Communication study
Effect of sitting vs. standing on perception of provider time at bedside: A pilot study

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Abstract

Objective

Patients commonly perceive that a provider has spent more time at their bedside when the provider sits rather than stands. This study provides empirical evidence for this perception.

Methods

We conducted a prospective, randomized, controlled study with 120 adult post-operative inpatients admitted for elective spine surgery. The actual lengths of the interactions were compared to patients’ estimations of the time of those interactions.

Results

Patients perceived the provider as present at their bedside longer when he sat, even though the actual time the physician spent at the bedside did not change significantly whether he sat or stood. Patients with whom the physician sat reported a more positive interaction and a better understanding of their condition.

Conclusion

Simply sitting instead of standing at a patient's bedside can have a significant impact on patient satisfaction, patient compliance, and provider–patient rapport, all of which are known factors in decreased litigation, decreased lengths of stay, decreased costs, and improved clinical outcomes.

Practice implications

Any healthcare provider may have a positive effect on doctor–patient interaction by sitting as opposed to standing during a hospital follow-up visit.

Introduction

Literature results vary regarding the effect of provider posture on patients’ perceptions of both the length of time and the quality of the patient–provider interaction. Medical and nursing students throughout the country are commonly taught that patients will perceive the provider as present at the bedside longer if the provider sits rather than stands during the interaction [1]. However, little published research substantiates this assertion. Several studies have been conducted on this topic in various settings, including the frenzied environment of the emergency room staffed with providers the patients had never before met, the emotional environment of a cancer practice that regularly gives bad news, and the sometimes impersonal setting of outpatient clinics that employ multiple physicians. Gross et al. [2] were the first to report a strong correlation between patient satisfaction and length of visit in the outpatient family practice setting, noting that certain physician behaviors can increase or diminish that level of satisfaction. No previous studies have been conducted in an elective inpatient post-operative setting.

With ever-increasing patient loads, limited resources, and exhausting work demands for physicians, it is imperative to understand the essentials of an effective patient visit. In daily practice, especially in the inpatient setting, it may be difficult for the physician to sit down during the visit due to perceived lack of time, lack of physical space, or lack of available chairs. We built upon the results of the previous studies by focusing on the lower-acuity illness setting of routine inpatient postoperative visits (as opposed to emergency or ICU care), conducted by a surgeon with whom the patients already had an established relationship.

Compared to the length of patient visits in the other studies, a routine post-operative visit is a very short interaction. In this pilot study, we sought to highlight the effect of posture in such a brief, focused encounter with a provider well known to the patient, and with whom the patient would continue in follow-up. We had two hypotheses: (1) hospitalized patients would perceive that the physician spent more time with them than he actually did when he sat during rounding versus when he stood, and (2) the physician would actually spend more time at the bedside when he sat versus when he stood.

By examining patients’ perceptions of provider time at bedside compared to the actual provider time at bedside, we may then further generalize to other health care settings and improve patient perceptions of the provider–patient interaction. These patient perceptions are a component of patient satisfaction [2], [3], [4], which is associated with decreased litigation, decreased cost, increased referrals, improved compliance, and improved clinical outcomes [2], [3], [5], [6], [7].

Section snippets

Design

After approval from the appropriate Institutional Review Board, this prospective, randomized, controlled study was conducted at one academic medical center between April 2007 and June 2008.

Data sources and description

The study included 120 adult post-operative neurosurgical inpatients, divided into two groups of approximately 60 patients each. All patients admitted to the medical center by one neurosurgeon for elective spine surgery were automatically included, unless they were unable to communicate because of a current

Results

A total of 127 patients were sampled for the project. Only seven patients were excluded (three refused to participate and four were unable to communicate due to postoperative sedation). Sampling continued until we obtained approximately 60 sitting encounters and 60 standing encounters for a total of 120 patients, which was the stated goal of the study.

Discussion

Patient–physician communication can influence outcomes such as symptom resolution, emotional health, pain control, and even physiologic measures such as blood pressure and blood sugar levels [4], [8], [9]. Effective communication skills have been associated with adherence to therapy [5], understanding of treatment risks, and even a reduced risk of medical mistakes and malpractice claims [9]. Stewart was the first to review studies linking communication with patient health outcomes, and found

Conflict of interest

No financial support was received for this work, and there are no conflicts of interest.

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