Should PAs Hug Their Patients?

[surgblumm]

I am writing an article for a malpractice company on this subject in a week and would appreciate your comments. Think first as C-1 did this a few months ago and people who have not practiced in more than thirty years responded. We live in a high profile age when it comes to "sexual harassment" so it is best to think from that viewpoint which would endanger the PA depending on the responses. I will place the article on Physicianassistant.com

[TWR]

I think it depends on the circumstance.  As an FYI probably not on an initial visit.  "hugging" should not be construed as inappropriate as long as your hands are placed appropriately.  Of course the double standard comes in to play because I am a male.  If a female PA hugged a patient would you think of it the same way as a male PA hugging a patient.  You are right we are in a crazy world.  I have practiced for 32 year family medicine and have never hugged a patient.  I have put a hand on a shoulder.

[surgblumm]

Thanks, Tom, you gave new information on this topic by mentioning the hand on the shoulder. I am impressed that you never hugged in all your fruitful years in practice. The double standard is generally accepted as proven experience on this subject.

[lkth487]

I'm a guy and I hug my patients and their parents. 

Although 99% of time, it is only when they initiate it.

[surgblumm]

The last part of your response is good guidance.

[lostzebra]

I'm a new PA. I think hugging patients is a little weird... but I'm also not a "huggy" person. I only hug close friends and family. I've never been hugged by a medical provider. 

[thinkertdm]

I wasn't able to read the article, and I've given bad news, and only once have been asked for a hug by a depressed woman going through a divorce. -the context was ringing alarm bells. Sorry, and next visit, she was seeing someone else.  I'm not a friend, I'm a guide.  Plus, I'm not a hugger.  There's a distinct line around me that only my wife, son, and mom cross.  I keep that part separate from my work.  I get to work, I put on work persona; it allows me to compartmentalize and not take home my work stuff.  Hugging crosses over.

Plus, scabies and bedbugs. 

[Reality Check 2]

I hug. My family hugs. I am a human touch kind of person. If you meet my extended family - you will be hugged, fed (repeatedly) and hugged some more. 

My patients initiate hugs 99% of the time. I work with PTSD and have to be careful about touching patients - at all. 

My conversations with patients have become different at the VA. Touch can be violating or controlling - particularly women vets but males too. After I know the history - PTSD, assault, trauma, etc -- I ask - I just put a question out there - "are there parts of physical exams that make you uncomfortable? Please tell me - we can adapt."

Many of my patients are surprised I ask and then pleased. I have a history myself so some motions and movements make me uncomfortable. I try to respect that in others. 

I helped a guy through methadone withdrawal the other day. He is in his mid 60s. He felt like hell and we got a lot done when he just walked in to address his situation. He is a widow - he doesn't have a lot of support.  He asked me at the end if he could hug me. Of course, I hugged him. Human contact is so vital to health and well being. It wasn't creepy or inappropriate.

My little old ladies in Family Practice hugged me all the time. I started to smell like their grandma perfume and had my fair share of itches from wool that I am allergic to. I would never NOT hug them though. Little kids gave me fist bumps and some are just huggers - whether they hugged my knees or climbed me to get around my neck. NEVER turn down a hug from a toddler who LET YOU examine them. 

We can't become automatons who don't interact. There are inappropriate hugs and touches - you worm your way out of those and set boundaries. Otherwise - please stay human.

 

[GetMeOuttaThisMess]

I pat shoulders a lot.  I’ve hugged at the VA in the past and also participated in a family prayer (same patient) that I was asked to give impossible options to in a terminal setting (first time I had seen the patient because the resident wasn’t available and scheduled the patient/family on a date that they knew they wouldn’t have to be there).  The family was made up of ministers and based on how I treated the patient/dad they asked me to join them which I happily did.  Probably one of the best moments in my 35 years.  In my current setting, aside from small kids hugging my leg, it’s hard to imagine a need for a hug because of treatment for snot/cough.

[AbeTheBabe]

I hug if the patient initiates only. I think it would be kind of rude to turn away a hug, no?

