The handshake is the first, and perhaps the most informative, portion of the physical examination.  Hand size, grip strength, muscle tone, skin texture, arthritic changes – all provide a huge flood of information to the analysis of the patient.

However, we are usually filled with thoughts and plans, and brush the handshake off.  It is the first communication as well as the first contact with the patient – it divides the subjective from the objective.

But usually are minds close the doors of perception, instead dwelling on our own ruminations, on building the script of the interview.  I have found it a struggle how to enter the room and begin the interview as an empty vessel.  Who knows how long it will last,where will it go?

Even more frightening for the schedule-conscious, I defer to the patient when we are going to end; when he or she finishes with his or her agenda.  In truth, it only adds two or three minutes onto the length of the interview if that – but it is a terrifying promise to keep.  Of course, when there is a patient with an interminable monologue, or one who wishes to argue over a dead-end point, I insist we stop.  But rarely

And at the end, the handshake again.  How is this one at the end different from the first?  One last piece of information.