The doctor’s attitude affects the patient’s experience and outcomes

Doctors and others who care for hospitalized patients may want to sit down for this piece of news.

A new study suggests that being at eye level when talking to a patient about their diagnosis or care can really make a difference. Sitting or bending over a hospitalized patient’s bed was associated with more confidence, satisfaction and even better clinical outcomes than standing, according to a new review of the evidence.

The study authors, from the University of Michigan and the VA Ann Arbor Healthcare System, note that most of the studies on this topic varied in their interventions and outcomes and were found to have a high risk of bias. Their findings are published in a systematic review at Journal of General Internal Medicine.

So the researchers sat down and figured out how to study the topic as part of their own larger assessment of how different nonverbal factors influence care, perceptions, and outcomes.

Until their new study is finished, they say their systematic review should prompt clinicians and hospital administrators to encourage more bedside sitting.

Something as simple as having folding chairs and stools in or near patient rooms could help – and in fact, VA Ann Arbor has installed folding chairs in several hospital rooms at the Lt. Col. Charles S. Kettles VA Medical Center.

Nathan Houchens, MD, a UM School of Medicine faculty member and VA nurse who worked with UM medical students to review the evidence on this topic, says they focused on physician attitudes because of power dynamics and hierarchy. of hospital care.

An attending physician or attending physician can change that relationship with a patient by getting down to 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 gone on to further medical training elsewhere: Rita Palanjian, MD, and Mariam Nasrallah, MD

“It turns out that only 14 studies met the criteria in our systematic review of the effects of eye height transition, and only two of those were rigorous experiments,” Houchens said.

“The studies also measured many different things, from the length of the patient encounter and patient impressions of empathy and compassion, to overall hospital patient evaluation scores as measured by standardized surveys such as the federal HCAHPS survey.”

Nathan Houchens, Michigan Medicine – University of Michigan

In general, he said, the data gave the impression that patients preferred clinicians who were seated or at eye level, although that was not generally true. And many studies found that even when doctors were instructed to sit with their patients, they didn’t always do so — especially if special seats weren’t available.

Houchens knows from supervising UM medical students and residents at the VA that clinicians may worry that sitting will prolong interaction when they have other patients and tasks to attend to. But the evidence the team looked at suggests that’s not the case.

He notes that other factors, such as concerns about transmitting infection, can also make it more difficult to consistently approach eye level.

“We hope our work will bring more recognition to the importance of sitting and the general conclusion that patients value it,” says Houchens. Providing seating, encouraging physicians to reach eye level, and senior physicians who speak to sit as role models for their students and residents could also help.

A recently initiated VA/UM study funded by the Agency for Healthcare Research and Quality, called the M-Wellness Laboratory study, includes physician posture as part of a suite of interventions aimed at making the hospital environment more conducive to healing and building bonds between patients. and provider.

In addition to encouraging providers to sit at their patients’ bedsides, the intervention also includes encouraging warm greetings as providers enter patients’ rooms and ask patients questions about their priorities and background during conversations.

Researchers will look for any differences in hospital length of stay, readmissions, patient satisfaction scores and other measures between units where the intervention bundle is being developed and those where it hasn’t yet.