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How Close Is Too Close?

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The surgeon saved your life. Do you hug him to say thank you?



What if your doctor gives you a grim diagnosis? Would you want his arm around your shoulder?



Do you let the nurse who delivered your healthy baby hug you?

As reported by the Medill News Service and subsequently covered in the Chicago Sun-Times, these scenarios are raising questions from both doctors and their patients about what is and isn't acceptable in the doctor's office. TV shows like Grey's Anatomy and Private Practice regularly feature doctors forming friendships and even intimate relationships with the people they're caring for. Is this what we're supposed to expect from a visit to the doctor? Has it become the norm?

Not necessarily.



It all comes down to what kind of treatment you want to receive as a patient.

"Hugs are good things if it's clear that that's something that the patient would welcome," said bioethicist Mark Kuczewski, the director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago Stritch School of Medicine.

"Is it appropriate? This to a large degree depends upon the patient and the particular relationship that the physician has with the patient," said Tod Chambers, director of the Medical Humanities & Bioethics Program at Northwestern University.

While the American Medical Association Code of Medical Ethics is explicit about the problems with sexual relationships between doctors and patients, it doesn't mention comforting hugs. This can leave room for questions about what exactly is appropriate.

As a patient, it's important to be clear about how you expect your doctor to treat you. If you're the kind of person who would welcome a comforting hug, let him know. You don't even hug your friends, let alone your physician? That's OK, too. Whatever your preference, honest communication is essential.

What about the other way around? Imagine your oncologist tells you your cancer is in remission. Is it okay to hug him?



"I think most physicians would accept it. I don't know that they would decline it. Maybe they've just gotten great news from you," said Nancy Berlinger, deputy director and research scholar at The Hastings Center for bioethics in New York.



If he or she were uncomfortable, "The physician could say, 'I would prefer we not do this,'" Kuczewski said.

Doctors play just as big a role as their patients in navigating these situations. There are many factors doctors should consider before offering hugs. Patients vary. Situations vary. Not all physical contact is the same.

Understanding a patient's preference and honoring it is essential, Beringer said. For example, a woman with bone cancer might welcome a hug when she's healthy, but not when her illness makes touching painful.



"Context really matters, what the patient wants really matters," she said.

A hug seems fairly harmless in most contexts. So why is this particular issue so divisive?

Visits to the doctor range from a simple checkup to something much more serious. Emotions can run high. What's an innocent gesture outside the office may be unwelcome there.

So how close is too close? Every situation is unique and demands careful consideration.

While doctors have strict professional policies to follow, as patients we don't have the same guidelines of behavior. At the end of the day, communication is the key. Letting your doctor know how you'd like to be treated is the best way to ensure you receive the type of care that's best for you.