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Instead of Handshake Hazard: Namaste, Salaam Gestures or Bumping Elbows?
Of course, we all teach our medical students from year 1 that
the handshake with the patient is a classic professional act to develop and
preserve the doctor-patient relationship. The basis for teaching our
students is that an initial handshake is, as I wrote in the thread "A Doctor's Touch" in July 2008, "the handshake, provides the first
connection with the patient. It can be represented as the marking of a
beginning doctor-patient relationship which is hopefully to continue to the
benefit of the patient. The quality of the handshake tells each party, at the
onset, something about the other." But these days with greater spread
of infection attributed by studies in part related to hand to hand contact,
despite emphasis to attend to hand washing, there is an argument in favor that
the professional handshake with the patient is now anachronistic and should be
eliminated. But what, less infectious but yet courteous behavior is
there to replace the handshake?
A recent article on this subject in a May 15 2014 issue of
the online Journal of the American Medical Association discusses the hand shake
which " has evolved over centuries into its currently profound cultural
role. Artifacts from ancient Greece suggest that the handshake began as a
general gesture of peace, revealing one’s open palm as a symbol of honesty and
trust. The custom and technique of this open-palm gesture subsequently evolved
into the modern form of the handshake, now representing an international symbol
of greeting/departure, reconciliation, respect, friendship, peace,
congratulations, good sportsmanship, or formal agreement."
So what might be an alternative, infection-free, method for
expressing a physician's greeting to and acknowledgment of the patient? This
excerpt from the JAMA article provides some alternatives: " Infection-conscious
alternatives to the handshake may be found in a variety of secular and
religiously based gestures from around the world. Some well-established
gestures include the familiar hand wave (using an open palm, and practiced
widely as an informal greeting/departure gesture) and placement of the right
palm over the heart (as practiced in the United States while facing the
American flag). Practiced predominantly in the Far East, the bow symbolizes
reverence and respect but can also have a variety of secular/religious meanings
and may signify greeting/ departure, humility, obedience, submission, apology,
or congratulations. The Namaste gesture, practiced for centuries throughout South
Asia, has become increasingly prevalent in yoga practice throughout the world.
By placing the hands, palms together, against the face or chest, and tilting
the head forward, the gesture symbolizes respect and may carry religious
significance among Hindus and Buddhists. In Thailand, the wai gesture functions
similarly. The salaam (peace) gesture—wherein the right palm is placed over the
heart, sometimes with subtle bowing—has been practiced among some Muslims and
generally represents a symbol of greeting/departure and respect."
But will these substitutes including even the doctor wearing surgical gloves or any of the popular Western actions such bumping elbows
(safe?), or giving a thumbs up sign in any way substitute for a warm handshake?
I think the best physical connection is
made by the extended arm of the physician with the open palm awaiting the
similar action by the patient and with, as we teach our medical students, washing
hands properly with soap and water just before making contact with the patient
and then again on moving on to the next patient. What do you think about the current value of
the handshake between doctor and patient? Should it be easily abandoned in the
name of safety?...Maurice.
Graphic: From Google Images