Losing touch

Teresa Vente is an Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine and is a full-time faculty member in the division of palliative care at Ann & Robert H. Lurie Children’s Hospital of Chicago.

COVID-19 has impacted the practice of healthcare providers around the world with higher patient volumes, rapidly evolving changes in treatments and experimental therapies, increased rates of morbidity and mortality, and physicians of all disciplines struggling to answer questions without answers. For many of us, COVID-19 has caused separation and isolation of healthcare providers from loved ones as they fear exposure and thus quarantine in separate rooms and homes. For myself, COVID-19 has separated me from my long-time partner due to the closure of the border between the US and Canada.

As a palliative care physician, I have been trained to operate in an environment of uncertainty and navigate difficult conversations. With the onset of the COVID-19 pandemic, uncertainty is no longer confined just to hospital beds but seems to have permeated into all facets of life for many people; difficult conversations are no longer happening at hospital bedsides but are now happening at kitchen tables and over video conferencing.  I have been trained to navigate difficult conversations. I have learned how to systematically approach communication as an instrument that can be used to break bad news, provide empathy and support, explore values and goals, and reach complex medical decisions. Communication, especially in difficult conversations, takes more than choosing the right words; nonverbal communication also plays a significant role. One of the most important modes of nonverbal communication used by physicians is touch.

Healing touch has a long history in spiritual and medical texts of both Eastern and Western societies and cultures. Understanding the importance of touch starts in infancy when humans first learn about their environment through touch and where touch from mother to infant is associated with health benefits such as temperature regulation, feeding and growth.  The role of touch in childhood guides social development with peers and ultimately informs our platonic and romantic relationships. Touch in the practice of medicine can be categorized as procedural or touch necessary for exams and tasks vs healing or touch related to expression or caring. Healing touch has been shown to build rapport between patients and providers, increase patient satisfaction scores and improve compliance with medical care.   Touch alone may even have the ability to communicate emotion.

COVID-19 has fundamentally disrupted the touch we share with loved ones and the opportunities for provider-patient touch in the medical setting. People are being encouraged to stay home and avoid nonessential interactions with individuals who are not members of their immediate household.  Visitor restrictions have been enacted in hospitals and long-term care facilities and patients are isolated in hospital rooms while providers are isolated behind layers of personal protective equipment (PPE). And while the risk of COVID-19 transmission is real, so is the escalation of vulnerability of patients, especially those seriously ill and separated from loved ones. It is important that we as medical providers recognize the important role touch has in helping to provide comfort and care. We need to ensure that we do not rely solely on procedural touch for exams, repositioning and dressing or equipment changes. Despite the hand being gloved, making physical contact with our patients may be one of the only therapies we can reliably provide.

We should continue to follow the guidelines recommended by our healthcare institutions regarding proper protection for ourselves and our patients. We know that PPE, when properly donned and doffed, mitigates the risk of infection and thus we should practice safe encounters.  We should not solely rely on virtual interactions or phone calls from provider to patient, or even loved-one to patient. As testing is more ubiquitous and results obtained more rapidly, we should give loved ones an opportunity to also provide healing touch to their family members especially in circumstances where other treatments have failed. In the event that family members cannot be present, caring touch from medical providers may serve as a proxy. Medical teams should be open to considering creative solutions such as holding a patient’s hand while playing a recorded message from a loved one. News stories and social media have included personal testimony from providers on the front line including bedside nurses, physicians, social workers and chaplains who have in the face of fear gowned and gloved to hold up a cell phone or iPad to a patient’s face while family members have expressed love, messages of hope and, in many cases, final goodbyes.

The importance of touch is not for patients alone. Providers too can benefit from touching our patients. For some providers disconnected from family and friends and even colleagues, this is an opportunity for a feeling of connectedness at a time when isolation reigns.