Don’t Shake Hands
One of the earliest memories I have is of my father teaching me how to shake hands. He would always comment to me whenever he received what he considered to be the hallmark of a quality handshake, a firm grip. Handshakes, he taught me, were important. The indicated something about the character of the person whose hand you were shaking, though whether he meant a sterling character, a commanding personality, or something else, I don’t know (nor am I sure he did himself). As a result, I grew up always making sure that when I grasped someone’s hand that I did so powerfully, giving a strong squeeze, letting go only after I was confident I’d delivered a clear message: I was definitely glad to meet you. Or definitely present here with you. Or just . . . definite. To this day I remain suspicious of weak handshakes—even a little annoyed, I must confess, at the people who come at me with them. I’m sure, in fact, that some part of my unconscious mind registers a subtle—or even a not-so-subtle—disdain for anyone who fails to grasp my hand with force.
Research in fact suggests that a firm handshake projects extraversion and emotional expressiveness, may affect the likelihood of our being hired for a job, and increases the likelihood of our being judged conscientious. On the other hand (pun intended), research also shows a vast number of infections are passed from person to person via the hands. Hand washing and sterile technique are now well known to have revolutionized surgery, dramatically reducing the number of post-operative infections and deaths, turning surgery from a likely date with death into a life-saving intervention that’s transformed the lives of tens of millions of people for the better.
For reasons that we still don’t understand, in the winter months in North America the rate of viral infections rises dramatically. Many theories have been proposed to explain this, but no definitive proof exists for any of them. But the same vector of transmission exist in winter as do in summer: coughing, sneezing, and hand-to-hand contact. Being a doctor, I see a disproportionate share of these viral infections, so find myself at a higher risk than most for catching them. Which is why I wash my hands constantly, as doctors are trained to do.
Only, studies show, they don’t. At least, not nearly as much as they should. It seems so simple. And in hospital settings where it’s been shown to reduce rates of patient infections in study after study, so important. So why don’t doctors do it more consistently? For the dumbest but most common of reasons: it’s a hassle. As with many other desirable behaviors, as low as the activation energy required may be, it’s often still too high. Hospitals across the country are engaged in experiments designed to lower that activation energy and get more health care providers to wash their hands more consistently, but only time will reveal if any of them work.
If doctors, who are explicitly taught to wash their hands before and after examining patients, don’t do so consistently, how well do the rest of us do at it in our day-to-day lives? In one observational study of female college students, only 2 percent washed their hands for more than 10 seconds with soap after using the bathroom. And after simply shaking hands? My own personal observation is that it’s even less. How often, after all, do we shake hands near a sink?
So here I am, making a case to change one of the most cherished traditions in Western culture. I don’t have much hope that my plea to stop all this handshaking will be heeded, though. I don’t think I can stop even myself. I like shaking peoples’ hands. Touch cements trust, an important feeling the handshake has long symbolized. Yet we can’t deny that a handshake has become, in one sense, a modern-day health hazard with the capacity to spread infectious diseases at an alarming rate. Of course, if most, or even a few, of the viruses that handshaking spreads were fatal—say, for example, that AIDS was ever found to spread through hand-to-hand contact—handshakes would undoubtedly disappear overnight. For now, however, handshakes represent a health hazard we all tolerate.
Unless, of course, we find ourselves shaking hands with someone who then tells us they’re sick. I strongly suspect most of us, even when ill, don’t refrain from shaking hands either because we don’t think about how we’re putting others at risk or because the awkwardness of refusing to shake hands even for a legitimate reason overpowers our concern that we might give someone else a cold. Like hand washing itself, the activation energy required to inform others we aren’t shaking hands may often be too great, or the need to perform some gesture of greeting too strong to resist. To those who feel the latter, however, I’d offer my own personal solution: “I’m sick, so I’m not shaking hands today,” I say. “I’m bowing instead.” And then I do just that.
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I wish we could adopt the practice of Gassho; Palms together and bowing.
The handshake has a literally barbaric origin, as a subtle method of checking for weapons! (Look it up.)
“Go for the Gassho!” It’s respectful and dignified.
Here in Mexico if people are experiencing a cold or the flu, they extend their wrist for you to wrap your hand around so you will avoid and hand-to-hand contact. It is mutually understood that, if you choose not to touch the wrist, there are no hard feelings.
