Dignity in a Handshake

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RESIDENT’S CORNER

The simplicity of a handshake has taken on a different meaning during my medical education. It is no longer a formal gesture to symbolize parting ways. It has become that moment with a patient when we both agree to embark on a journey together. This simple gesture has the power to transform an interaction between patient and physician.

In psychiatry, the importance of physical boundaries cannot be overstated, but a handshake often serves to build trust and human connection. This is crucial in a field where so many of our patients are stigmatized and feel disconnected from society. In the medical field, however, some hospitals have proposed ending the handshake because of concern about spreading infectious disease. These pragmatic matters should not overshadow the meaning that this gesture may have for our patients.

During psychiatry residency, I spent a morning each week at a residential community for those with schizophrenia. The residents were plagued by persistent delusions and hallucinations, often terrifying. They also displayed negative symptoms and cognitive deficits. This community focused on building social skills and empowering patients to create meaningful lives. As part of the healing process, we modeled social skills that promote basic human connection.

Early one morning, a patient with schizophrenia, “Mr A,” approached my office to tell me about his parents. He described their careers as teachers with great pride and detailed how many years they worked in education.

Unfortunately, Mr A often perseverated on concrete details because of his illness, which caused him considerable suffering. He subsequently returned to my office repeatedly that morning to clarify his story. He stated, “No, it was 12 years, but I said 11 years earlier,” then “Actually, it might have been 12 years,” and finally, “It could have been 11 years.” He was clearly distraught by his inability to convey his story.

The techniques I had eagerly studied in textbooks were not what was needed to ease his escalating distress. In that moment, I looked into his eyes, stood up, grasped his hand, and recounted his story. The combination of human connectedness from a handshake and appreciation of his narrative allowed him to feel grounded and calm. He gleamed with pride, nodded, shook my hand, and with a smile walked away, dignity intact.

I returned to my work, writing progress notes and ordering medications. However, being a physician that day was the comfort of a simple handshake that reminded someone of their own human dignity in the face of suffering.

This article was originally posted on 12/14/16 and has since been updated.

Disclosures:

Dr. Lochhead is Assistant Clinical Professor of Psychiatry at the University of California, Riverside School of Medicine, Riverside, California.

The author reports no conflicts of interest concerning the subject matter of this article.