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A few words about touch

When I was a college student, I received a short neck examination by someone whose touch clearly communicated expertise and efficiency. The exam was so impressive, that I have remembered it for more than 25 years. It helped me become aware of some of the communicative value of touch. Of course, that single experience didn’t provide me the breadth of information needed to manage the most appropriate clinician’s touch in all circumstances, and I’m not certain I ever will achieve mastery in skillful clinical touch. However, the experience generated in me an awareness of the importance of touch for me and many types of healthcare providers. I submit that skilled touch is particularly important for those of us in the chiropractic profession. How can it be anything but important for a profession whose examination and treatments are largely manually based and whose professional name was chosen in part due to the prominent role our hands play (Chiro – hand)?

Touch can be many things. It can be therapeutic, threatening, soothing, and educational. It can communicate empathy, intent, confidence, compassion and skill.[1] So then, why is the topic of touch so little discussed or studied in the chiropractic literature? In fact, touch as a topic of research or discussion is relatively sparse among most healthcare professions. Perhaps, because touch is so basic, we tend to simply look past it. Perhaps because, touch is so complex, it is difficult to study and accurately measure its effects.

For those interested in the topic, there is some informative literature available. Elkiss et al., discuss the subject of touch as an effective examination and therapeutic tool and as something that has the potential to enhance the doctor-patient relationship.[1] A study by Cocksedge et al., surveyed general practice physicians and patients in Great Britain on the topic of touch.[2] Patients reported that a doctor’s touch improved communication quality and considered non-procedural touch on the hand or forearm to be appropriate. Some physicians reported that they avoided touching patients unless necessary for examination, explaining that it wasn’t within their personality to otherwise utilize touch. Patients were somewhat more accepting of touch from female compared with male physicians and several doctors reported substantial concerns that their touch can be perceived as inappropriate. The article acknowledges that patients of differing cultural backgrounds may have different opinions about appropriate use of touch by providers and that different clinical scenarios may call for different amounts or types of touch.

More attention to the topic of touch is worthwhile for the chiropractic profession. As educators, we can and should infuse the importance of and communication components of touch into our teaching, as clinicians we can benefit from becoming more aware and educated about how our touch can be perceived and utilized most effectively, and as researchers, we can and should find ways to study aspects of this important and complex communication pathway.

Reference List

1. Elkiss ML, Jerome JA: Touch–more than a basic science. J Am Osteopath Assoc 2012, 112(8): 514-517.
2. Cocksedge S, George B, Renwick S, Chew-Graham CA: Touch in primary care consultations: qualitative investigation of doctors’ and patients’ perceptions. Br J Gen Pract 2013, 63(609): e283-e290.

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