Doctors and others who care for hospitalized patients may want to sit up and listen to this news.
A new study suggests that getting down to eye level with a patient when talking to them about their diagnosis or medical care can make a big difference. According to the new evidence review, sitting or crouching at a hospital patient’s bedside was associated with more confidence, satisfaction and even better clinical outcomes than standing.
The study authors, from the University of Michigan and the VA Ann Arbor Health System, note that most studies on this topic varied in their interventions and outcomes, and were found to be at high risk of bias. Their findings are published in a systematic review in the journal Journal of General Internal Medicine.
So the researchers sat down and thought about how to study the topic as part of their own broader assessment of how different nonverbal factors impact attention, perceptions, and outcomes.
Until their new study is completed, they say their systematic review should prompt doctors and hospital administrators to encourage patients to spend more time sitting at the bedside.
Something as simple as having folding chairs and stools available in or near patient rooms could help; in fact, the Ann Arbor VA has installed folding chairs in many rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.
Nathan Houchens, MD, a UM Medical School faculty member and VA hospitalist who worked with UM medical students to review the evidence on this topic, says they focused on the physician’s stance because of the power dynamics and hierarchy of hospital care.
A physician assistant or resident can change that relationship with a patient by getting down at eye level instead of standing over them, he notes.
He credits the idea for the study to two former medical students, who have now graduated and continued their medical training elsewhere: Rita Palanjian, MD, and Mariam Nasrallah, MD.
“It turns out that only 14 studies met the evaluation criteria in our systematic review of the impacts of moving to eye level, and only two of those were rigorous experiments,” Houchens said. “In addition, the studies measured many different things, from the length of the patient encounter and patient impressions of empathy and compassion, to overall patient assessment scores of hospitals measured using standardized surveys such as the federal HCAHPS survey.”
In general, she said, the data shows that patients prefer doctors who are seated or at eye level, although this is not universally true. And many studies acknowledged that even when doctors were assigned to sit with their patients, they did not always do so, especially if there were no seats available.
Houchens knows from supervising U-M medical students and residents at the VA that doctors may be concerned that sitting will prolong interaction when they have other patients and obligations to attend to. But the evidence the team reviewed suggests this is not the case.
He notes that other factors, such as concerns about transmitting infections, can also make it difficult to consistently achieve the visual level.
“We hope our work will help to increase the importance of sitting and make patients appreciate it,” Houchens says. Providing seating, encouraging doctors to sit at eye level, and having senior doctors make an effort to sit as role models for their students and residents could also help.
A recently launched VA/UM study, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes physician posture as part of a set of interventions aimed at making hospital environments more conducive to healing and patient-provider bonding.
In addition to encouraging providers to sit at their patients’ bedsides, the intervention also includes encouraging them to greet patients warmly when they enter their rooms and asking questions about their priorities and backgrounds during conversations.
Researchers will look for differences in hospital length of stay, readmissions, patient satisfaction scores and other measures between units where the intervention package is being implemented and those where it is not yet.
In addition to Houchens and the two former students, the systematic review authors are UM and VA hospitalist Ashwin Gupta, MD, Whitney Townsend of the UM Taubman Health Sciences Library, VA chief of medicine and UM professor Sanjay Saint, MD, MPH, and Jason Engle, MPH. Saint and Engle are part of the VA’s Center for Clinical Management Research, and Saint is a member of the UM Institute for Health Care Policy and Innovation.
Houchens, Gupta and Saint are professors in the Division of Hospital Medicine in the Department of Internal Medicine at Michigan Medicine, U-M’s academic medical center.
The recently published study was funded by U-M and VA grants. The newly released study is funded by AHRQ grant HS28963-01.