Christopher Searles, MD, has many titles. As a family practitioner and psychiatrist, he codirects a residency program for University of California, San Diego, medical residents that operates out of a large homeless shelter and clinic. To extend that care, he helped launch a mobile unit that travels around the city—wherever the patients may wander—to treat their medical as well as their mental and behavioral problems. He also is noted for creating the Physician Boundaries program, an intense three-day course that teaches physicians—including many who have gotten in trouble with their state medical boards or hospital executive committees—about the power and the danger of patient touch.
On the mental and physical connection of disease: In some cases, patients’ physical problems are caused by their psychiatric ones. Sometimes an up-trending A1C is not a measurement of worsening diabetes but worsening depression. If they were taking medication, exercising, and watching their diet, their A1C would be better. But too often we treat these patients as if their diabetes and their depression were unrelated entities.
On educating doctors about touch: We don’t talk about this in medical school, and it’s very rare that clinical touch is part of the assessment of physician performance along with outcome measures, but it’s so important, as doctors are increasingly being judged and paid on the basis of how their patients perceive them. Touch, and how a physician uses that, is a huge subliminal component of that.
On the social and procedural distinction of physician touch: It’s difficult to take something that’s inherent to the human experience, which is social touch, and blend it with procedural touch, which is the touch we learn in medical school. If you’re not savvy about when one should end and the other should begin, or how to balance them in one clinical moment with one patient, there’s always a risk you will be misunderstood.
On empathy and patient engagement: If the patient thinks that the physician is empathetic, the patient’s perception about the physician’s expertise goes up. Their compliance with prescriptions and their treatment plan goes up. And their satisfaction, measured by various tools, goes up as well. The goal is to have patients describe you as supportive, charming, friendly, as opposed to cold, hostile, bitter, and hard-hearted.