The authors have declared that no competing interests exist.
A daunting challenge for health providers and medical practitioners is communicating the vital importance of health promotion and medical treatment adherence and compliance. This article is an evidence-based, best-practices commentary advocating the use of touch-accompanied verbal suggestions during the touching portions of routine, near-universal Health & Physical examinations. Notional case examples are presented; based on the professional literature, underlying Behavioral Mechanics are discussed. Touch-accompanied verbal health promotion messages skillfully deployed in routine Health & Physical examinations offer a non-harmful and efficient technique to synergistically and substantially enhance the probability of patient compliance with health improvement and medical treatment regimens. Though it is not a magic panacea, the public health applications, extensions and benefits are incalculable in terms of healthy behavior adoption. Additionally, if deftly conducted in accordance with best practices, it has the potential to greatly improve practitioner-patient relations and increase patient satisfaction. Further avenues of research inquiry are considered.
A Health and Physical (i.e., “H&P”) examination is commonly considered a universal medical procedure performed as part of most face-to-face heath care encounters in which medical practitioners interview and examine patients for any medical signs and symptoms of medical conditions.
The H&P may involve standard tests (e.g., vital signs such as temperature, heart rate, respiration, blood pressure etc.).
The purpose of this commentary / review is to advance the notion of deploying subtle beneficial health improvement messages, accompanied by appropriate touching, during the portion of H&Ps that involve medical practitioner’s touching assessments. This is done in order to augment more formal and even written health instructions, and thus to achieve beneficial outcomes for patients. These may include a strengthened therapeutic medical practitioner- patient alliance.
A traditionally challenging task for medical practitioners is communicating the importance of treatment plan compliance, including but not limited to healthcare follow-up—be it therapeutic regimen adherence, medication schedules, diet restrictions, or follow-up visits
1. During a routine examination, a medical practitioner smelled tobacco smoke and residue on a patient and inquired about their smoking history. The patient admitted to smoking but expressed a desire to quit, and stated having tried several times yet not having the willpower to do so;
2. while auscultating with a stethoscope and listening to the patient’s respirations and touching the patient, that is, holding the stethoscope to the patient’s body;
3. the medical practitioner looked into the patient’s eyes; and,
4. very gently and subtly says, “You will get the willpower to quit smoking.”
Or,
1. A physician has a patient where it is imperative that they return for follow-up appointments, but the patient expressed ambivalence and vacillated about doing so;
2. during a routine H&P, the practitioner is palpating their extremities for abnormalities while the patient is reclining on the examination table;
3. the physician looks the patient directly in the eyes; and,
4. subtly yet mildly directs, “You will come back for your follow-up appointment.”
In each case, there are pre-existing histories from which the practitioners draw, and the verbal suggestions are integrated with appropriate assessment touching during the H&P. The medical practitioners’ verbal suggestions constitute a clear, concise, understandable reframing of patients’ words only into a gentle yet firm directive or command with direct gaze. Research confirms that verbal communications accompanying touch should work optimally when delivered in a gentle, nonjudgmental, subtle yet directing / instructing manner.
Patient (during Medical History interview) spontaneously expresses: “I am really having a lot of trouble keeping the pounds off.”
Medical Practitioner (during Auscultation Touching) reframes/synthesizes: “You will lose weight.” (Direct gaze, if possible, is ideal.)
That is in accordance with best practices. To be maximally effective, suggestions should be brief, clear, concise, structured, and prescriptive. Instructive or directive messages are reframed from patients’ own self-centered expositions and expressions of concerns to an attentive practitioner
Though the behavioral mechanics of touch and suggestibility are not well-understood, the nursing profession has long been aware of and asserted the power of the therapeutic alliance between touch, accompanied by instructive verbal instruction, in transforming behavior.
Montagu (1958)
Research has shown that collection and reinforcement of patient-centered expositions is related to a more formative medical practitioner-patient relationship and higher patient satisfaction with their treatment—if only in that it shows the medical practitioner is listening to the patient.
This report advanced the idea of using the “touching portion” of the medical H&P as an ideal opportunity for health/medical practitioners to combine and deliver subtle beneficial health and treatment improvement messages via touching (and preferably with direct gaze) in achieving maximum effectiveness and augmenting more formal and written instructions—even helping to cultivate the therapeutic medical practitioner-patient alliance. Put differently, if skillfully deployed in routine Health and Physical examinations, touch-accompanied verbal health promotion messages offer an inexpensive, minimally invasive, and non-harmful technique to substantially augment health improvement, medical treatment regimens, enhance patient satisfaction, and advance public health initiatives through healthy behaviors adoption. Its beneficial uses in the health field are practically limitless. Though exactly how it works may still be a mystery, what matters is that it does work, often powerfully—and that it can be marshalled into H&Ps for patients’ well-being. What is also unknown is the extent to which this technique already is being used, perhaps by the more successful practitioners. It is plausible that touch and verbal communication are so common a part of the H&P process that it has been overlooked in terms of designing meaningful evaluative studies.
Given that communication in such encounters is always two-way, a question might be to what extent and how medical practitioners are themselves affected by it.
The deft and skilled use of touch should be considered in health care professionals’ academic curricula and residencies, and this should be guided by best practices informed by scientific research.
*(Hypnotherapists have long recognized the “anchoring” power of touch accompanied by a subtle yet commanding suggestion. Touch refocuses attention to the area affected, thereby alerting the state of consciousness and making recipients more suggestable and even setting into motion internal auto-suggestion. Hypnotherapists’ common parlance for this auto- suggestive process is “dropping an anchor.”
**(Note: Auto-suggestive properties are commonly referred to in lay terms as “putting a bug in someone’s ear.”
Non-applicable, this was a commentary accompanied by a review of supporting open-source documents and analyses of anonymous publically available data.
Yes.
Yes, publications and sources are available on-line or provided by author upon request.
This project was supported in part by a grant from the National Institute on Drug Abuse to the University of Texas—Houston School of Public Health RO3 DA12328. The author gratefully acknowledges UT-MDACC for in-kind support.
Non-applicable, there is one sole Author.
The Author wishes to gratefully acknowledge in-kind support of the Department of Lymphoma and Myeloma, UT-MD Anderson Cancer Center, Houston, TX. in the preparation of this manuscript. Also, the author thanks Mr. Jasper Olsem for his encouragement in pursuing the subject matter. The author also expresses appreciation for Dr. David A. Lee, Ms. Annie Zachariah, Ms. Celia Ann Savoie, Ms. Jessica C. Chen for proof of concept and / or review and Ms. Aileen “Acey” Cho freelance-copy editor for proofing and copyediting drafts. The opinions expressed are solely those of the Author. Reprints and correspondence should be addressed to the author at