A controversial report on hand hygiene in clinics and hospitals puts shaking hands with your doctor under the microscope.
Stacey Hoffman always watches the doctor’s hands. At a recent appointment, she studied her family physician as he squirted sanitizer into his palms. Only then did they shake hands. After the exam, the Maple Grove woman saw him “foam out” before leaving the room to see other patients. “If you see them do it, then I feel better about it,” she said.
Diligent attention to hand hygiene isn’t a given in every medical setting. That’s why one California doctor is calling on hospitals and clinics to establish “handshake-free zones” to stop the spread of germs.
“We’re here to get patients well, not give them warm fuzzies,” said Dr. Mark Sklansky, a pediatric cardiologist and professor at the University of California, Los Angeles.
His case against the handshake — that time-honored greeting used to seal a deal or to convey warmth — has touched off a lively debate among doctors since appearing this summer in the Journal of the American Medical Association.
The notion of outlawing the doctor-patient handshake pits two values sacred to the medical profession against each other: do no harm vs. compassionate care. Many doctors say banning this small yet meaningful connection would erode the human touch central to the medical practice.
“It’s a really important part of being a caregiver,” said Dr. Robert Quickel, a surgeon at Hennepin County Medical Center in downtown Minneapolis.
But there’s no shaking it: Our germ-carrying palms are under fire.
Sanitizer dispensers are ever-present in the corridors of HCMC, with signs reminding staff and visitors to “always foam in and foam out.” At Park Nicollet Clinic, surveys ask patients to report if doctors and nurses did not clean their hands in the exam room. And while there may be no handshake-free zones at Twin Cities area hospitals, there are doctors who make a point not to shake hands.
One alternative — the fist bump — recently received a scientific stamp of approval. Researchers in Wales discovered that the popular knuckle tap spreads only one-twentieth the amount of bacteria as a handshake.
The attention to hands is well-deserved, argued Sklansky: “We touch keyboards. We touch phones. We touch doorknobs. We touch our own eyes and mouths. We have to go to the bathroom and such. … That’s how germs end up on hands.”
Keeping it clean
Quickel routinely offers his hand to patients as a way to connect with them.
His hands are often still wet from washing them when he approaches a patient. “Wet, but clean,” he tells them with a smile.
Given how much hospitals stress hand washing, he’s not sure what all the hand-wringing is about. In the surgical ward, doctors and nurses typically have a 95 percent rate of compliance with hand hygiene policies, according to internal monitoring programs at HCMC.
“There are so many other things that we [should] focus on first, like neckties, lanyards and sleeves,” he said. “Those things get really dirty and don’t get washed.”
Still, after reading Sklansky’s take on handshakes, Quickel said the topic should be studied to see if eliminating handshakes would really make a difference in curbing infections.
In the clash of health care values, those opposed to handshakes argue that “do no harm” should win. Sklansky suggests there are other, perhaps better, ways for doctors to show good bedside manner. “Sometimes the handshake can be somewhat perfunctory. Sometimes, people do that in place of a smile and warm contact.”
Alternatives to the handshake include: the Namaste gesture, hand waving, bowing or using the “salaam gesture” — putting your hand on your heart. (See box below.)