[SedRate]

I'm not a hugger but I will reciprocate a hug that was initiated by my trauma patient or their family. As you can imagine, the trauma field is often very emotional and stressful, and oftentimes they just need a hug. Universally, the hugs have been out of gratitude with the exception of one that was similar to Thinktdm that I also declined after stating my reasoning.

[Guest ERCat]

I have hugged or given caring touches to patients in the ER. For some reason I’ve had a lot of patients who have come into the ER and just start crying about some unrelated complaint, like feeling sad that a spouse that just died or feeling frustrated about their disability or feeling disappointed in themselves for relapsing. In those cases I have sat closely to the patient on the bed and given supportive hand squeezes or have put my hand on their shoulder - it is so hard not to when someone is in tears, and it really makes them feel better. If someone is in pain after a procedure like an I and D or after a digital block I will often pat their upper back and tell them they did a good job getting through that. When giving bad news I tend to touch the patients’ hands or forearms. The old ladies like hand squeezes when they’re scared! I am a female and never thought much of this...is this creepy?! I never have I ever gotten a complaint. I usually get positive feedback. I don’t usually initiate full on hugs but sometimes super appreciative patients and their families will come up to me, reaching their arms out for a hug, mostly in appreciation. In those cases I always hug back. I had a patient’s mom randomly run up to me in a cafeteria once, instantly hugging me and weeping because I had MRIed her son (NO reason to MRI, just a bad feeling) and found cancer, and maybe saved his life. I hugged her back. I also was walking through a parking lot once and heard a young male shouting at me. At first I was scared but when I saw him I recognized that he was a heroin addict I had seen a few months prior and had given him medications like clonidine and Zofran to go home so he could get through withdrawal and finally quit. He started crying when he saw me and told me he was so grateful to me that I listened to him and helped him when everyone else blew him off as a druggie. Then he hugged me and while we hugged each other we were both crying. Once I had an old Vietnamese lady whose family was talking for her and she kissed my hand in appreciation! Even that didn’t bother me. I never thought of any of the above situations as inappropriate. Overall I think you can gauge someone and in the right context a supportive hand squeeze or hug can do wonders for a patient.

[camoman1234]

I hug and pray with patients. I hugged 2 patients this Friday. I always ask: "May I give you a hug?" 

[rev ronin]

10 hours ago, AbeTheBabe said:

I hug if the patient initiates only. I think it would be kind of rude to turn away a hug, no?

This. I also will maneuver an offered frontal hug into a side hug.  Under no circumstances will I allow my groin area to come in contact with any patient.

I will do a seated their-hand-in-my-two-hands while they cry into a tissue with their free hand, and basically any similar gesture that's appropriate and I wouldn't mind candidly photographed. 

[TWR]

I agree that physical contact is appropriate in certain circumstances but I also think a "hug" should be initiated by the patient.

[lkth487]

Sometimes you have to make that human connection. For example, when a kid dies in the hospital, especially one you've been taking care of on the onc wards or the icu, EVERYONE is emotional.  I think physical contact like a hug is appropriate.  I think the key is that the other person should generally initiate it.  Last thing they need is to also feel uncomfortable. 

[thinkertdm]

I talked with my wife, apparently, I am emotionally disabled by not hugging.  But yes, i agree, in extreme examples, hugging would appropriate.  However, I think those situations are not common and really should have more than you and the patient in the room.

[ventana]

hardly never initiated by me - but is so I ask permission..  "can I give you a hug?"

if initiated by patient and not sexual in nature I hug back but carefully

 

 

 

[cinntsp]

I'm not really a huggy person but have hugged a patient/family when they've initiated it.  Obviously it's not some deep embrace, but a little human contact gives them comfort.  I do give plenty of stressful, bad, or even good news in the hospital and will often put my hand on the patient/family's shoulder or give a gentle squeeze of the arm to offer some comfort.  It always seems appreciated.  The little old ladies(80+) always want to hold my hand through our entire conversation.  Then they ask if I am married and have kids.  Then they tell me about their available granddaughters. 

