One of the important ways for me to convey empathy and compassion to patients over the years has been the application of the “laying on of hands,” whether it be in the initial handshake, placing a hand on a patient’s shoulder, or walking hand-in-hand or arm-in-arm to accompany a post-op patient during a hallway ambulation. The need for human beings and many other animal species to connect is found throughout the ages. As we transitioned to the “social distancing” that we all have experienced over the past few months, one of our greatest traditions—joining of hands—may be at risk for obsolescence.

Of all the various forms of greeting, the handshake is perhaps one of the most ancient. The handshake has existed in some form or another for thousands of years, but its origins are somewhat shadowy. As it is a nonverbal mode of communication, it may have existed before written records. One of the earliest depictions of a handshake is found in a ninth-century (B.C.E.) relief depicting the Assyrian King Shalmaneser III pressing the flesh with a Babylonian ruler to seal an alliance. Many researchers believe that the handshake was an indication of a gesture of peace, demonstrating that the hand held no weapons. By extending their empty right hands, strangers could show they were not brandishing armaments and bore no ill will toward one another. Some even suggest that the up-and-down motion of the handshake was supposed to dislodge any knives or daggers that might be concealed up a sleeve!

Yet another explanation is the handshake was a symbol of good faith when making an oath or a promise. When clasping hands, people indicated that their word was a sacred bond. The poet Homer described handshakes several times in his “ The Iliad” and “The Odyssey,” most often in relation to pledges and displays of trust. In ancient Greece, gravestones would often portray the deceased person shaking hands with a family member, signifying either a final farewell or the eternal bond between the living and the dead. In ancient Rome, the handshake was often used as a symbol of friendship and loyalty. Pairs of clasped hands even appeared on Roman coins.

From ancient to modern times, the cultural acceptance and method of shaking hands has been taught to us by our parents, and we have passed on this ritual to our children and grandchildren. Today, a handshake is offered upon meeting or parting. It is an expression of good will, gratitude and congratulations. Many people believe that a handshake reveals something about the character of the person who gives it. Our disposition and temperament are indicated by the nature of our handshake: strength, weakness, insecurity, shyness and so forth. A firm handshake reflects a confident personality while a floppy handshake reveals a shy one.

The concept of the clasping of hands, and now its avoidance, is correctly viewed as a method to both enhance relationships and mitigate the transmission of infection, respectively. Despite our aggressiveness in handwashing frequency and technique, there is a great fear that touching hands, except with our immediate family members, may be anathema. In this modern era of “high-tech, low-touch,” characterized by the electronic health record and telemedicine, it is my fervent hope that our recent requirement for physical distancing does not provoke an avoidance of hands-on contact. This would certainly be a sad legacy of this recent pandemic. This June 25, National Handshake Day, should convey an even greater importance in 2020. It should remind us that this custom, as well as our hands-on tradition in medicine, is one that we certainly cannot afford to give up.

-Dr. Greene is a surgeon in Charlotte, N.C.