Whenever sick or not feeling well I always explain to those who expect a handshake why I chose not to do so. I expect the same common courtesy from others. Do I receive….nope. Therefore nowadays I have resorted to the “bump.” No more handshaking for me. My fellow Rotarians just have to understand it is simple hygiene and respect for others of my choice.
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Yes, it spreads germs. But in a society that’s getting more phobic about touching another human being, it’s also sad that we are getting more and more concerned about what we may “catch.” There’s a lot of lonely people who crave a sincere hug, pat on the arm or just someone to hold their hand for a few seconds. I had an exchange with a mid eastern lady a few days ago and in the course of the exchange I was going to touch her arm in a gesture of friendship. When I touched her arm, she took my hand and smiled. It was such a small thing, but it was human connection. One we both appreciated.
In India, “namaste” or “namaskar” with folded hands and a bow, is the Indian way of greeting each other, no handshake involved….. The gesture is an acknowledgment of the soul in one by the soul in another. “Nama” means bow, “as” means I, and “te” means you. Therefore, Namaste literally means “bow me you” or “I bow to you.”
Thank you for acknowledging Jude’s point on the value of touch. As a primary care physician and a mother of 4 vectors of perpetual disease (sometimes called children), I admit that I have come to the point that I worry very little about the infectious diseases that I encounter through touching others, and just try to stick to the hand washing ritual—as my cracked knuckles attest to! I do avoid shaking hands with an obviously ill individual, but if touch seems appropriate I just wash my hands afterwards and not worry too much more about it. Like everyone, I succumb to some virus several times a year, but it’s almost never related to an exposure I can identify. I’m much more surprised by the fact that after directly caring for my sick children or spending hour after hour in rooms with sick patients that I DON’T get sick more often than I do. I also believe in the theory of lack of exposure to infectious agents contributing to higher rates of asthma and allergies, and maybe even autoimmune diseases. Acknowledging that some virus is inevitably bound to catch me sometime, somewhere, I subscribe to the philosophy, “That which does not kill you makes you stronger,” and we definitely subscribe to the “5 second rule” if something drops to the floor in our household. :-0
Funny that people are so afraid of potentially getting germs from the others by shaking hand. Do people have similar fear when they handle cash, which has been touched by unknown number of people’s hands? Think about the irony and stop being unnecessarily paranoid.
Often I find my hands are behind my back in an attempt to avoid the handshake, but I would rather shake hands than do the cheek kiss. Those with colds/flu ought to be the first to decline contact. There are certainly many other “touch” circumstances where I make it my responsibility to wash my hands or “alcoholize” after contact (elevator buttons, grocery carts, door handles).
A few years ago I watched a surgeon open 4 different doors in a hospital using the cuff on her cardigan, not once did her hand touch a doorknob. I worked through SARS in the same hospital where the threat of dying was very real so I understood her defense actions. I tap elevator buttons using my keys or even an elbow.
Touch keeps us connected, feel loved, needed, consoled and offers emotional warmth. Would be a shame to loose that.
My eldest son who is doing graduate work in antibiotic-resistant bacteria feels we are due for another 1918 flu epidemic. And international travel will just speed it up.
I’ll say keep your hands away from your face and increase hand washing!
Maybe in a medical situation you are correct about not shaking hands and washing after each contact but in real life my clinical experience (of one I admit) it seems over rated. I was a large animal veterinarian for 40 years and was clean but not fastidious and never caught anything from contact. And like most LA vets I was in some pretty dirty situations. I always told my self it was just stimulating antibodies and it seemed to work. I also never had a sink available and usually the bucket was getting dirty rapidly.
I do not advocate you not being clean as I also think the placebo effect of “I just touched someone and didn’t wash” will probably make you sick on occasion. Fortunately not 80% of the time like placebos treating many things works.
A handshake plus…! While visiting a island in the Caribbean a friend and I were invited to luncheon at the home of a prominent, formal elderly lady. The butler answered the door, escorted us into a parlor where introductions with handshakes were made to the lady. We had a nice luncheon, chit chat ensued and then it was time for me to leave to catch my flight back to the states. I felt in my bones that the hostess was so so lonely in her big home with staff but she remained distant. The formal goodbye moment arrived and I took her hand, cupped the hand, looked her in the eye and told her what beautiful hair she had and asked if I could touch it. She smiled and replied yes and I touched her hair and said it was just beautiful. My friend stood there with his mouth hanging open because I had made such an improper request. Upshot, the very formal lady and I became instant friends, her eyes twinkled and she eagerly invited us to return for another visit when I returned to the island. I learned then that a sincere handshake, a compliment and an extra touch can forge lasting friendships, break social class barriers and bring joy to many lonely people.
