‘I just want someone to talk toAnd a little of that human touch’ — ‘Human Touch’, Bruce Springsteen, 1992
Simple gestures
More than 5 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, healthcare 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 with other people or any surface that could have been touched by others was unsurpassed in the healthcare environment. We tended to turn door knobs with our elbow or press elevator buttons using our house keys. As time passed, these somehow obsessive behaviours gradually abated, but I felt that some subconscious concern still remained. In my personal experience, I decided not to shake hands with my patients.
For the last 10 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 it still was 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 it is much more. It not only denotes respect, closeness, and concern about their problems, but it can also provide us with 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 5 years I felt I missed this simple act in my everyday practice.
“Shaking hands with patients at the beginning and the end of each visit might seem a useless, formal action, but I think it is much more. It … denotes respect, closeness, and concern about their problems … give us clues about some potential clinical disorders according to their grip strength or tremor.”
The human factor
Imagine you are attending a patient in his 50s. 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 lowering and his eyes are flooding with tears, your first impulse is to hold his hand to show some understanding and compassion, but you quell this.
Imagine now that a young woman in her 20s presents with chest pain — a mediastinal mass has been detected on a chest radiograph. She has just completed a degree in education and has some knowledge of 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 glum (and I imagine 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 fear of being infected. That was until a few months ago, when I started noticing that more and more patients were willing to shake hands with me, especially when they were leaving the outpatient clinic. I look at this change with joy; I thought it may be a signal that the way back to ‘complete normal life’ was closer than originally thought. And it makes me feel glad.
The practice of medicine will still need the human factor as long as we don’t lose our human side.
- © British Journal of General Practice 2025
