Purpose: The physician introduction is a pivotal moment in the doctor/patient relationship and has traditionally been initiated by a handshake. However, there is limited data regarding patient preferences. Previous studies suggest that a handshake is preferred, but lack research into the rationale behind this preference. The objectives of this project were to: 1) better understand patient perspectives; and 2) educate providers, residents, and medical students in order to improve the patient experience and increase patient engagement.
Methods: Using a cross-sectional design, a total of 668 surveys were collected from adult patients in 4 community-based primary care practices (including family physicians, internists, and med/peds physicians) to learn more about patient attitudes regarding handshakes. Patients were surveyed prior to seeing their physician that day. Analyses assessed patient preferences and their rationales by patient gender, age, race/ethnicity, and educational level.
Results: With a response rate of over 90%, nearly 60% of patients preferred their physician to include a handshake, while less than 10% did not. The remaining one-third were unsure, most often citing “does not affect my experience.” There were few differences in handshake preference by race/ethnicity, but age, gender, and educational level all played a significant role. Males were significantly more likely to prefer a handshake as were patients 65+ years. Among those preferring a handshake, females cited “physician caring,” while males cited “helped to form a relationship.” Patients with a high school education or less preferred a handshake because it made them feel “more comfortable,” while those who attended college and beyond were significantly more likely to cite “helped to form a relationship.” Patients self-identifying as white were significantly more likely to not want a handshake due to "risk of infection,” while non-white patients were more likely to not want a handshake due to “cultural reasons.”
Conclusion: The results deepen our understanding of factors leading to patients accepting (or not) a physician handshake. To the extent that patient engagement might be enhanced by this early non-verbal contact with providers, medical education efforts at the UME, GME, and CME levels should include direct discussion of when and why a handshake should be included in medical settings.