I shake hands. Every new patient gets a handshake and follow-ups too, if after their initial assessment I diagnose them as being handshake people. Perhaps not surprisingly, men are more likely to be shakers. Women, especially older women, sometimes have to think about what to do when I offer my hand. It's like they're thinking, "Hey, you're supposed to look at my hand, not show me yours" They eventually catch on, but they don't get follow-up shakes at future visits. Men get it though. Usually I get a firm business-like shake and occasionally a hardy, elbow-at-shoulder-level bone crunching grab. Unfortunately, I do get the occasional flaccid meaty paw that I half expect will squeak when I squeeze.
As a rheumatologist, though, shaking hands is not a simple matter. Many of my patients have pain in their hands and a firm handshake will illicit contempt rather than good will. At the same time, most men, at least, will still make the effort, albeit with anticipation. Aware as I am, I usually give a pseudo-limp hand to start and await input. If the return is weak I don't push it but I do sometimes worry that the patient might think that I'm the one with the wimpy shake. If the return is firmer than my own I ramp up the pressure, slowly matching his or her own. The grip pressure is titrated up, via this feedback mechanism, until to the maximum allowable squeeze, or (MAS), the point at which one or both parties feel further input will have painful consequences. Done right, the shake is mutually satisfying, and not infrequently the patient actually uses it to show how much better he/she (but usually he) is doing. In fact, it may well be an informal grip-strength test like the one used by researchers to assess treatment success.But that's not why I do it. I do it because I'm a handshake kind of person.