title: Touch in primary care consultations: qualitative investigation of doctors' and patients' perceptions.
abstract: BACKGROUND
  Good communication skills are integral to successful doctor-patient relationships. Communication may be verbal or non-verbal, and touch is a significant component, which has received little attention in the primary care literature. Touch may be procedural (part of a clinical task) or expressive (contact unrelated to a procedure/examination).
  
  
  OBJECTIVE
  To explore GPs' and patients' experiences of using touch in consultations.
  
  
  METHODS
  Qualitative study in urban and semi-rural areas of north-west England.
  
  
  METHODS
  Participating GPs recruited registered patients with whom they felt they had an ongoing relationship. Data were collected by semi-structured interviews and subjected to constant comparative qualitative analysis.
  
  
  RESULTS
  All participants described the importance of verbal and non-verbal communication in developing relationships. Expressive touch was suggested to improve communication quality by most GPs and all patients. GPs reported a lower threshold for using touch with older patients or those who were bereaved, and with patients of the same sex as themselves. All patient responders felt touch on the hand or forearm was appropriate. GPs described limits to using touch, with some responders rarely using anything other than procedural touch. In contrast, most patient responders believed expressive touch was acceptable, especially in situations of distress. All GP responders feared misinterpretation in their use of touch, but patients were keen that these concerns should not prevent doctors using expressive touch in consultations.
  
  
  CONCLUSIONS
  Expressive touch improves interactions between GPs and patients. Increased educational emphasis on the conscious use of expressive touch would enhance clinical communication and, hence, perhaps patient wellbeing and care.
authors.affiliation: Manchester Medical School, University of Manchester, Manchester, UK. simon.cocksedge@manchester.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: Cocksedge
authors.forename: Bethan
authors.initials: B
authors.lastname: George
authors.forename: Sophie
authors.initials: S
authors.lastname: Renwick
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Chew-Graham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D001291:Attitude of Health Personnel; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D012938:Social Perception; D014110:Touch
references.citation: J Adv Nurs. 1992 Apr;17(4):448-56
references.pmid: 1578067
references.citation: Fam Pract. 2002 Jun;19(3):285-9
references.pmid: 11978720
references.citation: J Adv Nurs. 1998 Oct;28(4):809-17
references.pmid: 9829670
references.citation: Soc Sci Med. 1994 Sep;39(5):655-70
references.pmid: 7973865
references.citation: Commun Med. 2009;6(2):109-16
references.pmid: 20635548
references.citation: J Adv Nurs. 1993 May;18(5):838-46
references.pmid: 8514941
references.citation: J Relig Health. 1989 Dec;28(4):299-322
references.pmid: 24276964
references.citation: Br J Gen Pract. 2012 Mar;62(596):147-8
references.pmid: 22429421
references.citation: Br J Soc Clin Psychol. 1966 Sep;5(3):221-31
references.pmid: 5975653
references.citation: Med Educ. 1996 Mar;30(2):83-9
references.pmid: 8736242
references.citation: Br J Gen Pract. 2011 Aug;61(589):e484-91
references.pmid: 21801542
references.citation: Med Educ. 2008 Nov;42(11):1100-7
references.pmid: 18761615
references.citation: J Holist Nurs. 2009 Jun;27(2):127-35
references.pmid: 19443699
references.citation: Soc Sci Med. 2000 Oct;51(7):1087-110
references.pmid: 11005395
references.citation: Med Educ. 1998 Jan;32(1):25-34
references.pmid: 9624396
references.citation: J Commun. 1975 Summer;25(3):104-12
references.pmid: 1184772
references.citation: Nurs Res. 1979 Mar-Apr;28(2):76-80
references.pmid: 254064
references.citation: Fam Pract. 1991 Sep;8(3):237-42
references.pmid: 1959723
references.citation: Br J Gen Pract. 2010 Feb;60(571):83-7
references.pmid: 20132701
references.citation: BMJ. 2001 Apr 7;322(7290):865
references.pmid: 11321018
references.citation: J Gen Intern Med. 2006 Jan;21 Suppl 1:S28-34
references.pmid: 16405706