More on Introductions and Acknowledgment

handshakesindexThe other day, while I was on a vacation in Newfoundland, I took a walk around a beautiful pond in the heart of St. Johns. As I walked briskly down the path, I passed a lot of Newfies taking their daily constitutionals. Each and every one of them nodded or smiled to me as I passed by, said hello, and offered up a quick “how are you?” This happens pretty much everywhere I go. I am out of town, or even in my home town, take a walk and some passersby look up, say hello and ask how I am. I usually do the same. These are people I don’t know, who don’t know me, whom I will probably never see again. Yet, we all manage to acknowledge one another’s presence in some quick way. Obviously this is not true of situations in large cities where one is bumping into way to many people to make eye or voice contact with, but it is true in less crowded settings like the ones I describe.

As I have written about before on this blog, (and as Bernice Buresh and I have discussed at some length in our book From Silence to Voice: What Nurses Know and Must Communicate to the Public) this kind of routine behavior stands in stark contrast to what goes on in most hospitals or healthcare settings where people are in contact with each other day in and day out. Hospital personnel are trained to introduce themselves to patients and families but allowed — indeed enabled — to function anonymously with one another. Hospital personnel routinelywork  around each other, usually without any introductions at all. People who supposedly work together and who are part of a team, do so without knowing one another’s name or even acknowledging each other’s presence. Sometimes people actually resist — and justify that resistance with all sorts of clever rationalizations — making introductions, however brief.  In one workshop with nurses that I led a year ago, nurses in the OR lamented the fact that some surgeons refused their pleas to ask the team to make introductions before an operation began.  It took too much time the surgeon insisted.  When we role played the introduction between a half dozen staff, it took exactly 19 seconds for people to introduce themselves.  It took 26, if the surgeon objected during the process.

While interprofessional practice and education has encouraged people to understand the professional or occupational roles people play it does not necessarily encourage them to engage in the very first basic action of team/social behavior – finding out the name of who it is you are working with. So what is abnormal in the world of work and social life outside of healthcare, has become normalized deviant behavior in healthcare settings.

What on earth is going on here? Why do strangers in strange lands bother to introduce themselves to each other, or acknowledge each other’s presence – albeit in a perfunctory way? Why do people say hello as they pass by on the street? Why do they ask strangers how they are when really they couldn’t care less how that stranger is doing? Why do they shake hands when they are introduced? Why do they make any investment of even a second’s worth of time in people they know they won’t ever see again?  More to the point, why is it that people who depend upon each other’s skill and knowledge to produce high quality healthcare don’t do the same?

I am not a philosopher or ethnographer, but it is clear to me that what people are doing when they acknowledge a stranger walking down a street or shake the hand of a person whom they have just met is helping to create a psychologically – not to mention physically — safe environment. When you walk down a street and smile at a stranger and ask how they are, you don’t really want to know if they had a fight with their partner, if they have a cold, or had a good night’s sleep. What you want to know is if you are safe in their presence. Consider the meaning of the handshake in Western culture. According to archaeologists, people have been shaking hands since the 5th century BCE. Why? As an offering of peace and safety. Here is my right hand, give me your’s, and we will both know that we are not drawing out our swords and preparing for battle.

Handshakes are customary in athletic settings – particularly at the end of a competition to show that those who have won and those who have lost do so graciously. Handshakes, introductions, acknowledgments are gestures that help establish “trust, respect, balance, and equality.” Not equality as in I am the same as you but as in I am not out to get you or harm you so we are on equal footing where safety and security is concerned.

In Eastern cultures people acknowledge each other in different ways. They bow to each other, lowering their eyes. Again, anthropologists think this has the same origin as the handshake. Although bowing also suggests status, its primary function is to convey to someone else that you are not a threat.  When I checked out the history of the bow on the web, here’s what I found out,

“Ever heard the advice that should you come face-to-face with a bear, you should make no eye contact, back away, and if you see no way to escape, you should lie down into the fetal position and play dead? This is so that you don’t seem like a threat to the bear. If they don’t fear you, they are less likely to attack. Lowering yourself makes you look smaller and less threatening. Humans aren’t that different from bears in this sense, and believe it or not, a similar instinctive drive led to the development of the bow.

Delivering healthcare to sick and vulnerable patients is inherently a risky business – one that is full of threats both to patients and those who deliver their care. Delivering safe care is also unpredictable business, full of many things that are beyond the control of those who try to do their very best to provide that care. Lack of routine standards of civility should not be among those threats or problems. Implementing routine standards of civility is one thing that can and should be controlled in the healthcare environment. You should start now. Introduce yourself to people you work with. See what happens. It might surprise you how good it feels to work in an environment where people who work together actually acknowledge one another’s existence.


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