If they don't reach back: Hand-shaking etiquette for immunocompromised patients

George Sarnoff's question:
My wife’s immune system is compromised because of chronic lymphocytic leukemia. How can she tactfully refuse to shake a proffered hand without going into medical detail?

Philip Galanes' advice:
I walked in your wife's wedges, George, and tried avoiding shaking hands myself. It was no picnic: When people extend their hand in friendship, they want it shaken, an pronto!

At first, I kept my hands in my pockets and smiled extra big in lieu of shaking, which didn't work at all: Still Life with Outstretched Hand. Awkward! Next, I claimed a bum wrist, which led to a silly web of lies about a phony tennis injury, and my friend remembered that I play left-handed and we shake with our right.

So the best I can offer is a generic statement like, "I'm a little under the weather." It's vague and true. And if the would-be shaker is bold enough to inquire further (and many will), just say: "Oh, that's boring. How are you?"

So with apologies to Diana Ross, reaching out to touch somebody's hand isn't the only way to make the world a better place. Let's try a little understanding if they don't reach back.

Read another story about privacy.

Thanks to George Sarnoff for his letter, reprinted here from today's issue of the New York Times.

She has taken off her name tag: Hand-washing in hospitals

The WBUR radio station played a story this morning about hospitals' efforts to encourage staff to wash their hands frequently, to prevent hospital acquired infections.

At one Harvard teaching hospital, a nurse observes staff on the Cardiac unit to see who is washing their hands and when. What makes the nurse sure that they won't know they're being watched? Oh, she has taken off her name tag - but still wears the standard blue nurse's uniform and white coat. For ten minutes, she notes who washes their hands. Meanwhile, the Cardiac unit nurses hurry around the unit, probably aware of the one nurse, not from their unit, who isn't hustling around. Surprise! –everyone dutifully uses the hand sanitizer while she watches them. Does this spot-checking really raise compliance with hand-washing rules? Or does it just provide a reassuringly high rate of hand-washing?

A more reliable approach uses unobtrusive measures. Indeed, that ("Unobtrusive Measures") was the title of a book by Eugene Webb et al, written back in 1966. Such unobtrusive or “non-reactive” measures probably give a more honest view. At Beth Israel Deaconess Medical Center in Boston, for example, staff instead measure the volume of hand sanitizer used.

Advice to patient advocates: Bring a bottle of your own hand sanitizer, and keep it on the patient's bedside table as a gentle reminder.

Read another story on blue uniforms and hospital cleanliness.

Thanks to Sacha Pfeiffer for the source story on WBUR today.