncomfortable. "It would be odd to see [a patient] you've known for 20 years and not give some sort of embrace," Lee said. He added that some of his patients come to him after seeing a different doctor and complained that they weren't hugged. "The patient may not have needed to be touched. They just needed the doctor's opinion, but the patient wasn't satisfied," he said. "I firmly believe in the power of touch. Patients expect and appreciate it."

The arguments against hugging

However, providers who oppose the practice said a hug could be misconstrued as either a sexual advance or a romantic gesture, potentially leading to harassment or misconduct charges. Others said that hugging patients is unprofessional, potentially offensive to patients of certain cultures, and possibly damaging to patients who have suffered trauma or abuse.

For instance, Mark Kuczewski, director of the Neiswanger Institute of Bioethics at Loyola University in Chicago, argued that in a clinical setting, patients may consent to being touched for the purposes of an exam—but they don't consent to any other form of close contact and may feel pressured to accept an offered hug. "There's a power imbalance," Kuczewski said. "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."

So what do you do?

Even though Hornstein is a hug proponent, she said every patient—and every medical encounter—is different, and a clinician needs to pay attention to myriad factors. "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 said. "A given doctor has to decide whether it's okay in a given situation."

But regardless of where they fall in the debate, providers have outlined several recommendations for doctors considering whether to hug a patient:

  • Do not run counter to your instincts, Lee said. If you're not a hugger, then don't hug your patients;

  • Pay attention to your patient. Lee said he sometimes will touch patients on the shoulder or knee  so they know that they have his attention—but if he sees them pull away from the gesture, then he "understand[s] that that is something they don't want";
  • Provide patient-centered care. As Kuczewski put it, "The patient's culture is the one we want to take into account";

  • Ask for permission in a neutral tone and body language—and be prepared to accept a "no" gracefully, Hornstein said;

  • Remember that patient relationships change, and that a patient who wants a hug as a toddler may need more space as a teenager;

  • Make sure the patient is fully clothed before offering a hug—an understanding that Hornstein said should "go … without saying"; and

  • Be flexible in weighing the appropriate kind of support for the patient. "Responding appropriately is what we are after here," Kuczewski said. "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."

Ultimately, however, providers who are unsure about a possible patient interaction should always act cautiously. "As doctors, it's our responsibility to read the nuances of a situation and err on the conservative side," Hornstein said (Reese, Medscape, 1/3).

5 myths physicians believe about patient experience

5 myths physicians believe about patient experience

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