The hesitation before shaking a patient’s hand in the hospital

Today, during my psychiatry rotation, a very grateful patient confronted my attending and thanked him profusely for saving him. The patient had been severely depressed and was at his wit’s end before they met. The doctor listened to him, analyzed his situation, and came up with a plan to help which included involving the patient’ family as well as using proper medication. The patient had a great response to this and now wanted to express this to my attending. Thus entered the “hospital handshake.”

After spending enough time in the hospital, I have come to the conclusion that it’s a dirty place. This was not an epiphany that I experienced; rather, it’s just a simple conclusion after seeing/experiencing the dirtiest parts of people throughout the hospital. I’ve even seen a psych patient throw his own feces at his roommate because he “didn’t like the way he was looking at him.”

Therefore, when the grateful patient offered his hand to the doctor to shake as a sign of being thankful, I could sort of understand why the attending hesitated for a second. It was not just the hesitation that tickled me. As we were leaving the floor, the attending walked out of his way to dose his hands in hand cleanser.

A lot of people may have found that action as perfectly reasonable. Especially in this day and age in which around every corner you turn there is a sign about washing hands and stopping infection. And to add to that, I had to complete a form upon starting the rotation that quizzed me on the proper length of time of hand washing (it’s 15 to 20 seconds if you’re curious). However, the attending and I both knew that we were merely heading back to the psych floor where we were going to continue our conversation about his recent trip to India. There would be no spread of infection (there was no reason to believe this patient had an infection anyway) to other patients.

I bring this up not because I have a problem with keeping infection down by hand washing after physical contact with patients. In fact, I think it’s a great habit to get in to. It is because this scene struck me as borderline disrespectful to the patient that I bring it up.

Imagine this, you go to your parents house for Thanksgiving. It’s been months since you’ve seen them and your father has still not thanked you for helping him with a medical problem that he’d been dealing with.  He remembers that he forgot to tell you how grateful he was, thus he elaborates his appreciation as you greet each other. He finishes by giving you a stern, fatherly handshake to demonstrate how strongly he feels. In this particular case, neither your father nor yourself have any signs of an infection. Despite this, you walk past him to the nearest bathroom to wash your hands (for 15 to 20 seconds, of course).

Is this something your father would take offense to? If that was my child, I would feel like he just took my sign of appreciation and smacked me in the face with it. So why is this not the case when a patient wants to shake the hand of the caregiver that had such a profound effect on their life?

In this particular interaction with the attending and patient, I did not perceive the attending as respecting the patient. From the hesitation to shake his hand to cleansing the physical contact from himself once he turned from the patient, the attending came across as cold and uncaring.

My fear is that this lack of respect can be extrapolated to all patients. This would be even more prominent on an inpatient psychiatry floor in which many patients do not have a firm grasp on reality. Will I soon find myself losing respect for patients; declining handshakes and ignoring their displays of gratitude? I hope not.

“Nonmaleficence” is a medical student who blogs at his self-titled site, Nonmaleficence.

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