At another clinic where I work in Sherwood, Nottingham, there is a cartoon on one of the notice boards which has been there for as long as I have. It shows an old man in a cloth cap sat in front of a doctor. The old man is complaining of back pain. The doctor says, “Well, at your age you have to expect a few aches and pains. Take two of these four times a day”, and hands the old man a prescription. Then you see the old man getting up to go. There is an arrow embedded in his back.
Admittedly this is a relatively rare cause of back pain, even in Nottingham (Robin Hood and all that.) It is perhaps unfair on doctors (or at least on some doctors) who must see lots of people with back pain and do not have time to examine them all. But I see it as a criticism of a form of health care in which the practitioner does not or even cannot interact fully with the patient – does not look properly at them, does not examine them, does not even touch them. It is probably only recently in the history of humanity that any kind of professed healer could treat someone in pain without even touching them.
I get the impression in my clinical practice that patients only fully feel that I have started to understand their painful condition when I start to examine them. If I put my hand on their back and they say, ‘yes that is where the pain is’, that seems to me important, possibly even the beginning of the healing process. Perhaps they feel that I have somehow validated their experience; maybe with some people if they are just given pills, they may unconsciously believe that they are being told the problem is all in their mind. They need to be interacted with on a physical level to feel they are being taken seriously. If I then say something like ‘yes, this muscle feels very tight’, or ‘it feels unusually warm to the touch here’, (or, ‘you appear to have been shot by outlaws or Native Americans’) this further validates their experience.
Furthermore, how I do this matters. If I do it in a routine, mechanical way, this feels different to the patient than if I do it with sensitivity and awareness. People can tell the difference; we are very sensitive to the way we are touched. Examining a patient who is in pain with a heightened level of care, attention and sensitivity is often the beginning of their healing process.