Feeling the skin

I read Dr Cox's lovely squib ‘Palpation of the skin—an important issue’ in December's JRSM ¹ (2006;99:598–600) with a sense of pride and wistfulness.

I was fortunate to be trained at University of Pennsylvania School of Medicine (Penn) in Philadelphia by doctors who emphasized always touching a patient— somehow and somewhere—when interviewing and/or examining them. This was reinforced later on by my teachers of dermatology at Penn, who included (mirabile dictu) Walter Shelley, Albert Kligman, James Leyden, M Samitz, and many others.

The simple act of touching a patient reinforces the humanity of what is an unpleasant situation for a patient, and makes the all-important bond between patient and doctor very concrete and very immediate.

It drives me crazy when I'm in the clinic at Penn or elsewhere and I have to repeatedly urge Derm Residents (who should know better) and the med students (who quickly do learn better under my lashings) to touch a patient, both for diagnostic information as well as for a personal communication of concern and empathy.

I know of dermatologists who were trained never to even shake hands with a patient upon meeting the person, much less touch and palpate their skin. Such an attitude is foreign and unacceptable to me, and verges on (no, reaches) the repugnant and imbecilic!

I cannot—and never will—understand why many doctors and dermatologists still believe that they are ‘going to catch something bad’ by touching a patient. If teaching them by means of Dr Cox's trenchant missive won't work, then perhaps a crack with a bat (baseball or cricket) might be in order.