Suffice to say, as a physician, I’m not germ phobic.  If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic.  I certainly respect the pathogens I come in contact with daily, along with the host who harbors them.  For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my main task becomes preventive: help the patient bolster his/her own immune system to wage the battle on their own and keep that virus from finding another susceptible host.  If there is a vaccination available,  I urge everyone to be immunized. I’m ready to offer up my arm so I’m less vulnerable when exposed to ill patients and less likely to pass it on to those who are healthy.

Hand washing is very effective in preventing transmission of pathogens in a clinic or hospital, but outside a health care setting, it is not always possible or practical. Hand sanitizer dispensers may now sit on board room tables, but how often are they used?

There comes a time when a little paranoia about viruses is warranted, especially if no vaccination is yet available because of a new viral strain, such as our recent experience two years ago with H1N1 influenza.  In those cases, there may be good reason for new adaptation of social rituals to protect the unprotected.

There is reasonable evidence that influenza outbreaks really take hold in environments where people do a great deal of “meet and greet” activities—schools, social gatherings, and worship settings.  Hand shakes and hugs, or the seemingly benign cheek kiss, can confer more than good will.  They become the vectors of an unwanted viral gift, ready to transfer to our mucus membranes with an innocent rub of an itchy eye, or licking of our lips after touching the outside of our mouths, or running the back of our hand across our noses.

In other words, we inadvertently share and receive more than we intend with a simple greeting ritual.  This becomes especially important during a time when potentially fatal viruses are circulating widely, as a certain percentage of the population will tend to be “carriers” without having obvious symptoms,  effectively becoming unwitting transmitters.

It may be necessary during viral outbreaks to altogether stop greeting with hand shakes, particularly in “high volume” situations like political rallies, wedding and funeral receptions, church and temple lobbies and school activities.  The options to replace the hand shake are plenty, but ideally should minimize physical contact.   I prefer a simple nod, leaning forward, hands at my side or behind me, similar to the Japanese greeting bow. I actually use my vocal cords to do the work of greeting:  “good to see you” or some other gracious few words.

I’m not being unfriendly, nor am I rebuffing a friendly extended hand.  I just don’t want to share what I may have just been exposed to a few minutes earlier without having had a chance to adequately wash my hands.  Just like the classic classroom exercise illustrating how many sexual partners you exponentially end up with when you consider all the partners of the partner’s partners, etc. —when you shake my hand, you are shaking the hand of everyone I’ve touched since the last time I washed my hands.  In certain social situations, that can be an overwhelming number of contacts.  Let’s just take handshaking out of the equation and make it a little tougher for a virus to find its way from me to you.

So it’s good to see you looking so well. And I really want you to stay that way.

Emily Gibson is a family physician who blogs at Barnstorming.

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