This article appeared February 19, 2018 in Medscape. Because clinical medicine is called a helping profession (as is teaching, nursing, psychotherapy, and social work) the relationship between doctor and patient is crucial to improving health and providing care for those whose health is deteriorating beyond what doctors can do. In such professions, dilemmasare rife. Whether or not to hug patients, a dilemma known to others in the helping professions where values of being a professional and being personal and humane clash, speaks to educators as well.
Avoid Hugging Your Patient
Although there are many pro-hug physicians, there are also many who are strongly against it. Many physicians are adamantly opposed to hugging because they believe that it changes the physician/patient relationship and creates potential risks.
A neurologist said:
I was always taught a hug can be misconstrued. I still stand by this concept. If someone has a loss, I will touch their arm and express my sympathy. This is why it is good to keep a certain distance to avoid this situation in the first place. To treat a patient, you must have their respect. If someone is too familiar, it can get in the way of treatment. Just my two cents. You want to be treated by your physician whom you respect, not your buddy you can have a beer with.
An infectious disease physician agreed:
I try not to hug anyone when I am in a professional setting. I try not to even handshake, in that I consider that action a business-to-business relationship (sealing the deal with a realtor, for example). Furthermore, in my subprofession, infectious diseases, I think some patients are appreciative not to shake my hand upon entry to the exam room or arriving at the patient’s bedside.
One anesthesiologist talked about potential risks:
A physical exam includes more than enough touch to comfort a patient. Take the vitals yourself, listen to the heart, lungs, and abdomen, and that is more than enough touch. Do not put your career in the hands of a potential nut-job or gold-digger (they do exist, you know). If a woman accuses a man of improper touch, Oprah says we have to believe her. The risk/benefit ratio is too high.
An ob/gyn echoed the comments above:
What you think will be a good idea hugging the patient may come back to haunt you. You’re not a mind-reader. You don’t know how the patient will react or what the patient thinks about you reaching over and hugging them. It’s like walking through a minefield. Maybe you get across without being hurt. One misstep and it can blow up right in your face.
A dermatologist who is against hugging, but who has been hugged by a patient, said:
I have grappled with this question over the years, but I mostly settled on total avoidance of embrace. An occasional hug when there has been a death in a patient family, but I recall this as once every few years. I have also been caught unawares on a few occasions when the embrace was initiated by the patient.
Awkward, but I have always managed to extricate myself from it. Those of us who have chosen a single lifestyle do have to be that much more careful. In the current environment, I will institute total avoidance without exceptions henceforth. Fortunately for me in a consultative specialty practice, long-term relationships are few.
This physician concurred: “My office visits are strictly on a professional level for the benefit of the patient. I do not hug any patients, or allow any patients to hug me.”
The reasons to avoid hugging are plentiful, says an emergency medicine physician. Hugs may make the recipient feel better, but the cons include the following: “The recipient calls the police and files charges of sexual battery. The district attorney chooses to prosecute. The patient files a lawsuit. The medical board revokes the doctor’s license. The doctor becomes bankrupted from the costs of his legal defense, plaintiff’s award, and loss of income and restriction from practicing medicine.”
Another emergency medicine physician agreed. “Many a career has been ruined by three simple words: ‘He touched me.’ It all comes down to how the recipient perceives the contact. If it is perceived as a physical violation, then that’s what it becomes.”
Another healthcare provider said that listening is better than hugging. “No, we should not ever hug patients. It is an unequal relationship and can be misconstrued. Shaking hands, speaking kindly, and spending time are proper. And practicing the lost art of listening. That’s what patients want.”
Another physician adamantly opposed to hugging said, “No hugging. This is not a friendship; it’s a professional interaction with a patient. Businesspeople don’t hug, lawyers don’t hug, we shouldn’t either.”
This physician offered an alternative to hugging:
I shake hands or say a traditional ‘namasthe’ with both hands touching as in praying, which conveys all of my good feelings, thoughts, and wishes to my patients effectively. I go out of my routine and keep a hand on the shoulder of the depressed and those suffering a poor prognosis. The mind conveys everything. I have never had to hug a patient to convey my best intentions or my empathy. I am in the business for the past three-plus decades.
One psychiatrist suggested an interesting interpretation of the hugging interaction:
Come on! Who is this hug for? The hugging doctors sound like they are tethered to prove something to themselves and by extension to their patients. I’m a nonhugger with exceptions, but as a psychiatrist, respecting the boundaries of people for whom that has not always been the case is something I can do for them. If a doctor hugged me, I’d get another doctor. I’m not convinced the hugging docs truly read their patients correctly because of the inherent power imbalance.
Finally, although it appears that there are numerous reasons why physicians have different views when it comes to hugging patients, they have also made it clear that in the current climate where hugs may be misconstrued as sexual harassment, it is wise to assess the situation and to use a cautious approach when initiating a hug or when receiving a hug.