Patient Contact: Shake Hands, Hug, Fist Bump, or Just Smile? Shelly ReeseDisclosures May 20, 2014

Is a Handshake Becoming Passé? You walk into the exam room. You smile at your patient and then…

Hopefully, you extend your hand. While the patient greeting may seem like a relatively insignificant part of the jam-packed office visit, experts say it’s a vital determinant of patient satisfaction. What’s more, despite cultural differences and concerns about germs and infection, most patients say they want and expect their physician to shake their hand.

A Lesson in Etiquette Greeting a patient — either someone new to the practice or a long-time visitor — shouldn’t be complicated, but the fact is, sometimes it can seem that way. Harried schedules and electronic medical records can make interpersonal communication less than personal.

But studies show that patients expect their physicians to rise above such distractions and extend their hands. Gregory Makoul, PhD, Professor of Communications at the University of Connecticut School of Medicine, has interviewed hundreds of patients about their expectations. “We’d done loads of focus groups with patients to discuss what professionalism looks like to them, and as part of that, the topic of greetings comes up over and over,” he says. “Even though it’s a very mundane part of the encounter, you can’t trivialize it.”

In 2007, Makoul published a study in the Archives of Internal Medicine based on more than 400 patient interviews.[1] The vast majority of patients (78%) said they wanted the doctor to shake their hand when greeting them. While the handshake isn’t a universal greeting and individuals from certain cultures may prefer not to shake hands, it’s overwhelmingly preferred by patients in the United States.
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. “If you walk in and you don’t touch them, patients have an icky feeling when they leave,” he says.

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.”