Hello, I did enjoy this well-written and amusing article, and having just got over a cold, I am taking up your suggestion. Though with a deep curtsey rather than a bow. Clearly this will look better if I wear a skirt or dress, not so flash in gym clothes!
Alex,
I agree with you and like your essay title. No mincing of words.
Sending a virtual air kiss through the ethers.
Giselle
gisellemassi.com
I appreciate the information. When I use a Target or a grocery store’s rest room, I always notice the sign that says employees must wash their hands for 8 to 10 seconds before going back to the floor. My earlier reaction was that I wasn’t working there, just shopping. I spend a lot of time at home because of a chronic illness. I wash my hands often, but only for a second or two. I’m also taking care of 3 left behind cats, until we find homes for them, and my five older cats. This morning I began washing my hands for a much longer time—also important because of my illness.
Forgot to mention that I also think touch is valuable. A fellow member of the cactus and succulent society, who I worked with years ago in a city position, greeted me with a hug at yesterday’s meeting. It means so much, since some of my memories of experience in that city job were not positive. Yes, stay in the moment.
Your response is eminently civilized.
European culture itself is rooted in barbarism, as most cultures are: bowing is a way to acknowledge relative status and indicate subservience. International etiquette does not require me, an American, to bow to anyone—a privilege reserved to us during our founders’ creation of a democratic republic in an age of hereditary leadership. I bow when it’s courteous & socially appropriate but I’m aware I don’t actually have the cultural context to grade my bows correctly.
Handshaking provides more information about intent, circulation and health, which I’ve always considered an advantage. Also, as humans are hardwired to respond to touch, and it does create more rapport much faster than not doing so.
When I was working as a nurse, I loved it when patients shook my hand (which isn’t reflexive for nurses; we’re in & out of the room all the time.) Someone who stuck out his or her hand for a shake was a lot more likely to recover quickly, whatever their condition. I could tell if they were hypoglycemic or feverish, or if their kidneys were bad or the liver was REALLY bad, by the combination of temperature, moisture, and the degree and texture of the subtle stickiness in an unwell palm.
Your handwashing makes you unusual, doctor. There’s another study, done either at Hopkins or Harvard awhile ago, where med students stood in the bathroom during a break in a professional conference being held on campus and counted which doctors washed their hands after using the toilet.
Most of the female doctors wet their hands. A small percentage washed them for more than 10 seconds. NOT ONE of the male doctors washed their hands after using the bathroom, even though some asked why the students were there and were suitably informed.
My clinical observations indicate a noticeably higher percentage than 0%, indicating that male doctors consider patients filthier than their own biohazardous waste. I’d like to grow out a few culture plates to test that theory!
The hospital I first trained at installed waterless hand cleaner dispensers between the handwashing sinks, and the physicians’ hygiene improved considerably. Rubbing biotoxic scum over their hands is apparently much more appealing and much more fun than the pleasure of warm water and soap! Whatever works …
I ask my doctors to wash before touching me, now that I have a chronic disease. I never assume they did so outside the room.
One more anecdote … We were taught that the main vectors that carried infection were “fingers, feces and fomites,” the latter meaning anything that gets touched.
In microbiology class, everyone cultured the vilest things they could think of (including the men’s bathroom). I cultured the sink taps. Guess who had the filthiest plate?
I used to go around with a bleach wipe and hit the doorpulls at least once a day in flu season. We always had a lower rate of sick leave.
I’m just wondering if that doc removed her cardigan before entering a patient’s room.
I saw my primary care physician last week. He always washes his hands before beginning. I see him every 3 months because of a chronic illness. The nuses who weigh me and check temperature also wash their hands
I also work as a Standardized Patient at the local university medical school. We give the medical students feedback on how it felt to be their “patient.” All of them wash their hands as soon as they enter the room, or mention it if they didn’t do so during the evaluation with the monitoring doctor.
Isy, please understand that Alex mentioned bowing in somewhat humorous way—he bows instead of shaking hands. I laughed because Alex and I both are Nichiren Buddhists and very familiar with the Japanese culture (we don’t know each other).
