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compassionate human response. Touch, however, can raise a number of social and
cultural issues and therefore is a controversial behavior: “The only thing that is
commonly agreed in this controversy is that touch can have different meanings for
different people” (Dewane 2006 , p. 546).
We suggest you be aware that touching patients might be misinterpreted. People
vary in their comfort with being touched by strangers. Abuse survivors may be particu-
larly sensitive to touch they did not invite/initiate. Some patients may feel they are
being patronized or put in a submissive position when you place a hand on their shoul-
der or arm. There are also wide cultural variations in who may touch and how they may
do so. Touch can be particularly risky if you initiate it. Some patients will initiate touch
(reach out to shake your hand, extend their arms and/or ask for a hug); children gener-
ally are more likely than adults to communicate through touch, and some patients with
intellectual disabilities such as Down syndrome may use touch to express connection.
Please note that shaking hands, while generally appropriate in Western cultures,
may be regarded as offensive in some cultural groups (e.g., some individuals from
Middle Eastern cultures will only shake hands with a person who is of the same
gender). One strategy is to wait to see if your patient offers her or his hand first.
Finally, there are ways to connect with patients without touching them. You can
convey your sentiments by moving your chair closer, leaning forward, putting down
your visual aids, softening your voice tone and volume, and slowing your pace.
When patients convey that they are pleased or relieved with news, you can express
your happiness and support with a hearty “great news” or “I’m happy for you.”
Other Considerations
- Formality: People vary in their comfort with informal approaches. We find it’s
best to begin by being more formal with every patient unless and until their
behavior invites less formality. Ask how they would like to be addressed (Mr.,
Mrs., Ms., Dr.). Avoid initiating physical contact such as a handshake unless they
extend their hand first. Tell them how they may address you. - Courtesy: All cultures have politeness norms. Early in a session if you wish to
ask a question, begin by seeking the patient’s permission, “Could you please tell
me...” or “I’d like to ask about____, if that is ok with you.” Give an explanation
for why you are addressing certain topics and/or asking certain questions. If you
take notes, explain what you are doing and why. Be sure to always turn off your
pager and phone or put them on mute. Excuse yourself if you are called away,
and apologize to the patient for the inconvenience when you return. - Interpersonal dynamics: When other people accompany the patient (whether
partner, family members, friends), watch for nonverbal indicators of who the
decision- maker may be. Who speaks first? Does the patient look at the other
person before responding to you? How hesitant is the patient in her/his speech?
What is the interaction among all parties? In many cases, it may be appropriate
to provide family genetic counseling. The fact that your patient brought other
people to the session may signify a preference for having those individuals
3 Listening tofiPatients: Attending Skills