Sitting at patients' bedsides may improve patients' perceptions of physician communication skills

Abstract

Sitting at a patient's bedside in the inpatient setting is recommended as a best practice but has not been widely adopted. Previous studies suggest that a physician's seated posture may increase the patient's perception of time spent in the room but have not included hospitalists. We performed a cluster-randomized trial of seated versus standing physician posture during inpatient rounds on a hospitalist service at an academic medical center. Patients whose physician sat were significantly more likely to rate their physician highly on measures of listening carefully and explaining things in a way that was easy to understand. The average time spent in the patient's room was approximately 12 minutes and was not affected by physician posture. Sitting while interacting with patients is standard in the outpatient setting and encouraged in the inpatient setting as a best practice.1,2 Michael W. Kahn defined etiquette-based medicine as a set of easily taught behaviors that demonstrate respect for the patient; sitting at the bedside is included.1 A prominent healthcare consulting group also recommends that physicians and nurses sit at the bedside, claiming that "the patient will estimate you were in the room 3 times longer."3 Previous studies suggest patients may perceive physicians who sit at the bedside as more compassionate and as spending more time with them, and may perceive the overall interaction as more positive when the physician sits. [4][5][6] Two small studies found that patients perceived the physician as having spent more time with them if he or she sat rather than stood. 5,6 A study in the emergency department found no effect of posture on patient perception of physician communication skills, and a study of a single attending neurosurgeon found that patients reported a better understanding of their condition when the physician sat. 5,6 The effect of physician posture on hospitalist physician-patient communication has not been previously studied. Despite evidence that sitting in the inpatient setting may improve physician-patient communication, studies suggest that physicians rarely sit at the bedside of inpatients. 7,8We conducted a cluster-randomized trial of the impact of hospitalist physician posture during morning rounds. We hypothesized that patients whose physician sat rather than stood would perceive that their physician spent more time with them and would rate the physician's communication skills more highly. We also hypothesized that sitting would not prolong the length of the patient-physician encounter. PATIENTS AND METHODSWe conducted a cluster-randomized clinical trial with a crossover component randomizing physicians on the order of sit/stand within a consecutive 7-day workweek. We enrolled patients being cared for by attending hospitalists on a resident-uncovered general internal medicine service in an academic tertiary care hospital. We also enrolled the hospitalists and collected demographics and practice information. Wall-mounted folding chairs ( Figure 1) were installed in all rooms on t...

Grab a Seat! Nudging Providers to Sit Improves the Patient Experience in the Emergency Department

“…Effective communication relies on both verbal and nonverbal cues. Prior studies in the ambulatory setting suggest that communication, measured by satisfaction surveys, is improved when a provider sits as opposed to stands (7,9). This is the first study to show that provider sitting at any point during the clinical encounter improves patient perception of their care and overall satisfaction in the ED setting.…”

“…Nonverbal cues such as provider posture (sitting versus standing) during ambulatory and inpatient encounters increases the patient’s perceived length of time spent by the physician which may improve provider–patient communication and ultimately patient satisfaction (6 –9).…”

Moving beyond the measure: Understanding patients' experiences of communication with nurses

“…For example, Riordan's (2014) description of empathetic listening closely overlaps with our description of engagement. Merel et al (2016) noted that patients were more likely to perceive their physicians as listening carefully and explaining things in an understandable way if the physicians sat at their bedsides during rounds, a feature of engagement. Findings from numerous studies point to the importance of effective patient teaching and the role of nurses in delivering this teaching (Ma et al, 2015; McHugh & Ma, 2013; Weiss et al, 2011).…”

Keeping Time: Implementing Appointment-based Family-centered Rounds

“…We suspect this is a halo effect, similar to documented improvements in patient–physician communication when physicians sit down with patients. 17,18…”