[surgblumm]

This is one heck of a forum and I am sorry that I have not contributed to it far more in the oast but being on another board and responding to almost 100 e-mails daily is like working from home doing today's charts. the responses that I have been sent from all of you have been beyond excellent. Most are very careful, must wait for the patient to initiate it, one turns sideways and I have seen a patient sue a PA for examining a nose with a headlight while she was sitting and his groin touched her knees. I like the sideways action as well as the holding two hands to communicate and be supportive. One saves hugs for his family only; probably good sense. My wife worked in my Plastic surgery practice the first year we were married and so many cosmetic surgical patients are grateful and a little dizzy and they hug and more big time. I had to ask her to leave the practice because it became the source of jealousy for her "teddy bear." Her surgical oncologist was a good looking man, nice expensive clothes, had office hours until 2 AM and since he specialized in breast surgery the women had their breasts bared while sitting in the table and he sat next to them with a hand over their shoulders, compassionate--yes, Stupid-- a louder yes. And he had no Chaperone.

This forum is the absolute best for getting a response and I thank all of you for your many experiences and ideas and new revelations.

[surgblumm]

I just read the comment of the PA who hugged and prayed with two patients in one day. One of my past Chiefs of Surgery prayed with his patients who were spiritual and receptive based on their conversation. I prayed with an elderly minister and his wife, also a minister, as I knew this meant more than a hug or a response on a declining medical condition which took his life a few months later. I have a strange background as a Special Forces Combat Medic in Vietnam, a past ordained minister, a PA in many specialties and a PA leader who was a past president of NYS and four specialty groups. I am a lecturer, an author and have been an administrator and still practice surgery. I try to find the balance in responses, using sensitivities, logic, and good leadership experience. This forum has many people very much like myself and many who are my friends and have told me to be active in it. I am delighted that I have. Bob

[lemurcatta]

I have suffered from bad anxiety on and off throughout my life after a childhood illness. Relatively recently, I had gone to see an internist at my PCP's office after having some weird symptoms. He walked into the room, saw how I looked, and immediately gave me a hug. I was not expecting it, but it made me feel SO much better instantly. I certainly did not think it was weird. This experience makes me think that [appropriate] human contact needs to be an important part of my practice when I am a PA. I cert

[Guest ERCat]

The patient I described above who had back pain and I MRIed him and found cancer (lymphoma) - it’s funny this thread is roaring because today at work I ran into his mom and she came to me and guess what - reached out and gave me a HUGE hug! :-)

[surgblumm]

Thank you Lemurcatta and ERCat: There is always a mix of emotions on this subject because, yes, some people use it as an expression of a huge "thank you" as in your Lymphoma patient and they initiated it. In  Lemurcatta's experience her personal depression and anxiety required a human to intercede and if there is an absence of a parent or mate, this medical provider took the initiative and used the best tool in his/her toolkit. I need the mix of experiences so thanks for making a post. Bob

[SedRate]

On 5/20/2018 at 11:25 AM, Sed said:

I'm not a hugger but I will reciprocate a hug that was initiated by my trauma patient or their family. As you can imagine, the trauma field is often very emotional and stressful, and oftentimes they just need a hug. Universally, the hugs have been out of gratitude with the exception of one that was similar to Thinktdm that I also declined after stating my reasoning.

Just thought I'd share a recent event. Since chiming in about not being a proactive hugger but rather a reactive one, I had a longtime polytrauma patient (who also worked in the medical field) who waited in the lobby for me to get a second in between clinic patients to talk with them. They told me they remember waking up from extubation after their prolonged sedation in the ICU and admittedly being scared. They told me that my face was the first one they remembered seeing and they were thankful that I was the one there to get them through it and their hospital stay as well as their subsequent outpatient follow up.

Maybe this thread has softened me a bit, or maybe it was just coincidence that I talked with this one particular sad-turned-positive case who waited in the lobby for me to express their gratitude, but seeing them get choked up as they were saying all this to me, I couldn't help but feel like I wanted to hug them. And so I hugged them -- the first patient I've ever initiated a hug with. It was gratifying and reciprocated with a big bear hug.

This post wasn't meant as an opportunity to gloat, but as a thank you, I suppose, for reminding me that I'm not just some jaded machine. We can often get caught up in the day-to-day workload, especially when dealing with certain patient populations or administrative BS, but it's nice to hear others' experiences and get reminders like those shared here that there's still a human component to being a medical provider in today's dog-eat-dog world. So, thank you!