When Handshakes Are Like Smoking

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When Handshakes Are Like Smoking

Unhealthy cultural practices are as unhealthy and American as apple pie. Just look at the Fourth of July: we celebrate our independence by eating hot dogs, getting drunk, and blowing shit up.

But there's one cultural habit that, in the interest of promoting health or something, an article in the Journal of the American Medical Association is advocating doctors give up. It's not the Fourth of July, but the practice of shaking patients' hands in the office.

The research team from UCLA acknowledges that the handshake is a “deeply established cultural custom,” but, nevertheless, everyone's hands are filthy vectors for disease. While you may miss the semi-norm of shaking hands with your doctor or nurse, is it worth getting diarrhea from Clostridium difficile spores?

“Health care workers’ hands become contaminated with pathogens from their patients, and, despite efforts to limit the spread of disease, cross-contamination of health care workers’ hands commonly occurs through routine patient and environmental contact,” the report states.

It goes on to say that despite the importance of hand hygiene being known since at least the 1940s, “compliance of health care personnel with hand hygiene programs averages 40 percent.”

There are a considerable number of stock images of doctors shaking hands and also about to shake hands. Image: Shutterstock

The study rolls along pretty well, and I'm pretty on board—thinking about how little I want to come into contact with Clostridium difficile spores—when it reaches for a comparison.

“Although the mortality associated with smoking has been found to be substantially greater than that associated with hospital-acquired infections, some parallels may be drawn between the proposal to remove the handshake from the health care setting and previous efforts to ban smoking from public places.”

You see, smoking was once the norm—even the doctors were lighting up. Then 50 years ago the first surgeon general report, Smoking and Health, suggested banning smoking, even though it would be difficult. Forty-two percent of America, then known as "flavor country," smoked. Today, the JAMA paper says only around 18 percent of American adults still smoke, that smoking as a practice is probably on the run, and they're betting it can't run long.

Changing the norm meant “the development and promotion of effective alternatives, such as nicotine gum,” so it should come as no surprise that this paper not only suggests signs that could be used so that people don't just conclude that the doctors are leaving them hanging because they're all a bunch of self-important jerks—“Handshake-free zone: to protect your health and the health of those around you, please refrain from shaking hands while on these premises.”—but it also suggests that doctors find a “suitable replacement gesture...to be adopted and then promoted with widespread media and educational programs.”

“Some well-established gestures include the familiar hand wave (using an open palm, and practiced widely as an informal greeting/departure gesture) and placement of the right palm over the heart (as practiced in the United States while facing the American flag). Practiced predominantly in the Far East, the bow symbolizes reverence and respect but can also have a variety of secular/religious meanings and may signify greeting/departure, humility, obedience, submission, apology, or congratulations.”

I'm not sure if big data has yet determined when it is medically advisable to change a cultural norm, but there may actually be a case to be made here. Every day more than 200 Americans with health care-associated infections die during their hospital stay, according to Tom Frieden, the director of the US Center for Disease Control and Prevention. Hospitals are full of sick people and therefore full of potential maladies that can spread to other patients with compromised immune systems. This paper in JAMA doesn't really have hard numbers on how much of this can be attributed to shaking hands, but given that the cost is, like, three awkward moments a day, you may as well try it.

Maybe bowing really could be considered a sort of nicotine gum. :lol:

http://motherboard.vice.com/read/when-handshakes-are-like-smoking?trk_source=recommended