A recent article in Medscape has reignited the conversation over whether it’s better for hospital doctors to sit with a patient when visiting their rooms, and if it improves the consultation. And if sitting is better, is it okay in this infection-conscious era to sit on a patient’s bed?
Of course, sometimes sitting isn’t even an option for a busy hospital doctor trying to get through the ward rounds and juggle priorities. The article acknowledges this fact and points to previous studies showing that hospital doctors sit during only one out of every five meetings with patients.
The author also points to a recent US study, which took these considerations further and focused on the position of the chair in relation to the patient’s bed. And here’s where it gets a little messy. When you pick up a paper that’s titled ‘Effect of chair placement on physicians’ behaviour and patients’ satisfaction: Randomised deception trial’, you know it’s going to get complicated.
The objective was to evaluate the effect of chair placement on the length of time physicians sit during a bedside consultation and see how this correlates with patients’ satisfaction. The authors included 51 hospital doctors providing direct care services, and 125 observed encounters of patients who could answer four orientation questions correctly before the study began. The research was conducted between April 2022 and February 2023.
Each patient interaction was randomised to either chair placement (≤3 feet (0.9m) of the patient’s bedside and facing the bed), or with the usual chair location (the control group). The overall primary outcome was the binary decision of the physician to sit or not sit at any point during a patient encounter. Secondary outcomes included patient satisfaction, time in the room, and physicians’ and patients’ perception of time in the room, respectively. In the results, they noted that chair placement was not associated with time spent in the room (10.6 minutes v control 10.6 minutes), nor perception of time in the room for doctors (9.4 minutes v 9.8 minutes) or patients (13.1 minutes v 13.5 minutes).
“Chair placement is a simple, no-cost, low-tech intervention that increases a physician’s likelihood of sitting during a bedside consultation and resulted in higher patients’ scores for both satisfaction and communication,” they wrote.
Make of that what you will. The majority of research to date seems to suggest that sitting down with a patient, even just for a couple of minutes, results in better doctor-patient communication, satisfaction with the interaction, and trust. It falls into the category of ‘etiquette-based medicine’, which is too unwieldy a subject for this short column. The take-away message appears to be: If you can, take a seat, even just for a couple of minutes.
When it comes to sitting on the patient’s bed, things get a little more murky. Perhaps the patient’s chair is covered with clothes, gifts, or one of their relatives. So, armed with the assumption that sitting with a patient is likely to improve the interaction, should you sit on the bed?
Common sense should prevail. If a patient is neutropaenic, for example, it’s obviously better not to get too close if that’s avoidable. And as you might imagine, since Covid, attitudes toward sitting on the bed have become more rigorous.
A perspective by US physician Dr Joseph S Alpert from 2023 and published in The American Journal of Medicine made some interesting personal observations. Among these is the fact that when he was a medical student and intern, he often sat on the patient’s bed for a considerable amount of time if a sensitive issue was being discussed. While most of the patients appreciated it, it was not universally popular, he noted.
“In general, the gesture of bedside sitting was perceived as inappropriate by the majority of people,” wrote Dr Alpert.
“It was criticised for being ‘indecent’, ‘uncomfortable for the patient’, potential to ‘spread cross infection’, and even ‘professional misconduct, especially towards female patients’.
“Because of these strong ideas, I practised bench-side sitting during my medicine residency, except for an occasional scenario of cardiac auscultation, for which I preferred the bedside sitting.” Clearly, asking for permission to sit on someone’s bed is always a wise move.
So the debate about sitting or standing remains ongoing. As always, it should be guided by common sense and respecting a patient’s boundaries.
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