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Touch and psychiatry have become like vinegar and oil – they don’t mix. It is hazardous if not contraindicated for a psychiatrist to touch a patient, particularly one with a history or trauma, intimacy issues, or poor boundaries.   Then there is a hygiene matter: primary care doctors have easy access to soap and sinks to wash their hands after every encounter with a patient; psychiatrists don’t.

This taboo against touch rankles me, for I know the the value of Touch.  Touch is powerful, therapeutic, and healing. We reach out to hug and hold those upset and scared.  In medical school I was trained to always find someway to make physical contact with each patient, even if they are only coming in for some paperwork item. Sometimes this contact is disguised via ‘let me take your pulse’ or listening to their breathing. Hands are shaken when saying hello and farewell.

Traditionally I do not shake hands or make contact with my patients. When meeting new ones I would make a slight bow to indicate politeness but convey we are not going to shake hands. This safe move has mostly backfired: I sense patients, particular the males, find it rude and/or disappointing I don’t shake hands.  Lately I decided to risk the scorn of  Public Opinion and find some way to make some physical contact.  Outstretched hands are being offered at the beginning or end of the appointments.  My desk is located so that when I get up to go around a sitting patient I can momentarily place my hand on their shoulder as I pass, or tap their shoulder with an index finger to say ‘follow me’. It ain’t much but at least I made contact. My family practice mentors would be pleased although the psychoanalyst professors would be rolling in the graves.

I am limiting this experimentation of touch to male patients, so as not to risk being accused by the females as being inappropriate.

So far I have not been arrested or dragged off by the APA secret police, nor have I been arrested.

Quite the contrary, I think my patients are more relaxed, see me as more friendly, and – do I dare think it – they are more healthy for this contact?

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