Should you stop shaking hands with your patients?

By John Murphy, MDLinx
Published November 21, 2018

Key Takeaways

What’s the polite thing to do when you meet someone? You look them in the eye and shake their hand, right? But these days, when hospitals and offices are oozing with indestructible bacteria and patients are trigger-happy with lawsuits over perceived offenses, should you still be touching your patients’ hands?

Say hello to my bacteria

When you shake hands with someone, you’re not only saying hello to that person—you’re greeting dozens, if not hundreds, of species of bacteria.

In one study, researchers found that the typical person’s hand has more than 150 distinct species of bacteria living on it. And the bacteria are diverse—the microbes on the other person’s hand are vastly different from the ones on your hand. Specifically, researchers found more than 4,700 different bacteria species among 102 human hands, with just 5 species shared among all participants—a commonality of only 13%.

Even your right hand has only 17% of the same bacteria as your left hand, the researchers found. Also of interest, women in this study had a significantly greater diversity of bacteria on their hands than men.

Surprisingly, the researchers also showed that the overall diversity of bacteria on individual hands was not significantly affected by regular handwashing. “Either the bacterial colonies rapidly re-establish after hand washing, or washing…does not remove the majority of bacteria taxa found on the skin surface,” the study authors wrote.

Still, that’s no excuse to skip washing your hands. “The vast majority of bacteria are non-pathogenic, and some bacteria even protect against the spread of pathogens,” said study co-author Rob Knight, PhD, who is now the director of the Center for Microbiome Innovation, University of California San Diego, San Diego, CA. “From a public health standpoint, regular hand washing has a very positive effect.”

Shaking hands in the #MeToo era

The #MeToo movement, and the attention that has come with it, have only added to the abundance of caution that physicians now take when encountering patients in the exam room. Perhaps these days the best greeting is one that involves no physical contact whatsoever?

“How do we ‘care’ for patients in this modern, highly regulated, and, frankly, contentious and litigious era? Is this the era of ‘do not touch?’” wrote health-care attorney Elliott Oppenheim, MD, JD, in a recent post on “Are patients like museum pieces—for display and analysis only? Seems cold, but consider the risks to you, the physician.”

Dr. Oppenheim comes down hard on shaking hands, hugging or even, it seems, a pat on the shoulder. “Is hugging related to care? Does the touching relate in some rational way to care?” he asks. “Any touching which exceeds that which is necessary for medical care is wrong.”

What do patients want?

Should you avoid shaking hands with patients because they’re just big petri dishes rife with all kinds of bacteria? Should you also avoid touching them because any show of affection might get you slapped with a lawsuit?

Forget, for a moment, your point of view. What do patients want?

In a classic study on this exact question, researchers showed that 78% of patients said that they do want the physician to shake their hand.

“Physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior,” the authors concluded.

On a side note, half of all patients surveyed also reported wanting the physician to use their first name when greeting them, and approximately 56% reported wanting physicians to introduce themselves using their first and last names.

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