Editor ’ s Corner
Hugging It Out
P
ATIENT ZERO IS an active and charming older widow , measuring approximately 4 ’ 11 and weighing in at 90 pounds , who wisely moved to the dry deserts of Arizona from the East Coast with a rather indolent , but persistent , extramedullary myeloma in tow .
At our first appointment , she announced that we would begin each meeting with a hug because that ’ s what her hematologist out east always did . I happen to know that hugging hematologist – he is not a small person . Slightly bemused by the visual incongruity of the 6-foot doctor embracing this tiny lady , off-a-hugging I went . And , for the past five years , patient zero and yours truly have reenacted the ritual every time I enter and exit the consultation room .
I didn ’ t think too much about the ceremony until a few weeks ago when a retired , well-groomed business executive , sporting crisply pressed golf apparel , returned to see me . He had decided to move to Texas to be closer to family and was telling me about his plans to transfer care . After our usual exchange of pleasantries and review of his labs and treatment plans , he shifted somewhat uncomfortably in his seat , cleared his throat , and said , “ Dr . Stewart , would you mind if I gave you a hug ? My new doctor in Texas gave me a hug .” What ? I ’ m just saying , hugging a diminutive grandmother is one thing , but wrapping my arms around a tall , reserved gent in golf shorts wasn ’ t in my repertoire . I went for it gamely , though it was an abbreviated and slightly awkward moment for both of us .
Now , I don ’ t know about medical school these days , but when I trained in Scotland in the mid-1980s , learning to hug patients wasn ’ t in the curriculum . In that reserved , taciturn culture , all public displays of affection toward anyone except your own children ( below the age of 12 ) are viewed with high skepticism and raised eyebrows that seemed to say , “ He has been in America too long ; best cross the street .”
After the golfer left , I was basking in my newfound empathy when it dawned on me that the hugging thing was indeed more ubiquitous than I had thought . Maybe I should take a cue from the hugging hematologists of Hoboken and Houston and less grudgingly offer up the benign token of comfort and friendship .
So , I entered the next exam room full of ambition – only to find an all-business , 42-year-old lawyer with shiny black shoes , a thick portfolio of lab results , and audio recordings of our visits . He is a wonderful human being , but I sensed he would not appreciate my awakening .
Slightly deflated , I contemplated the outbreak of hugging hematologists coinciding with a media explosion of harassment accusations and an overdue and healthy debate on appropriate workplace behavior . It got me thinking – with respect to patients – when is a hug not just a hug ? What , exactly , is the appropriate hold-and-release time ? Are there eligibility criteria – age , performance status , past exposure , number of prior appointments , active visible infection ? Can you rub a bald head in encouragement ? Do the rules change according to geography and the social norms of the country in which the hug occurs ?
On a trip to New Zealand , I participated in a receiving line that , depending on the Anglo- American , Maori , or Northern or Southern European origin of the participant , involved a
Keith Stewart , MBChB , MBA , is the Carlson and Nelson Endowed Director of the Center for Individualized Medicine and the Vasek and Anna Maria Polak Professor of Cancer Research at Mayo Clinic in Scottsdale , Arizona .
bewildering array of formal handshakes , hugs , air kisses ( sometimes one cheek , sometimes both ), and nose rubs .
In retrospect , this desensitization marked my tipping point , but because this was a social event rather than a patient encounter , my unease lingered . What is an aging misanthropic hematologist to do ?
I sought out my most-trusted , younger , more in-touch ( pardon the pun ) colleague to ask about his experience in contact with patients . With barely a second ’ s pause , he offered the following guideline : “ Below the elbow when sitting , below the knee when lying flat .” He went on to explain this was the recommendation he received in medical school in the 1990s regarding appropriate ways to comfort patients . The advice seemed eminently sensible , but guidance on hugging in 2017 was not forthcoming .
An online search was revealing ; it turns out patient-physician hugging appropriateness is a common discussion point in online forums . The balance of opinion favored the friendly embrace when initiated by the patient – counterbalanced by some rather funny rebuttals from germophobic and olfactorilysensitive doctors .
So , with a heightened sensitivity , I paid special attention as colleagues renewed acquaintances at the recent ASH annual meeting , where innocent hugging , back-slapping , and air-kissing were as common as plush carpet on the exhibition hall floor . I did get some quizzical looks as I confronted unsuspecting attendees with the question , “ Do you hug ?” As for the exam room , I deduced that the answer is , “ Only when asked .” I ’ m hoping that ’ s right .
Keith Stewart , MBChB , MBA
The content of the Editor ’ s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated .
Have a comment about this editorial ? Let us know what you think ; we welcome your feedback . Email the editor at ACNEditor @ hematology . org .
8 ASH Clinical News January 2018