Shaking hands again

Jorge L Polo-Sabau is an internal medicine generalist and Associate Professor of Medicine, Nursery and Biomedical Engineering at the Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain. He has been a medical residents’ mentor for the last eighteen years.

I ain’t lookin’ for praise or pity

I ain’t comin’ ’round searchin’ for a crutch

I just want someone to talk to

And a little of that Human Touch

Just a little of that Human Touch

Bruce Springsteen (1992)¹

More than five years after the beginning of the COVID-19 pandemic, “normal life” has returned in many aspects. Nevertheless, it seems that some simple gestures are not easy to resume. When this global nightmare started, health care workers were overwhelmed with uncertainty, fear of being infected or even dying, endless work days and uncomfortable personal protection equipment worn for long periods. As part of general measures to prevent transmission of the virus to ourselves and to others, we were aware of the importance of hand washing and the routine use of hydroalcoholic solutions, as it was also promulgated to the general population.

The avoidance of direct contact to other people or to any surface that could have been touched by others was unsurpassed in the health care environment. We tended to turn door knobs with our elbow or to press elevator’s buttons using our house keys. As time passes, these somehow obsessive behaviours have been gradually abated, but I feel some subconscious concern still remains. In my personal experience, I decided not to shake hands with my patients.

For the last ten years or so I have spent most of my professional activity attending patients at the outpatient clinic and teaching medical residents and students. Despite all the technological advances and the emergence of artificial intelligence, I always tried to let them see how crucial still is to establish a good physician-patient relationship, which is in great part based on non-verbal communication.

Shaking hands with patients at the beginning and the end of each visit might seem a useless, formal action, but I think is much more. It denotes respect, closeness, concern about their problems, but it can also provide us subtle information about their worries and fears or even give us clues about some potential clinical disorders according to their grip strength or tremor. These last five years I felt I missed this simple act in my everyday practice.

Imagine you are attending a patient in his fifties. He has raised levels of triglycerides and liver enzymes. When you ask him if there has been any change in his diet or physical activity he confesses with a faltering voice that he started drinking high amounts of alcohol after his daughter’s unexpected death. While his head is bending and his eyes flood with tears, your first impulse is to hold his hand to show some understanding and compassion, but you quell yourself.

Imagine now that a young woman, in her twenties, presents with chest pain –  a mediastinal mass has been detected on a chest radiograph. She has just completed an education degree and has some knowledge on possible diagnoses. She is anxiously anticipating the side effects of chemotherapy, worried about whether this will affect chances of her future motherhood, and envisioning her premature death. Again, you prevent yourself from holding her hand. And you do the same several days later when the results of percutaneous needle biopsy reveal she has lymphoma.

Such scenarios would make me feel really glum (and I imagine may readers would feel the same). I wouldn’t be proceeding the way I used to encourage others to do.

Nonetheless, I perceived that patients themselves did not long for this skin contact anyway, perhaps because we both were sharing this unconscious, mechanical attitude of avoidance, this somewhat exaggerated awe of being infected. Until a few months ago, when I started noticing that more and more of them were willing to shake hands with me, especially when they were leaving the outpatient clinic. I took this change with joy and made me think that may be it is a signal that the way back to “complete normal life” is actually closer. And it makes me feel glad.

The practice of Medicine will still need the human factor as long as we don’t loose our human side.

Reference

1. https://brucespringsteen.net/track/human-touch/ [accessed 8/9/25]

Featured photo by charlesdeluvio on Unsplash