Happiness in this World

Reflections of a Buddhist physician

Don't Shake Hands

Why a handshake is riskier than you think

Photo: buddawiggi
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One of the earliest memories I have is of my father teaching me how to shake hands. He would always comment to me whenever he received what he considered to be the hallmark of a quality handshake, a firm grip. Handshakes, he taught me, were important. The indicated something about the character of the person whose hand you were shaking (though whether he meant a sterling character, a commanding personality, or something else I don't know—nor am I sure he did himself). As a result, I grew up always making sure that when I grasped someone's hand that I did so powerfully, giving a strong squeeze, letting go only after I was confident I'd delivered a clear message: I was definitely glad to meet you. Or definitely present here with you. Or just...definite. To this day I remain suspicious of weak handshakes—even a little annoyed, I must confess, at the people who come at me with them. I'm sure, in fact, that some part of my unconscious mind registers a subtle—or even a not-so-subtle—disdain for anyone who fails to grasp my hand with force.

Research in fact suggests that a firm handshake projects extroversion and emotional expressiveness, may affect the likelihood of our being hired for a job, and increases the likelihood of our being judged conscientious. On the other hand (pun intended), research also shows a vast number of infections are passed from person to person via the hands. Hand washing and sterile technique are now well known to have revolutionized surgery, dramatically reducing the number of post-operative infections and deaths, turning surgery from a likely date with death into a life-saving intervention that's transformed for the better the lives of tens of millions of people.

For reasons that we still don't understand, in the winter months in North America the rate of viral infections rises dramatically. Many theories have been proposed to explain this, but no definitive proof exists for any of them. But the same vector of transmission exist in winter as do in summer: coughing, sneezing, and hand-to-hand contact. Being a doctor, I see a disproportionate share of these viral infections, so find myself at a higher risk than most for catching them. Which is why I wash my hands constantly, as doctors are trained to do.

Only, studies show, they don't. At least, not nearly as much as they should. It seems so simple. And in hospital settings where it's been shown to reduce rates of patient infections in study after study, so important. So why don't doctors do it more consistently? For the dumbest but most common of reasons: it's a hassle. As with many other desirable behaviors, as low as the activation energy required may be, it's often still too high. Hospitals across the country are engaged in experiments designed to lower that activation energy and get more health care providers to wash their hands more consistently, but only time will reveal if any of them work.

If doctors, who are explicitly taught to wash their hands before and after examining patients, don't do so consistently, how well do the rest of us do at it in our day-to-day lives? In one observational study of female college students, only 2 percent washed their hands for more than 10 seconds with soap after using the bathroom. And after simply shaking hands? My own personal observation is that it's even less. How often, after all, do we shake hands near a sink?

So here I am, making a case to change one of the most cherished traditions in Western culture. I don't have much hope that my plea to stop all this handshaking will be heeded, though. I don't think I can stop even myself. I like shaking peoples' hands. Touch cements trust, an important feeling the handshake has long symbolized. Yet we can't deny that a handshake has become, in one sense, a modern-day health hazard with the capacity to spread infectious diseases at an alarming rate. Of course, if most, or even a few, of the viruses that handshaking spreads were fatal—say, for example, that AIDS was ever found to spread through hand-to-hand contact-handshakes would undoubtedly disappear overnight. For now, however, handshakes represent a health hazard we all tolerate.

Unless, of course, we find ourselves shaking hands with someone who then tells us they're sick. I strongly suspect most of us, even when ill, don't refrain from shaking hands either because we don't think about how we're putting others at risk or because the awkwardness of refusing to shake hands even for a legitimate reason overpowers our concern that we might give someone else a cold. Like hand washing itself, the activation energy required to inform others we aren't shaking hands may often be too great, or the need to perform some gesture of greeting too strong to resist. To those who feel the latter, however, I'd offer my own personal solution: "I'm sick, so I'm not shaking hands today," I say. "I'm bowing instead." And then I do just that.

 

Dr. Lickerman's book The Undefeated Mind will be published in late 2012.

Alex Lickerman, M.D., is a general internist and former Director of Primary Care at the University of Chicago and has been a practicing Buddhist since 1989.

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