Diana, that’s delightful 🙂 I felt the humorous tone in Alex’s remark. I sometimes come off as more prim than I am, in print. What happened in my mind as I was writing about the stuff above looked like the Keystone Kops, but on rereading it, I sound like I’m wearing starched underwear. More emoticons, perhaps 🙂
For the record, I’m a fan of:
1. Touch when it works, not when it doesn’t.
2. Hands off face (I learned that quick when I was a nurse).
3. Wash slightly more than I’d like to, rather than less.
Here’s a fun trick. When I worked in cool, dry New England I washed my hands in cool water for every other washing. I could tell when I washed twice in warm water because my skin got more brittle; in cool water twice, my joints got slightly more sore. As long as I alternated strictly, I was fine.
I love Tom F’s story. Such a re-humanizing moment there.
Very well observed. . .and a brilliantly well constructed article. I have always felt that bacteria etc has been passed through touch so even if we have high tech cleansing in every area of life. . .it is still going to be spread through each and everyone touching. . .breathing and living! Hand washing is great. . .but if the person leaving the washroom before you hasn’t done it, it’s pointless! But cleanliness and anti-bacterialism has gone too far . . .every house now has wipes for this. . .for that and everything in between. . .what happened to good old soap n water and a good scrubbing brush. . .and opening the windows and doors!!
Oh yeah and guys pleeease wash your hands after going for a whizz. . .and before picking up your partner’s drink to pass it to them!!
Isy, you made me laugh! Thanks for your response to my comment.
“I’m bowing instead”; great! I may try this instead of the “I’ve got a cold, so I’m not [cheek] kissing” that’s often necessary where I live. Bowing is beautiful. And I always have hand sanitizer in my bag. (As well as hand cream because the sanitizer dries my skin out. Oy.)
I am big on hugs and kisses. I reserve handshakes for more formal occasions. Bowing is not part of my culture at all. I just think the hugs and kisses really convey feeling.
But here’s an interesting anecdote regarding hospital behavior. When my oldest son was an infant (nearly 30 years ago so maybe things have changed), I was instructed to wear a hospital gown when I was in his room. However I was breastfeeding so the baby was under the gown anyway. Interestingly, the doctors that came to see the baby didn’t wear any protective garments at all.
All’s well that ends well. My son is fine. I’m fine and as far as I know none of the doctors got sick either.
I was going to mention the namaste gesture, but Shivani, above, beat me to it! Even though I’ve lived my enitre life in America, I actually prefer the grace and respect in that gesture, especially as a woman. Also, I’m a total germaphobe, which might add to my haste to make use of it! haha.
I learned to wash my hands often when I was teaching. I kept getting colds; in fact I was rarely without one and was beginning to think I was infecting myself. Once I began washing regularly during the day, the colds stopped. I am now retired, but wash my hands often during the day: always before handling food or after using the toilet; after returning from collecting the mail or using an elevator; first thing in the morning. I’m probably overdoing it some but I’d rather that than be down with a cold. I’m very aware when I do have a cold; I then wash my hands even more often and am careful not to shake hands or embrace and to advise people to keep some distance.
The practice of embracing acquaintances and friends as a greeting is something new to American culture I think. I don’t remember it when I was growing up. In fact, I find it a bit awkward, especially when I submit to another’s embrace only to have them turn their faces away completely; why even make the offer?
We definitely could use a better way to greet people in our culture.
I have found this week’s topic really interesting, so I’ll post again! I think this “getting sick” (cold/flu) thing is a combination of germs/virus finding the perfect portal. Sort of like the perfect storm.
To the angst of my mum, when I was a teen, I would always go out in the coldest weather with really, really long wet hair. It would freeze in icy strands. I never got sick. No colds. No flu
ever.
Now I just have to float past an emerg dept or wait in a crowded doc’s office (notice that they don’t keep baby/kids toys in the waiting room any longer!) I wonder why? 🙂 and I can be sick for weeks after those exposures. Also a mix of reduced sleep and stress is my portal for getting sick.
I am huge fan of airing pillows, quilts and blankets all year round. The scent of a summer (or even winter’s cold) sun-kissed pillow is stunning in it’s ability to induce sleep. I still think hands not touching the face is #1 defense.
