Introduction Given the numerous accusations recently directed at high-profile people for alleged sexual harassment and inappropriate behavior, there is a new caution affecting personal interactions. People are concerned that formerly "acceptable" behavior could now land them in trouble. Doctors care about their patients, and a hug is a common physical expression of caring. But is it appropriate to hug a patient? A recent Medscape article that asked this question received numerous responses. Some physicians say that a hug is a natural way to show patients that you care, especially if a patient has cancer or is grieving. Receiving a hug also enables the patient to show gratitude, said several physicians. On the other side, some physicians contend that hugging a patient changes the dynamics of the physician/patient relationship and that doing so is very risky because it could result in discomfort and lawsuits. Other physicians said it's fine to hug a patient, but only if the patient initiates the gesture. Giving and Receiving Hugs Hugging patients comes naturally for some physicians, especially when the patient has a terrible disease, is grieving, or is lonely and needs moral support. A family physician said: I began hugging my HIV/AIDS massage therapy clients in 1995, when many healthcare providers were terrified to touch them. That experience has made me a "hands-on" physician today. As a woman, mother, friend, and physician, I always say, "I'm a hugger; are you?" And then extend my open arms to patients, allowing them to accept or not. Never has a patient expressed dislike or discomfort. Many have expressed gratitude for the contact, especially elderly and terminally ill patients, who get very little, if any, human comfort daily. This emergency medicine physician said that hugging is the norm where he lives: Being from Hawaii, we hug and kiss our patients all the time because it's part of our culture... If I thought a hug was appropriate, I'd open my arms... If the patient liked hugs, they'd step forward to receive it. If not? They say, "Ah, thanks doc"...and be on their way. I only had two refusals. And it was always in the presence of staff, for today's "rules" and lawsuits arena. Another physician said: I hug every one of my patients and kiss most. That's my culture. It's what "feels right" to me. That's my expression of sympathy/empathy; of "I am in this with you." I strongly believe it helps to build trust, not undermine it; to solidify my commitment to the patient, not the bill. It is my choice to practice this way, but understand if others are not like me. One ob/gyn said: I offer hugs in appropriate situations, and I have many long-term patients for whom this is a natural gesture of greeting or farewell... It is common for me to encounter patients who share enormous pain...marital infidelity, aging parents, deaths in the family, job stress, errant teenage children... during the course of their appointment...and who feel comfortable being honest and vulnerable with me. I have never felt anything but gratitude and human kindness from any patient who either initiated or accepted a hug if the situation warranted. Another ob/gyn agreed. "I hug my patients, usually when they initiate it. Sometimes I'll ask first. Sometimes I don't. Sometimes it's just a human response to the situation. It's OK to hug. Shows you're human." Still, some physicians found it sad that human interactions are now being regulated. "So now we need "guidelines" for hugs?" asked one physician. "That is pathetic." The same physician continued: So many of our elderly patients need and ask for hugs as a greeting or more often, a goodbye. They have had long lives with a lot of tragic and wonderful events...and only discuss or vent about extremely private issues to us. We have known them for years or decades, and the hug is part of the healing art of medicine. We review their history, examine them, and discuss their treatment, and then as they are leaving the office, many want a hug. This hug is acknowledgment and confirmation that we are doing our best to help them, knowing that their personal struggles may be significantly impacting their ability to get well. Several practitioners who are in favor of hugging said that it's important to be cautious. "If my patient asks me 'Doc, can I give you a hug?' my answer will always be 'yes'; however, it will be a 3-second hug and nothing more. I know that they may be grateful or friendly, but in the current climate we should not indulge in any longer embrace," said another physician. A gastroenterologist agreed that it's wise to be careful when hugging a patient: Touching the patient appropriately is therapeutic. Side hugs are highly advised, and NEVER belly hugs. Always let the patient initiate it, and this often involves nonverbal cues. Use common sense. And if you're socially awkward, then it's time to practice and work on your bedside manner. That's part of your job and healing power as a physician. 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. Source
