The Handshake Layer Cake: Meeting and Regreeting Difficulties for a Non-French Surgeon in France


Colin G Murphy, MCh, FRCSI

Perm J 2016 Summer;20(3):15-232 [Full Citation]
E-pub: 06/27/2016

“I’m not shaking hands with you,” my friend and colleague says loudly. With a dramatic flourish, he withdraws his hand and hides it behind his back, pointing his chin and lower lip towards me in a classic Gallic pout. No one else present bats an eyelid. The chomping of lunch and chewing the fat continues around the table, and I am left offering my hand to empty space. This response is slightly better than the “Aaaagh, salaud” (“Agh, bastard”) I received a few days earlier when committing the same social faux pas. Twice in one week—not good.

These are two of the more aggressive responses to this particular social bêtise and pointed reminders of the highly codified systems of salutations here in France. Just when this Irishman abroad thinks he has the natives cracked, he realizes the magnitude of his ignorance for a new social situation. Happily these rebukes are usually followed, and were immediately in the two above cases, by a grin, a pppffffhhhh, or a backslap.

There are kinder rebukes: “HEEEEY, on croise les doigts cette fois-ci?” (“Hey, how ’bout we shake fingers this time instead?”), or a big, exaggerated outstretched hand followed by withdrawing the hand to do the thumb-to-nose and wiggling fingers maneuver—like we did when we were kids—and a “OOOH, on se connaît déjà nous!” (“Hey, we already know each other!”). It is strange to see grown Frenchmen doing this at you at work and stranger still that you get used to it.

Typically the regreet conundrum develops like this: say you see a colleague walking down the corridor, maybe with a patient. You shake hands in passing and give a Bonjour/Ça va?/Ça va, the absolute-scraping-the-barrel-bare-minimum of conversational interactions. Then at lunch you walk into the Café En Face (my colleagues rarely seem to eat in the hospital cafeteria—unsurprising given the quality of the plat du jour at the local café), say with a different colleague, where seven doctors are sitting down eating away and chatting animatedly. You don’t interrupt, but you both start at the head of the table and work your way around shaking hands or giving les bises (the cheek-kissing of a female colleague). Sixth of seven at the table is the colleague you greeted earlier that morning in passing in the corridor. He is deep in chat, holding court. What do you do? Your colleague ahead of you has just shaken his hand (first greeting of the day for those two), and not wanting to make a fuss or interrupt the flow of invective of your seated colleagues, you might be tempted to offer your hand to him, again. Big mistake. Prepare to be taken to task. You have just created a scene as now he stops talking, leans back in his chair affecting deep insult, and pointedly refuses to shake hands.

The best strategy for the regreet scenario is very much person and situation dependent. I am becoming a big fan of the index-finger shake, which can be done with the same familiar and safe nonverbal cues as a full handshake: approaching his or her personal space, making eye contact, and lifting your hand, but only the index finger is offered for a playful sword-cross style greeting. It is perfectly acceptable for this all to be done without speaking.

For regreeting a senior colleague you don’t know well enough yet to tutoyer (to address someone in French using the familiar form of the pronoun “you”—“tu”—rather than the more formal form of “vous”), I copy my own boss who does an elegant head nod and an “On s’est déjà vu” (“We’ve already met”). This avoids committing to a second-person singular familiar/second-person singular respectful pronoun and obviates the need to offer either hand or index finger.

Maybe the index-finger shake is the informal fist-pump to the more formal handshake? I’m going to have to watch my French gangster movies again to be sure, but it seems one doesn’t regreet a senior ranking surgeon with the index shake, or thumb-to-nose-with-fingerwiggle. Layers on layers. And so different from home. Coming from a culture where work greetings are mostly nonverbal, this represents a quantum change. Eye contact and a nod are considered eminently sufficient for both greeting and regreeting. Verbal greetings are also acceptable; for colleagues a clipped, “Morning” or “Doctor”; for the consultant surgeon a “Mr/Ms O’Brien,” usually with eye contact and a nod (if feeling particularly effusive one could add in a temporal “Good morning/afternoon Mr/Ms O’Brien”). Tactile greetings in Irish hospitals are almost unheard of. On one six-month rotation, the only physical contact I had with any of my bosses was a backslap from the senior ranking surgeon on the morning he came in late for the morbidity and mortality conference after I stood to vacate the chair nearest the exit door for him.

