Touch is a primary mechanism by which one person contacts another. The patient is touched by the physician; the physician is touched by the patient. At the moment of contact, there is an interaction of dynamic, complex systems that creates a greater system still—the patient-physician dyad—with emergent thoughts, feelings, and dialogue that are greater than the sum of the individual parts. This interaction is known as the patient-physician relationship. Ideally, this relationship is an interactive partnership with health as its goal.
There is no aspect of osteopathic medicine that is neither informed nor deepened by the process of touch. It differentiates the unique training and practices of osteopathic physicians. We evaluate our patients through history and physical examination. We supplement our evaluation with tests of structure and function. At the core of the osteopathic physical examination, however, is a dependency on palpation. In clinical practice, we touch to evaluate, communicate with, and treat patients.
Of course, in every medical tradition, palpation at some level is a tool of diagnosis. Taking of pulses, palpation of the viscera for tenderness or enlargement, palpating for the cardiac apical impulse—these all represent examples of using touch to diagnose. It is uniquely osteopathic, however, to link the palpatory examination of the musculoskeletal system to the functioning of the whole person, including his or her immune, nervous, endocrine, circulatory, and visceral systems. This link can be the driver for a more dynamic biopsychosocial diagnosis. The osteopathic examination is designed to ferret out elements of impaired structure and function through the findings of static asymmetries, tissue texture abnormalities, and functional limitations of motion. In addition, touching can elicit findings of tenderness or pain to help us understand the local, regional, and global impairments that can become the focus for therapeutic interventions. Touching sets in motion an intimate, tactile, verbal, and nonverbal dialogue.
For osteopathic manipulative treatment (OMT), the routine use of palpation is certainly critical. Osteopathic physicians are trained in layer palpation. When light touch is applied to the body, the skin is palpated; by applying more pressure and shearing force, by changing focus and palpating more deeply, the subcutaneous tissues, deeper fasciae, muscles, tendons, ligaments, joint capsules, and finally bones can be palpated. The physician will sense the patient's breathing, pulsations from arteries, inherent rhythms, and the range and quality of movement of their joints. Palpatory diagnostic techniques and dialogue are integral to the identification of somatic dysfunction elements, as well as to the treatment of patients and the monitoring of the effects of treatment on behavior, mood, and thinking. We as osteopathic physicians touch our patients at all levels.
For the patient, touch communicates a sense of being examined comprehensively, being cared for, and being treated directly by the physician's touch. For the physician, touch is a process for continually collecting and monitoring clinical data. In addition, it is a method for having a direct, therapeutic influence on patient well-being. For both patient and physician, it is an intensely meaningful, heartfelt, therapeutic interaction with touch as the interface. In its own way, touching our patients—both diagnostically and therapeutically—can be seen in direct juxtaposition to the technical and impersonal aspects of contemporary medicine, which often annexes the body to the world of images, fluid testing, and machines.
Patients are deeply touched by words, as well as by deeds. Touch as an example of empathic communication complements the equally empathic communication of words. In fact, the process of touching and talking to our patients facilitates a clinically relevant integration of psyche and soma.