These words were in the NY Times two days prior to her marriage to Prince Harry. I wonder if things will change now that she has become the Duchess of Sussex. She is now a royal, and royals don’t hug in greeting. Culture matters. It does for duchesses and it does for PAs and NPs. We are not just Americans; we are medical professionals and that can make a difference! But my responsibility is not to be judge and jury; instead, I went to the readership of PhysicianAssistant.com and received 30 responses in two days on the subject. These are thoughts from your peers which have gone through my screen as a malpractice sleuth.
Different cultures greet and demonstrate gratefulness in different manners. Patients coming from different areas of our country do likewise. For some, a hug may be as beneficial as a prescription and for others, an unfathomable gesture.Neither you or I have a crystal ball on our desk and therefore we cannot assume anything about anyone. The current atmosphere is heavily weighted toward extreme discretion and that may provide the direction needed on this subject.
Hugs can mean many things: compassion and connection, comfort, bonding, romance, or most troubling, possession or sexual harassment. All sexual harassment is obliged to be investigated by OPMC or its equivalent and can destroy a reputation, a career and cause loss of licensure. Hugging is a very human thing and is often more therapeutic than a prescription, but it has its variations. Therefore, we need some guidelines.
Suggestions from our peers are to simply ask first: “I am proud of you. Can I give you a hug?” One of my close friends says, in 32 years of practice, he only goes as far as placing a hand on a patient’s shoulder and has eye contact. Another stands sidewards so that there is no front to front touching. A hug is never longer than two seconds and does not include a kiss. It is suggested that, if you are a huger, you should always have a chaperone in the room with you, for your safety and that of your patient.
This subject came up on Clinician1.com a few months ago, but responses were not from PAs practicing in this era, but from thirty years ago when medical professionals were held in high regard. Unfortunately, this is not true today with high profile politicians, newscasters, movie magnates, actors and physicians being accused of sexual assault. Today the waters are murky and good intentions can be received as indiscriminate action. We live in a different era and one is almost fearful of smiling at the checkout person and giving them a compliment, Therefore the paranoia has set in, affecting everyone and keeping us aware. That is why this subject has been on the physician, NP and PA social media, it needed to be addressed by our peers. My purpose is two-fold: to discuss this question and give guidelines. Despite our diligence in trying to offer appropriate emotional support, what happens if a patient feels that you have crossed the line? What protection do you have? Have you studied your malpractice insurance like you studied Harrison's Textbook of Medicine? Did this take place outside the office? These situations are deal breakers, our inner awareness tells us not to take a patient out to dinner and drinks because we may have crossed an imaginary gray line, We work in high-stress areas as part of a team and learn to appreciate our colleagues and it is not an unusual occurrence to see two healthcare providers fall in love but is there a script to do so without fear of confrontation and litigation? We hope for a return to the simplicity of following our feelings and good judgment.
Most of our profession is female, about 70%. Most new PAs are 25-30 years of age. Most want to learn, experience, climb the ladder and become the best they can as PA Professionals but most also possess an empathy and have a desire to achieve wellness for their patients. Their reputations and acceptance are built on creating well being and comfort and I believe they will succeed and enjoy the same benefits as us dinosaurs. I hope this has not been offensive to anyone as it is an attempt to summarize a contemporary situation and address it head on.