But it’s not just the handshakes. Les bises is another minefield and much more complex than handshakes. I frequently cringe at the different ways I achieve social awkwardness at work by getting even the primary greeting wrong, let alone the regreeting. We have all done it: offer the cheek when she puts out the hand or vice versa. At work, after a few months here and meeting the same folks daily, playing l’etranger card just isn’t an option anymore. Reluctance to experiment with social greetings with female work colleagues means, happily, that I can’t shed any light on the regreet avec bises conundrum, but here is a quick summary of what I have observed to be the Initial Daily Greet the Ladies at Work Rules: no handshake or bises for the secretaries, just verbal Bonjour/Ça va?/Ça va; a handshake for the female docs one doesn’t know well; bises for the ones one does know well; bises for any woman sitting in the Café En Face regardless of whether one knows her or not (it’s a social context); bises for one’s scrub nurses (who are friends at this stage), but only if they aren’t scrubbed, and there isn’t an awake patient in the room, in which case neither bises nor handshake just verbal greeting; no bises for the nurses on the ward or the physiotherapists—except the pretty physio who is a friend of the boss and who has a slightly disinhibited demeanor and a desire to chat about Irlande every time we meet—she gets the bises greetings.

A particular ward round crystallized this morass of mores for me. When I arrived for the very first ward round on New Year’s Day, I found all the nurses in the ward office were wearing little Santa hats, cheerfully calling, “Bonjour, Docteur.” I held my distance, in truth a little intimidated by an office full of French nurses all making eye contact, all chirping in sync and looking expectantly at me. I remained in the doorway, offered neither hand nor cheek, but offered a group reply (in formal-platitude-banter mode) “Bonjour, vous allez bien? Pas trop débordées?” (“All good? Not too busy?”). There followed The Pause, the one with which I am now quite familiar, the one that corresponds with an ever-so-perceptible thaw in the room that tells you you’ve missed a social cue. The boss walked in behind me, and I realized the magnitude of the faux pas and how a seasonal trick had been missed. Admirable in his ability to round speedily and efficiently, he previously only ever paused to give bises to those nurses he knew very well and liked (and not infrequently the new, leggy or pretty nurse he hadn’t met before), but on this day he stopped to faires les bises with every single female nurse, nurses’ assistant, and catering staff on each ward (and it seemed a few nurses who came back for seconds). Romain, the solitary male nurse, got the handshake. While giving un bisou, the boss wished each of the nurses the New Year trio of greetings—Bonne année, bonne santé, et meilleurs voeux—and moved on. He finished covered in lipstick and perfume, looking very pleased with himself. I haven’t been on a round that took so long since I was a student doing general medicine in a peripheral country hospital.

As always, the first work-greeting of the day, be it a handshake or les bises, is complicated by context: age, seniority, work status, employer/employee status, family, familiarity, the other people present at that interaction, whether it is break/coffee time—these are all variables in play. In the operating theater it gets further complicated by physical barriers: being scrubbed, wearing a facemask, and glove-related issues. Such is the disdain for the gloved handshake that people will offer their bare forearm to shake instead of a gloved hand. Offering a gloved hand, even to someone wearing gloves, ce n’est pas cool, and it’s not just because they might be dirty or contaminated. As Serge, one of the theater porters, pointed out to me in no uncertain terms in my first week with a slow head shake and a tut-tut, “Doc, c’est pas cool du tout ça.”

All of this has to be balanced against the unthinkable, not greeting someone at all, or thinking (like an idiot) that the wave or nod from a distance that you gave earlier in the day constituted a greeting. Failure to execute the primary, most basic salutation of the day is le nec plus ultra of social ignorance, regardless of distractions or confounding factors. It is perceived as a calculated snub, one that folks have no problem letting you know about by marching up to you (regardless of who you are with or what task you are engaged in) and enquiring, “What’s the matter with you?”, “Have I annoyed you?”, “I didn’t realize we aren’t friends anymore, you and me?”, or the classic “Ey-oh, tu fais la tête?” (“Are you sulking?”).

Always the fine line in this wonderful country. On mature reflection, when it comes to the regreet dilemma, it is probably better to receive the playful rebuke for attempting to steal a second handshake than the sharp word for none at all, but it is infinitely better, as with most operative procedures, to get it right the first time.

How to Cite this Article

Murphy CG. The handshake layer cake: meeting and regreeting difficulties for a non-French surgeon in France. Perm J 2016 Summer;20(3):15-232. DOI:


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