April 20, 2010 in Features

Doctors would do well to sit

Study: Standing makes patients feel shortchanged
Alan Bavley Kansas City Star
 

It’s a common patient grievance: If only my doctor would take the time to listen to me and explain things.

Maybe all your doctor has to do to remedy that complaint is just sit down.

Patients gave their doctor significantly higher marks for satisfaction and thought they had spent more time with him when he sat – rather than stood – by their bedsides, researchers at the University of Kansas Hospital in Kansas City, Kan., found.

In fact, the doctor the researchers studied actually spent slightly less time with patients when he sat with them. And he gave his patients much less time than they realized.

“In the hospital, doctors and nurses usually stand. They might think sitting takes them longer,” said Joan McMahon, a university nurse and one of the researchers. “We have to let people know they have to change their practice.”

The wisdom of sitting with patients to build rapport has long been a part of medical folklore, something that is taught to students in nursing and medical school.

But there has been very little scientific backing for it. McMahon and the other researchers set out to test the idea.

They recruited neurosurgeon Paul Arnold as their doctor-guinea pig to see how his patients reacted when he stood or sat.

During the 14-month study, Arnold made his usual visits to 120 of his patients who were in the hospital recovering from routine surgery for back or neck pain.

He would ask the patients basic questions: how they felt, whether they could get in and out of bed easily, what plans they had made for returning home.

The researchers picked at random Arnold’s posture for each visit.

“I didn’t know if I would be sitting or standing until I was there,” he said.

Hospital rooms are not designed for a doctor who wants to sit with a patient. Chairs may be covered with clothes. Visitors may be using them.

Sometimes Arnold had to improvise, sitting on a windowsill or at the foot of the bed.

Another researcher, nurse practitioner Kelli Swayden, stood outside the room with a stopwatch to time Arnold’s visits. After he was done, she would ask the patient questions.

On average, Arnold spent one minute, 28 seconds with patients when he stood and one minute, four seconds when he sat – not a statistically significant difference, the researchers calculated.

But when the patients were asked to estimate the time that Arnold spent with them, on average, the patients who got a standing visit said three minutes, 44 seconds; those who got a sitting visit said five minutes, 14 seconds – a significantly longer time.

As Swayden spoke to the patients, she found a striking difference in how they reacted to Arnold.

“They would chime in with comments about the quality of the interaction,” she said. “They felt they had his attention when he sat down.”

To tap into these reactions, the researchers added an open-ended question to Swayden’s list: What did you think about the interaction with Dr. Arnold?

When Arnold sat, 95 percent of patient comments were positive.

“The doctor took the time to sit and listen,” one said.

“He sat down long enough to get all of my questions answered,” said another.

But when Arnold stood, 61 percent of patients had positive things to say.

“I didn’t have time to ask the doctor any questions,” one complained.

“He was in and out of my room before I even knew what was going on,” another said.

Arnold said he did not think his demeanor changed standing or sitting. Either posture, he said, “I’m the same guy.”

But Arnold did sense a difference among his patients.

“They seemed a lot happier when I was sitting, like they felt they got what they wanted,” he said.

The few previous studies on sitting and standing doctors generally supported what the KU researchers found.

Patients at a hospital emergency room underestimated the time doctors and medical students spent at their bedsides when they stood, and overestimated the time when they sat, a Mayo Clinic study found.

But the ER patients in that study did not give sitting doctors any extra points for bedside manner.

In another study, patients at the University of Texas M.D. Anderson Cancer Center watched videos of doctors breaking bad news to cancer patients. Patients perceived the doctors who sat as significantly more compassionate than those who stood.

Arnold admitted that in the past, he usually stood at his patients’ bedsides.

“I felt I could get out of the room quicker if I had to,” he quipped.

But sitting has its advantages, Arnold has found: “I feel less rushed when I’m sitting down. I’ve made it part of my practice.”

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