What a great thread. I love the comments. Group hug! 😉
Alex, I want to add one important aspect to this discussion of handshakes: the pain they cause to people who have ARTHRITIS in their hands.
I have arthritis in both hands (I was a physical therapist for decades, so I’m not afraid of touch!). When someone gives me a heartily firm (translate: bone-crushing) handshake, it causes me agonizing pain in the moment, and sometimes for many hours afterwards, to the point where I have to take extra arthritis meds (or pain meds).
Guys with heavy “linebacker” handshakes are the worst—they seem to think the more vise-like the grip, the more sincere/honest they will be perceived to be. Even when I mention my arthritis ahead of time, to explain why I don’t shake hands, people are either not paying attention or they FORGET—and the next time I meet them, it’s round 2 of the same thing.
As to hygiene, my mother had TB when young, so we grew up with her OCD about cleanliness, and OCD is not a bad thing in today’s environments (offices, travel, and esp. health-care & hospitals). I will turn a doorknob with my coat sleeve, push elevator buttons with my elbow or a gloved knuckle, etc. In a hospital setting, I simply behave as if every single thing in the place is radioactive.
I go through (literally) gallons of Purell in the course of a year—I’m never without a pocket-sized container of it. And I wash my hands more frequently AND for longer than most people do (I used to volunteer in NICU & they are not kidding about hand-washing there!). I also use a nail brush to clean under my fingernails at home.
Yeah, my behavior is kinda OCD, but to the extent that it helps me avoid getting sick unnecessarily, it’s well worth it.
Thanks for the column, Alex, and for letting me have my say on this issue!
Please don’t make light of OCD or suggest you’re “kinda OCD” aboout things or that being “OCD in the workplace” can be a good thing. OCD is not convenient, clever or efficient to those who have it, or their families.
Thanks for your post. I totally agree with you. It’s best to be kind to everyone.
@Molly, I don’t know your background, but your comment implies OCD is an issue either for you and/or for someone close to you. I am definitely NOT making light of OCD, because it’s real, and it’s in my family. I know perfectly well how inconvenient & inefficient it is.
That said, OCD *does* have its uses (as in hospital hygiene).
I manage my OCD pretty well (after a lot of therapy, I am now not as badly affected as my mother was). So when I say I’m “kinda OCD” it means I am MANAGING my OCD successfully much of the time. It seems that my use of the word “kinda” offends you; presumably if I said I was in the fullest throes of OCD daily, that would have been OK with you.
Maybe you could temper your criticism and not lash out at someone whose background you cannot know, over ONE word. Your comment has, for me, certainly negated that “group hug” you were apparently cheerfully giving out up-thread.
Sarah, I didn’t lash out and I didn’t need to temper any criticism. I was simply suggesting awareness and I sense that offended you.
Your reaction seems to indicate a high amount of reactivity regarding my blanket suggestion (not directed at you, but you’re the one who commented, “Yeah, my behavior is kinda OCD,” either you are or you’re not) that one not make light of having OCD. Not only did I not know you have suffered with OCD, because you stated it was your mother: “my mother had TB when young, so we grew up with her OCD about cleanliness, and OCD is not a bad thing in today’s environments (offices, travel, and esp. health-care & hospitals).” Your words also don’t indicate that she *had* OCD, but only manifested its behaviors, i.e., “with her OCD about cleanliness.” Your words, not mine.
My great grandmother died of typhus and her daughters, my grandmother developed all manner of stresses and OCD as a result. That woman raised my mother, who is crippled by the disorder. She raised her children, of which I am one, and we deal with it in our own way as well, wishing it weren’t so.
You indicate working in NICU, so I am grateful you are “kinda OCD” about your treatment around the babies. Because you say you have it, I now understand and hope that you would understand how OCD is a noun, not an adjective, and its casual usage and bandying about in all environments from the media to a web blog can be disturbing to those of us who suffer and see their loved ones suffer. Maybe your answer was flip, maybe you didn’t think about it, maybe having and living in an environment stifled by OCD is so normal to you that it’s funny. To me, it is not funny. I have witnessed the ravages of true, clinical, diagnosed OCD and its effects on my grandmother, my mother, my cousins, and my sibling. OCD is not funny to me (and before you suggest it, I don’t think it’s funny to you).
