Monday, 18 Mar 2019

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I Got a Hug Today

It was at the end of the visit with the patient I've only seen three or four times for her osteoarthritis, carpal tunnel syndrome and back pain. During these visits, her pain steadily improved as we refined her medications to something both effective and safe. She was pleased with her progress and was compelled to convey her thanks in a hug. 

She was so pleased she told my nurse that she was going to kiss me and admitted to saying so at the end of the visit, out loud and in front of the office staff. Of course, I blushed and said “bring it on”. She grabbed me, pecked my cheek and engulfed me with in a bear hug that made everyone smile. We congratulated each other on making each other feel special.  

I have another long-time patient who, since I've known her, always begins and ends the clinic visit with an overly demonstrable hug. I walk in and am greeted with a “come here baby you know I need my hug” and each visit would conclude with another big embracing hug and smile. For years this has gone on, no matter how well or ill she would be. I have to admit, for a long time this was quite uncomfortable and I was a reluctant hugger; you know a hug on top, a lot of air in between and a quick release. Was this the right thing to do?  

I got over my hesitant reciprocation when I realized the hug was not only something she needed to give, but something she needed to receive. This became more evident when she was admitted to the hospital with a flair for lupus. I went to visit and upon entering her room, could tell that just my showing up was the relief she needed. By showing up (when she wasn't expecting me), everything was going to be all right because she got her hug from her doctor, who she trusted and who was her friend. Her hospital stay changed when she got her hug.

Hugs come in many forms and carry many meanings, but they are just not that common in the clinic setting, Oddly, I’ve seen more hugs between doctors and drug reps than I’ve seen between patients and doctors. Nonetheless, when they happen, they’re a great surprise and can have great effects. I realized that there should be more hugs in clinic, and that I should not just be the recipient but also the one who dispenses them.  

Types of Hugs 

  • The Lean To: Joined at the top (like the letter “A”) with a lot of distance between. This may be better than a handshake, but not by much. There’s a lot of uncertainty in that in between space, but hey...it’s a start.
  • Side-by-Side (half-hug): Signifies a friendly agreement or burgeoning alliance, maybe even partners (in care).
  • The Back Pat: These are confidence builders. Effective, polite and usually smile evoking.
  • Bear Hug: Wherein the wrap-up is like being folded into the other (sort of like a pig in a blanket). These can be thankful, protective, earnest or even emotional. But there should be a 3-second break rule; go beyond at your own risk.
  • The Almost Hug: A hug that appears to be the equivalent of a Hollywood air kiss.  This merits a do-over or more practice. It’s a pitiful attempt by two who are all head and no heart.  I suggest they practice hugging their pillows. 

Advice: when receiving a hug, don't go limp and act like a rag doll! That's the emotional equivalent of the limp, dead-fish handshake. 

Hugs Vary by Age or Person

  • Older Hugs from older people are humbling, respectable, rewards. If you’re old enough, exert the power. If you’re young enough, accept with glee.
  • Younger Hugs: Hugging younger folk is not usually well received by them. But there are instances when they need to know you care, have their best interest at heart and will always be their protector. 
  • Peer Hugs: Hugs amongst us makes for great greetings and partings.
  • Women Hugs:  I don’t know why, but in my experience women hug and men roll their eyes. While it may not be for us men to understand this social phenomenon, we should watch and learn - I think it has something to do with trust. 
  • Men Hugs:  Outside of sporting events, such hugs are unexpected and possibly unsettling. These can be good buddy hugs, or real hugs of thanks. I say take the risk, surprise someone with a buddy hug, they’ll appreciate it and won’t forget it.

What's great about the hug is that it’s a firm stamp of something accomplished, done well or that the other person is important. It can be a sincere affection or connection between people who need one another. Each time you get or receive a hug you should take a mental picture of that moment, and store it to remind you of what's great and special about what you do. 

Hugs are big amongst politicians, texting kids, goal scorers, and those who console for a living.  I would argue that a hug in the medical setting has nothing to do with patient pandering. Instead a hug can signify genuine trust, dedication to welfare and an elevated awareness of the other. The hug will enrich you and will tangibly affect those who witness that “hugging doctor”.

So, do yourself a favor and try to hug someone today. Then, if you live through the experience, try to hug two people tomorrow.  If this is not part of your usual clinic repertoire, start at home or with good friend. Hugs need not be more or less than a hug, delivered with a smile as an exclamation of success, alliance, hope or the promise that more hugs will come.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He a Professor of Clinical Medicine at the University of Texas Southwestern Medical School.
 
Dr. Cush is the Executive Editor of RheumNow.com and also Co-Edits the online textbook RheumaKnowledgy.com. 
 
Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

Rheumatologists' Comments

I love this article.After 42 years I'm retiring.I'm getting hugs every day.Very perspective on the hugging types
A hugging rheumatologist!? NO way we can let you retire. Guys like you make all of us look good. Thanks for endorsing the movement and being and example for many others!
Perceptive.
Cant tell you how important I consider this. For me not to hug is an exception . Not only is it good for the soul but it moves biomarkers- read Fam Med. 2009 Jul-Aug;41(7):494-501. Practitioner empathy and the duration of the common cold. Rakel DP(1), Hoeft TJ, Barrett BP, Strong Stuff Lenny
LC, your right. The down-stream benefits of the hug can be as powerful as the best medicine - thus to not hug would be a mistake, a missed opportunity, money on the table. Empathy in action!
You get a hug for this article. Buddy hug. 2.5 second buddy hug. Nice!