MR. Sam Adams, let’s shake on it. On the other hand, let’s not.

The earliest documented handshake depicts the Assyrian King Shalamaneser III (859 BC -824 BC) shaking hands with Marduk-zakir-sumi I of Babylon in a public display of friendship between the two kingdoms. The handshake is thought by some to be a gesture of peace, an empty hand without weapons. In the healthcare setting it can express empathy, trust, and calm.

In modern times the handshake is a gesture of greeting, trust, sportsmanship, or agreement – doing business with a handshake (bad advice these days). Customs differ in different cultures and countries from the firm handshake of the American West to the preferred soft handshake seen in some Asian countries. Also differing is who can shake hands with whom (often gender related), who initiates, how long the hand shake lasts, and one handed or two (a la Bill Clinton) – or no handshake at all: bowing, Namaste, and the wai gesture.

Well, an editorial in OnLine JAMA by Mark Sklansky,, calls into question the wisdom of handshakes in the healthcare setting. Stating the well-known vector role hands play and the variable rates of hand care hygiene practiced by many medical practitioners, the editorial goes on to promote consideration of hand-shake-free zones and suggests alternative greetings. These greetings, some mentioned above, also include just a friendly wave or a hand over the heart (with or without the slight bow – as in the Salaam gesture).

In a more modern version, the fist-bump – occasionally followed by the starburst explosion – has been demonstrated to reduce transmission (who studies these things?!). Once the fist-bump becomes commonplace as a healthcare setting greeting, it will no doubt become uncool. Or as my daughter would tell me, since I am the one mentioning it here, it must already have become so.

BTW, you did get the MR. Sam Adams clue?

Marshall Kubota, MD

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