Insignificant things

“I called in my next patient, Jane and she sat down in front of me and we shook hands. Instead of letting go, our hands slipped back a little and our fingers interlocked, our thumbs raised …”. This is the beginning of a blog post by Johnathon Tomlinson, a London GP.

To be honest, I stopped reading the post after this. I started wondering when was the last time I shook hands with a doctor, as a patient, of course. I actually couldn’t remember. And I still cannot remember. But that raises a question – does it matter?

There are two answers – no and yes. No, because in the grand scheme of things I care much more about what the medics call ‘the outcome’. But only in the grand scheme of things. In the not-so-grand scheme of things, yes, it does matter.

Before I go on, I’ll tell you a story (from my Men’s Discourses of Depression). I was visiting a friend of mine, a consultant psychiatrist in a large university hospital in Poland. We were walking through a ward, when we were approached by a woman, who, as it quickly transpired, was also a consultant. My friend and she engaged in a professional conversation, as I was standing by. My presence was not acknowledged by the woman in any way. After a few moments my friend realised that I was being ignored and introduced me to his colleague as Professor Galasiński. The change in his colleague’s behaviour was extraordinary. Not only did she greet me showing highest reverence, but started apologising for having to address his colleague rather than me. She probably assumed I was a professor of medicine and in one way or another she was in a relationship of professional dependence with me (Polish medicine is extremely hierarchical).

For those interested in language I’ll add that the introduction was “pan profesor Galasiński”, which can easily be translated into German as “Herr Professor…”, but not into English. I guess, the closest would be something like “Mister Professor” (just like you would say “Mister President”). The honorific adds another level of linguistically constructed respect.

Now, as much as the whole situation was quite embarrassing, it was also quite irritating. For a couple of minutes it was almost as if all social graces and practices were completely suspended. Not only did she not greet me, however perfunctorily, she didn’t even look at me. I presume, though I never asked, my friend’s colleague assumed, I was a patient and one does not greet patients. Or perhaps I was not a patient, but given that I was not anyone her rank or higher (she would know everyone of status in the hospital), she decided, I was insignificant. This is, indeed, whence the change, I think. From someone completely insignificant I became someone powerful (labels for you!).

So, yes, I think, the handshake matters. It acknowledges my presence, recognises me as a person, it might even recognise me as a person who has an equal relationship with the doctor (I don’t, but the handshake helps on the way to equality). Basically, it’s a sign of respect. And yet, I don’t get to shake hands with doctors I see. Granted, I don’t see them very often, yet, enough to say: No, I don’t shake hands with doctors. In fact, I should probably say: No, doctors don’t shake hands with me. They should initiate, shouldn’t they?

It is all this that made me stop to think when I read Tomlinson’s blog (I did finish reading it later). What struck me, was that in the first sentence the handshake is mentioned in passing, it doesn’t draw attention to itself. It appears to be natural. Wow, I thought. A doctor who simply shakes hands with his patient! Unbelievable!

And so, medics, how about looking at me, when I walk into your surgery, shaking my hand? To be honest, as I get older, the younger amongst you might even consider getting up (I know – I am pushing it, but I actually do get up, when someone considerably older walks into my office). You might also consider not calling me by my first name, but this is a matter for another blog. All those things only appear to be insignificant. But they are the canvass for our conversation.

Yes, here is to insignificant things!


1 Comment
  1. I have a dual role as both a mental health patient and a handshake initiator. You can possibly imagine the perturbation when I first brought my lifelong Handshake Initiation Disorder into the mental health service in my early 40s!

    I’ve almost always had positive experiences with GPs and the power imbalance has never seemed all that great to me. I remember once when I was quite young, I questioned a doctor about a medication (for me) that he was discussing with my mother, so he handed me his BNF book to look up the name of an alternative drug I thought he had prescribed previously, and included me in the decison-making from that point on. I think I must have taken that as an open invitation to pick up the BNF from the GP’s desk as a standard ritual at each appointment thereafter. (I was probably in my 30s when I realised that I was possibly the only one… I did well not to be referred to mental health until my 40s really, all things considered!)

    It is interesting that you hint at wanting additional respect (and deference, maybe?) on account of your age. Maybe I’m not “there” yet in terms of accepting the inevitable ageing process but I am also a “Please do call me [First Name]” initiator, and I struggle a bit if some doctors (usually younger than me) just can’t do it. My tendency though is to expect GPs to be fully human, and to be surprised if their behaviour is less than amiable. In psychiatry, my initial experiences fell so far short of my expectations that the one or two recent positive encounters have been a surprise and the small courtesies have been of immense significance.

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