If you and I were to meet I would likely shake your hand. The next time we crossed paths maybe we would greet each other with a smile and a hug. Perhaps a cheek kiss? Anything but a fist bump. These greetings are situationally and culturally determined.

I work in part, as a physician communication consultant: I help other physicians learn how to better connect with their patients and other colleagues. Often when doing this work I refer to something called the “Four Habits Model.” This model guides physicians through a patient visit and helps them understand ways they can communicate that will ease the interaction with a patient. Riva Greenberg, in a Huffington Post article about this model, explained that:

The model teaches four key habits, or behaviors: 1) Invest in the beginning of the visit and build rapport, 2) Elicit the patient’s perspective, 3) Demonstrate empathy and 4) Involve patients at the end of the visit in designing a treatment plan. The pay off: physicians become more effective and successful in their work and patients get better health outcomes.

I believe in this model of interaction – it works! This success seems to come especially from the very first step: the greeting. “Invest in the Beginning” gives advice for a struggling physician about how to quickly connect with another person: smile, sit down, acknowledge their wait, greet everyone in the room and shake hands – if culturally appropriate.

Ah, but that last bit is hard to get right! How we greet each other – for work or with friends – is more difficult than it appears on the surface. Both inter-culturally and within my own (white, professional, highly educated, middle-aged mother of three.) Many of my colleagues are not “hand shakers.” I am. They seem uncomfortable with the intimacy. I enjoy starting a patient visit with the connection of touch. Perhaps doing so eases the way towards the more intimate or invasive touching that I need to do as a physician with my patients?

Socially and in business settings Americans tend to shake hands with a firm grip and a few firm pumps of the hands. To convey extra warmth, we often use our free hand to cover their shaking hand. In a social setting with friends and families the handshake can evolve into a hug. Or, the handshake can be skipped altogether and replaced directly with a warm embrace. I am a hand shaker and I am also a hugger.

Once at a funeral, a friend whose mother had died spoke. She said that through the weeks surrounding her mother’s death she had learned a few things about life. She had learned how short time was. She had learned that her mother had many friends she’d never met. She learned that she too had a wide group of friends ready to support her. And, she had learned that “Jim Davis is the best hugger ever. When he hugs you it feels like you are safe and loved.” She was right. This friend of ours Jim stands six-foot six and is truly the world’s best hugger. I have learned through him how much a hug can mean. At the end of a dinner it can mean the most genuine of thanks. When my dog was hit by a car it meant that he was hurting with me. When I was frustrated beyond belief by doing taxes for the first time as a 50-year-old, it meant he had my back and knew how to help so – calm down.

All of those messages mean so much. As does the simple “I am so glad to see you” that comes with a big smile and hug as we greet friends. Or, the “I can be trusted and I care about you” that comes from a handshake and a smile when a doctor meets a new patient.

I am at work a hand shaker and in my private life a hugger. Both make me feel more connected to those around me and this connection makes me far happier with my life. Now, I am learning to be a kisser – a cheek kisser. In Europe social greetings involve cheek kissing. In the U.S. at least in major metropolitan areas, a single cheek kiss is becoming more common. Some sophisticated sorts even kiss on each cheek – right then left. Or is it left then right? My attempts to use cheek kissing as a greeting are not meant to mimic European sophistication but rather to bond with my boyfriend’s European friends and siblings.

I have had both many siblings and none. To be clear, I had three step siblings, three half siblings and married into 5. I was however, raised as an only child – usually wishing for some company and always wishing I fit in with all those part-sibs. When I got married it felt like I’d won the lottery but joining that pre-made family did not turn out to be a simple process nor did the marriage last.

Now years later, I have a wonderful relationship with a wonderful man who has two sisters. Meeting them for the first time was nerve-wracking. When I was a child I wanted so much to connect with my father’s three other kids. Before seeing them I would think hard about how I looked and what I wore. I would worry about how I acted and wondered if I was thin enough for them? Surprisingly now, as a normally confident and happy adult I found myself wondering the same things about meeting my boyfriend’s sisters.

He is Swiss, I am decidedly American. Europeans have an odd relationship with Americans. They want to visit our cities and beaches. They want to see our enormous national landscape and to shop in our stores. However, they cringe at our politics, manners, too ready smiles, white socks and sneakers. They think we are cool and… decidedly uncool. When I met his sisters I wanted to fall on the cool side of that spectrum. Clothing-wise I knew I would be fine (I own no tube socks.) I had spent enough time around him to be clear on manners. My politics are in line with theirs. But there was one smaller thing left that worried me.

Greeting people here at home is effortless. Handshakes and smiles around. A one-cheeked kiss with close friends or in big cities. Who thinks much about it? However, I knew in Europe they had a complicated cultural thing about cheek kissing. European women always look so stylish (with perfectly tied scarves) as they warmly greet each other with cheek kisses. No hesitation (right side or left, two or three, noise or no?) and they certainly don’t end up lip-locked. How’s an American gal meant to keep up?

I even went so far as to Google “cheek kissing in Europe” to find no less than 525,000 entries. Turns out there’s even a Wikipedia page explaining the custom. I found numerous blog posts and videos demonstrating how an American could learn this foreign ritual. My research, though, did not really guide me. The number of kisses depends on where you are – not just which country but within each country! Some areas start left, some right. Some make contact and some make noise.

I gave up trying to perfect the local custom. I gave up trying to be sure I fit in and just decided to be terribly American and… smile, shake and hug. The cool part? They did too. They smiled and kissed and laughed at my ineptness. Now, a few years later, he says I am “family” and they make me feel like it is true. They laugh and tease me every time we greet. And I am still not sure, if in the German part of Switzerland, it is two kisses or three.

So, I am at work – a hand shaker. In my social life – a hugger. Now I throw in the occasional cheek kiss – giggles and all.