Advocates for preventing swine flu transmission are suggesting a hand bump instead of a handshake. Fine. But in my mind, this presents many questions and the huge potential for social dilemmas and discomfort.

We all know the hand bump, seen often on the athletic field. It’s bending the arm at the elbow and raising the wrist to knock knuckles with a similarly close-fisted colleague. That works well on the football field as an expression of mutual acknowledgment for a job well-done. I’m not so sure how it will play in the business and social worlds most of us inhabit, though.

OK. Say we don’t shake hands anymore because that will spread germs. That leaves hand bumps or doing nothing at all as our choices.

Let’s take the hand bump route. I cant visualize just meeting someone new and then raising my fist as if I am about to punch them. I wonder if their reaction will be to duck. Just imagine someone coming at you with a smile on their face and a raised closed fist. Does that seem friendly—or scary--to you?

Also, isn’t the hand bump a little too sporty, frivolous, or even light hearted for most situations? Would you greet another person in a serious situation, such as a new patient, with a hand bump? Well, maybe a 10 year old. But what about his grandmother? What about family members coming to see a very sick patient? Would you hand bump your boss? I have my doubts that a hand bump could ever be a sincere and professional greeting.

Let’s look at what happens if we choose not to offer our hand for a handshake. We might seem cold, aloof, or unfriendly if we don’t extend a hand. We could explain we don’t want to spread disease, which may either offend or scare the other person. It might even make them wonder if we are a clone of Howard Hughes, the eccentric and notorious germaphobe.

Meanwhile, if we don’t offer our hand in our effort not to spread H1N1, what happens if the other person has not gotten the message and extends their hand? In their mind, it's not good if we dont follow through and complete the act. Just think how embarrassed, offended, or awkward someone will feel once their handshake has been rejected.

Of course, for infection control purposes, we wont want to touch someone who wants to shake our hand, but does that mean we should pump hand sanitizer into our palms immediately if our hands make contact, either after shaking hands or even post hand bump? If this were an ethics decision, deciding on the side of doing the greater good would be to do just that—sanitizing after fraternizing. After all, we don’t want to either spread of receive a contagious infection, do we? We just need to be aware how this will affect our business and social relationships.

To hand bump or not; to abstain or not—that is the question. And there are no easy answers. Whatever happens, there will be embarrassment, awkwardness, and misunderstandings.

And I wont even begin to talk about the infection potential generated by social hugs and kisses. Handshakes are as far as my mind will let me go. Anything more gives me a headache.