Research indicates that when doctors position themselves at their hospitalized patients’ eye level, it can lead to better outcomes compared to standing. However, a new study aims to confirm this observation.
Healthcare providers caring for hospitalized patients might want to take note of this important information.
Recent research indicates that engaging with patients at their eye level during discussions about their diagnoses or treatment can significantly enhance the experience. Sitting or crouching by a patient’s bedside has been linked to higher levels of trust, satisfaction, and even improved clinical results compared to when doctors stand, based on a comprehensive review of existing evidence.
The authors of this study, affiliated with the University of Michigan and VA Ann Arbor Healthcare System, highlight that many previous studies on this subject utilized varied methods and outcomes, often introducing substantial bias. Their analysis appears in a systematic review published in the Journal of General Internal Medicine.
To address this, the researchers devised their own study as part of a broader investigation into how non-verbal cues influence care, perceptions, and results.
While this new study is ongoing, they suggest that hospitals should foster more bedside sitting among clinicians based on their review findings.
Simple measures, such as providing folding chairs and stools near patient rooms, can promote this practice. In fact, the VA Ann Arbor has already equipped many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center with folding chairs.
Nathan Houchens, M.D., a faculty member at U-M Medical School and a hospitalist at the VA, who collaborated with U-M medical students to evaluate this topic, emphasizes the significance of physician posture due to the inherent power dynamics in hospital care.
A physician—whether a resident or attending—can positively alter the dynamic of their relationship with a patient by lowering themselves to eye level rather than looming above them, he points out.
The inspiration for this study came from two recent medical graduates who continued their training elsewhere: Rita Palanjian, M.D. and Mariam Nasrallah, M.D.
“In our systematic review, we found that only 14 studies met the criteria for assessment regarding the effects of maintaining eye level, with only two being robust experiments,” Houchens noted. “Additionally, these studies varied widely in their focus, ranging from the duration of patient interactions and patient perceptions of empathy and compassion, to overall hospital evaluation metrics like the federal HCAHPS survey scores.”
Generally, the evidence suggests that patients favor clinicians who sit or engage them at their eye level, although this preference isn’t uniform across the board. Many studies reported that even when physicians were assigned to sit with their patients, they often neglected to do so, particularly when dedicated seating was unavailable.
Houchens acknowledges that, through overseeing U-M medical students and residents at the VA, he’s observed that healthcare providers may worry that sitting down could extend the interaction time when they have other patients and responsibilities waiting. However, the evidence reviewed indicates this concern may be unfounded.
He also points out that factors like fears of infection transmission can hinder the ability to consistently engage patients at eye level.
“We aim for our research to increase awareness of the importance of sitting down and the overall conclusion that patients value this approach,” Houchens explains. Encouraging availability of seating, urging physicians to meet patients at eye level, and having senior doctors model this behavior for students and residents could further promote these practices.
A newly initiated study by the VA and U-M, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes the stance of physicians as part of an array of interventions designed to create a healing-friendly hospital environment that fosters connections between patients and their caregivers.
This initiative not only advocates for providers to sit at their patients’ bedsides but also encourages friendly greetings upon entering patient rooms and asking patients about their priorities and backgrounds during discussions.
The researchers plan to evaluate differences in metrics such as hospital length of stay, readmission rates, patient satisfaction scores, and other relevant measures between units implementing this set of interventions and those that have not.
In addition to Houchens and the two former students, other contributors of the systematic review include U-M and VA hospitalist Ashwin Gupta, M.D., Whitney Townsend from the U-M Taubman Health Sciences Library, VA’s chief of medicine and U-M professor Sanjay Saint, M.D., M.P.H., and Jason Engle, M.P.H. Both Saint and Engle are associated with the VA Center for Clinical Management Research, with Saint also part of the U-M Institute for Healthcare Policy and Innovation.
Houchens, Gupta, and Saint are faculty members in the Division of Hospital Medicine within the Department of Internal Medicine at Michigan Medicine, the academic medical center of U-M.
The systematic review recently released was backed by funding from U-M and VA resources. The new study is supported by AHRQ grant HS28963-01.
