Patient Contact: Shake Hands, Hug, Fist Bump, or Just Smile?

Shelly Reese


May 20, 2014

In This Article

Is Your Concern About Germs Creating a Problem?

At West Virginia University, researchers were concerned enough about bacteria transmission to explore whether fist bumping might be a more hygienic alternative to shaking hands. Last year they published a pilot study in the Journal of Hospital Infection in which they found that handshakes expose more than 3 times as much skin surface as fist bumps and the contact lasts 2.7 times longer, resulting in a significantly higher rate of bacterial transmission.[4]

The popular press jumped on the story, with major newspapers and television stations extolling the rise of the fist bump as the new form of greeting. Members of the medical community were more circumspect.

Mark Schleiss, MD, Division Director of Pediatric Infectious Diseases and Immunology at the University of Minnesota, contends that fist bumping is a poor substitute for the old-fashioned handshake.

"Holding someone's hand in a handshake is a more personal way of touching and interacting than a fist bump," he says. "For me, it's absolutely inculcated in the way I interact with patients and families. Upon first meeting patients, it's a sign of respect and courtesy, and if you have a well-established relationship with a patient, it becomes almost an exchange of endearment."

That's not to say there aren't exceptions. Some patients may prefer not to shake hands because of cultural differences. Others may be particularly demonstrative and so familiar with their physicians that they expect or initiate a hug. Still others, because of physical limitations or disease, may find shaking hands painful and may prefer a gentler physical greeting, such as a shoulder squeeze or a light squeeze of their fingertips.

In such cases, "patients are pretty good at conveying their preferences," Makoul says, and physicians should follow their lead rather than trying to anticipate it. "I'm not a big proponent of stereotyping people and saying, 'Oh, you look like you're from this culture; let me look at my pocket guide and see whether or not I should shake your hand,'" he says.


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