Lewis Thomas comments wisely in The Youngest Science that playing is the oldest and most effective tool to deal with.
The meaning of touch in healing.
This statement sounds good to me. I am convinced that touching a patient gives the psychiatrist an advantage that he feels and simply listens to. Touching is a way to get important information.
In a first interview, the conversation is usually impersonal. The relationship with the patient often changes drastically after the physical examination.
The distance disappears, replaced by a pleasant and fluid conversation. Material that was not revealed or suspected. A few minutes before, a stranger discovers an intimacy that has generally been won thanks to a long and friendly relationship of trust.
Medieval doctors place an ear on the abdomen or chest wall of a patient to detect bowel sounds or heartbeats. Some could hear loud whispers. It would be difficult to approach the patient. The ear stuck in the chest wall was an expression of human affinity. “It’s hard to imagine a more friendly human gesture, a more intimate human signal of personal interest and personal affection than those heads that are prone to skin.”
Thomas wrote that it was one of the greatest advances in the history of medicine.
The first touch
The first intervention that the doctor makes to the patient should be the handshake: a greeting of welcome, a gesture of hospitality and the willingness to accept a person as a human being.
For the doctor, this is a true source of information. First, the entire transaction is a character of the character and the psychological state that provides important information.
Is the hand tense with enthusiasm, timid or shy to move forward simply because it reacts reluctantly to the extended hand of the doctor?
The firm grip of a controlling person contracts with the slippery and barely touching fingers of an insecure or restless patient.
You could write a document about the diagnostic value of a handshake. For example, a 65-year-old man came to see me in the middle of winter due to palpitations. With his trembling hands, his warm and slightly sweaty palm fascinated me. It was very cold outside and I told her that she should have nice, warm gloves on the skin of a bitch. He replied that he rarely wore gloves.
Immediately I assumed hyperactivity of the thyroid, which was confirmed by appropriate laboratory tests. When the thyroid gland is overactive, increases the metabolism of each organ, the skin that receives more blood flow becomes warm and red, while the heart that beats fast is predisposed to cardiac arrhythmias.
Thomas noted that the doctor’s oldest skill was the hands that were needed. Until this century, in most cases, little was possible. Over time, this simple act of compassion has become art. After all, it has become a scientific skill and the hand has become an important diagnostic tool.
The heart rate and heart rate were in the foreground: the chief physician of the Romans, the Greek Galen, first analyzed the heart rate by palpating the pulse. Palpation of the chest wall may reveal the size of the heart or the presence of aneurysm, neck, enlarged thyroid or the presence of aortic valve disorders. The abdomen provided a large amount of information for the sensitive fingertips: an enlarged liver or spleen, an enlarged aorta; The presence of an inflamed process and a tumor could be detected first with a throbbing hand.
Although I never mastered the art of listening with my ear in my stomach or chest, I was often rewarded by pounding gently against the chest wall. My assertion that a persistent heart attack can sometimes be detected is usually met with disbelief from colleagues. About thirty-five years ago, on a hot July day, I did it.
When two new postdoctoral researchers arrived at Peter Bent Brigham Hospital, the first patient we visited was a middle-aged athlete, a former Salt Lake City field marshal.
The gallbladder was removed that day and our visit was a routine postoperative visit. The signs of life were intact, but placing his hand on the thick chest wall of man, usually without movement. I whispered to my co-workers that we should immediately order an emergency electrocardiogram because there could be a heart attack.
The boys looked at each other in astonishment. The most cynical and daring of the two let out a deep chuckle and suggested putting them on.
We continue with laps. About twenty minutes later, there was a code in the room we had just visited, and we learned that the man we just had a heart attack. He did not respond to resuscitation and an autopsy revealed a massive heart attack. The two companions, intimidated and confused, looked at me for at least a few days with excessive anxiety.
Another method of contact is the battery, introduced by the doctor Leopold von Auenbrugger of the eighteenth century, to deepen the secrets of the body. Young Leopold watched his father, a wine merchant, tap a barrel to see how much wine was left. When he became a doctor, he also patted the body’s cavities. Percussion helps identify the consolidation of lung tissue (such as pneumonia) and fluid in the thoracic and abdominal cavities and provides an approximation to the size of the heart. By contributing more to the connection between the doctor and the patient, the measurement should be encouraged with confidence.