But I stand on my ground and I repeat: *OCD* is not convenient in the workplace. Cleanliness, attention to hygiene and care of one’s self and disease management has its place in the workplace. Certainly not true, real, diagnosed, treated or ignored OCD. There is a clear distinction.
I still believe in my group hug. And I offer it to you, with clean hands and a happy heart.
Molly, thanks for that diatribe—it’s a unique way to “suggest awareness” (as you call it). Maybe you should re-think the wisdom of your approach.
Your reaction is out of proportion to the *one word* I wrote that bothered you in the first place. My opinion right now is that you have a reading comprehension problem AND a boundary problem on top of your OCD problem.
You know virtually nothing about me, yet you have managed to consistently read things into my comments that reflect your own mind’s workings, not mine. You may have read what I wrote, but you have not comprehended it! You have misread (literally) and misunderstood what I wrote, and then you’ve insulted me in multiple ways based on your misinterpretation.
I repeat: “Yeah, my behavior is kinda OCD.” Sometimes it is, and sometimes it isn’t. That sentence is a true and accurate statement that I can make about myself. No interpretation or commentary by you changes the truth of it for me, regardless of your intention.
IMO, OCD *does* have a usefulness in the workplace; you likely cannot see it because you are so busy fighting it in yourself.
Yes, OCD can have funny aspects. It may never be funny to YOU, but the members of my generation in my family have learned to recognize & laugh at our behaviors. Doing that brings the issue out in the open—into the light, where it can be seen and discussed without shame. What is hidden in shame will never be healed. I can find the humor in OCD because I’m NOT living in an environment “stifled by OCD” as you suggest—instead, I’m living in an environment where OCD is not any more shameful than the color of my eyes or what size shoe I wear.
I can only wish you luck in dealing with your OCD. I do recommend therapy to anyone dealing with OCD, because it works—and works way better than “wishing it weren’t so.”
If you want to get the last word in, Molly, go ahead and reply, because I will not engage with you on this topic any further.
In many social circles we hug instead to say hello and goodbye. Can you imagine a world where this became commonplace? Sure, maybe close contact is a cause for concern, but we won’t be picking up germs on our hands, at least. 🙂
For some reason I really enjoyed this article. I think it’s one of your best—or at least most entertaining, which I realize was probably not your primary purpose, i.e., to entertain. Maybe it’s because I have my own memories of my father’s idiosyncrasies and sayings and so forth that it appeals to me, your sharing what you’ve inherited, beyond the physical, from your father. I think about stuff my dad said or did very often. What’s odd and really sort of sad is that I never appreciated his little quirks or stuff he was into when I was very young living at home. I miss him a lot. I have been remembering special almost-forgotten times when he and I were “buds.”
Anyway handwashing is something I’m fairly conscientious about, in some ways because I realize a lot of others are not so it means I have to take up the slack on that. Now you have to go and remove my disillusions that doctors, of all people, observe cleanliness as well as or better than most of us.
Anyway, lol, to your “on the other hand.” Another good touch, I like little subtle “funnies.” Good job, for whatever it’s worth. Consider the source?
Actually, Beibei—yes—I do worry as much or maybe more about CASH. It’s very dirty. Which reminds me of something I found amusing. My mother’s second husband was sort of a know-it-all blowhard kind of guy. Anyway, he really believed, and was quite offended when I tried to dissuade him, that there was a new job making the scene: Money Laundering. When asked what he meant by Money Laundering he spelled it out quite clearly, someone using tubs and soap and water to wash money. Well, I thought it was funny and so did my brother.
Anyway, I DO think about how dirty our currency and coins are. Which is why I’m gaining a whole new appreciation for plastic (currency).
There is one handshake issue not brought up but that has been quite important for me. For one reason or another I have very sensitive hands to pressure (I have played a lot of guitar, do a pretty advanced yoga practice that involves a lot of arm balances, and have sprained at one time or another at least half of my finger joints) and when someone gives me even a slightly firm grip I can often feel it for hours. On more than one occasion it has exacerbated a sprain for days. I am a doctor and I never offer to shake hands for this reason. If someone does offer me their hand I give my left or offer the right with my pen in hand—I can’t take the risk of someone giving me one of those “firm” grips that will likely cause me a lot of unnecessary pain—the antithesis of the “friendly” handshake. My vote is for more bows and fewer handshakes.
Eliminate all the problems of a “handshake” and just do the bump handshake. Easiest.