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

Shelly Reese


May 20, 2014

In This Article

Balancing Hygiene and Human Touch

As far as the germ transmission goes, Dr. Schleiss notes that proper hand hygiene mitigates the risks associated with shaking hands. "If we're going to live in a world where doctors don't wash their hands, then we should go to a head nod as a way of greeting patients. But I have yet to see a study that shows there will be influenza transmission or MRSA transmission if the physician practices good hand hygiene. Hand hygiene enables us to retain an important social and therapeutic gesture."

Ironically, W. Thomas McClellan, MD, a plastic surgeon and lead author on the fist-bump pilot, couldn't agree more. "The overall goal of the study was to do one thing: to bring attention to the importance of hand washing. It's a funny way to raise attention, I know, but my goal wasn't to get rid of handshaking and supplant it with fist bumping."

Incorporating human touch into the clinical encounter in a way that is safe and hygienic isn't very complicated, says Robert Lee, MD, a family practitioner in Johnston, Iowa. It just takes awareness and good habits.

Dr. Lee washes his hands at the end of every patient encounter so that when he walks into the exam room with his next patient, he can greet him or her with a smile and a handshake. After shaking hands, he avoids touching his face by making it a point not to raise his own hands above his chest for the remainder of the encounter. If he walks into a room and a patient is hacking into his hand or showing obvious signs of an infection, he says it's easy enough to clap them on the shoulder and say something to the effect of, "That sounds awful. Let's see what's going on."

"If you walk in and you don't touch them, patients have an icky feeling when they leave," he says.

Not long ago, Dr. Lee says he referred a patient to a neurosurgeon whom he likes and knows to be an excellent specialist. So when he later asked the patient about the encounter, he was surprised to hear a negative report. The patient complained, "He never touched me during the entire visit."

"Those of us in family medicine know the importance of touch, but my friend who is a great guy and a great surgeon -- that's not his training. I really feel that touch is very, very important. It doesn't need to be skin-to-skin, but I think it's very important that we have physical contact with a patient -- that they know that they're not some kind of leper."

Dr. Lee says the handshake is likewise an opportunity to educate patients and model safe behaviors. After examining a patient, Dr. Lee washes his hands. If a patient wants to shake his hand at the end of the encounter, he simply raises his hands and points out that he's already washed them so as to keep the next patient safe. "They get it," he says. "No one is ever put off by that. Their reaction is, 'Right! I should have thought of that.'"

As for fist bumping, during a recent flu outbreak Dr. Lee notes that his church adopted the practice in lieu of handshaking as an alternative sign of peace. The gesture enjoyed momentary novelty -- the older ladies in the congregation seemed particularly amused by the display, says Dr. Lee -- but when the flu season subsided, "It just sort of went away. Everyone seemed ready to revert to handshaking."


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