Speculations On Physician Seat Time With Patients

I’ve been thinking about the notion that sitting with a patient when I’m listening to them may give them a sense I’ve actually spent more time with them. This has been studied and overall, while there are a few caveats about the hypothesis including the obvious caution that empathy should and does involve more than just the physician’s posture, the results generally appear to favor sitting compared to standing:

Swayden, K. J., et al. (2012). “Effect of sitting vs. standing on perception of provider time at bedside: A pilot study.” Patient Education and Counseling 86(2): 166-171.
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.

Given the overall time I’ve been practicing as a consulting psychiatrist, the time I’ve spent using my camp stool in the patient’s hospital room has been relatively brief–only since late July 2016. Recall the camp stool is a $165 item which was given to me as a gift by a physician who I respect and admire a great deal. He began his career as a surgeon and is now a palliative medicine consultant.

In my unscientific appraisal so far, patients and families uniformly like the little camp stool or seggiolina as I’ve called it. That’s Italian for “little chair,” and pays homage to Dr. Jenny Lind Porter, one of my undergraduate professors.

Nunchucks

For some reason I can’t fathom, a few people mistake my little chair for nunchucks.

Maybe the mistake is understandable. People get a few chuckles out of it and it breaks the ice.

The other observation I’ll make is that, regardless of patients’ perception of how much time I spend with them while sitting on a camp stool, I can say that, given human anatomy and the design of the stool, I can’t sit on it very long before my right leg along with other parts go numb (could we then call it “numbchunks?”).

And then would that sacrifice of comfort say more about masochism than empathy to patients? Would it convey an impression of Calvinistic fortitude for me to sit on it for too long and rise from it, only to fall over into the bedside commode because I can’t feel my leg? Frankly, if there is a real chair in the room, I use that instead. However, there are rarely enough chairs in a hospital room.

You could get them cheaper at Amazon, but I have a habit of reading the bad reviews about items instead of the excellent ones. I think I do this because I believe I’ll get a more realistic appraisal. Most of the reviews mention the discomfort. One buyer thought it was a great product but probably spent more money modifying it than it was worth. Part of the process involved intentionally burning (“singe”) the straps. I suppose skin grafts resulting from burn injuries is a potential complication, but if your health insurance pays…

I’ve considered handing down seggiolina to one of the residents when I retire. We could have an arcane ceremony including a marathon seat time event followed by one-legged races.

Maybe not.

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