Have a seat, doctor: Study suggests eye level connection makes a difference in hospitals

Review of research suggests patients feel better when providers sit or crouch during bedside conversations

11:35 AM

Author | Kara Gavin

green background with white drawing of doctor at patient beside having conversation
Getty Images

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

A study suggests that getting at a patient’s eye level when talking with them about their diagnosis or care can really make a difference. 

Sitting or crouching at a hospitalized patient’s bedside was associated with more trust, satisfaction and even better clinical outcomes than standing, according to the review of evidence.

The study’s authors, from the University of Michigan and VA Ann Arbor Healthcare System, note that most of the studies on this topic varied with their interventions and outcomes, and were found to have high risk of bias. 

Their findings are published in a systematic review in the Journal of General Internal Medicine.

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

Until their study ends, they say their systematic review should prompt clinicians and hospital administrators to encourage more sitting at the bedside. 

Something as simple as making folding chairs and stools available in or near patient rooms could help – and in fact, the VA Ann Arbor has installed folding chairs in many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.

Nathan Houchens, M.D., the U-M Medical School faculty member and VA hospitalist who worked with U-M medical students to review the evidence on this topic, says they focused on physician posture because of the power dynamics and hierarchy of hospital-based care. 

We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it."

-Nathan Houchens, M.D.

An attending or resident physician can shift 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, M.D., and Mariam Nasrallah, M.D. 

“It turns out that only 14 studies met criteria for evaluation in our systematic review of the impacts of moving to eye level, and only two of them were rigorous experiments,” said Houchens. 

“Also, the studies measured many different things, from length of the patient encounter and patient impressions of empathy and compassion, to hospitals’ overall patient evaluation scores as measured by standardized surveys like the federal HCAHPS survey.

In general, he says, the data paint the picture that patients prefer clinicians who are sitting or at eye level, although this wasn’t universally true. 

And many studies acknowledged that even when physicians were assigned to sit with their patients, they didn’t always do so – especially if dedicated seating was not available. 

SEE ALSO: What Doctors Wear Really Does Matter to Patients

Houchens knows from supervising U-M medical students and residents at the VA that clinicians may be worried that sitting down will prolong the interaction when they have other patients and duties to get to. 

But the evidence the team reviewed suggests this is not the case. 

He notes that other factors, such as concerns about infection transmission, can also make it harder to consistently get to eye level. 

“We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it,” said Houchens. 

Making seating available, encouraging physicians to get at eye level, and senior physicians making a point to sit as role models for their students and residents, could help too. 

A recently launched VA/U-M study, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes physician posture as part of a bundle of interventions aimed at making hospital environments more conducive to healing and forming bonds between patient and provider. 

In addition to encouraging providers to sit by their patients’ bedsides, the intervention also includes encouraging warm greetings as providers enter patient rooms and posing questions to patients about their priorities and backgrounds during conversations.

The researchers will look for any differences in hospital length of stay, readmissions, patient satisfaction scores, and other measures between the units where the bundle of interventions is being rolled out, and those where it is not yet.

Additional authors: In addition to Houchens and the two former students, the authors of the systematic review are U-M and VA hospitalist Ashwin Gupta, M.D., Whitney Townsend of the U-M Taubman Health Sciences Library, VA chief of medicine and U-M professor Sanjay Saint, M.D., M.P.H., and Jason Engle, M.P.H. Saint and Engle are part of the VA Center for Clinical Management Research, and Saint is a member of the U-M Institute for Healthcare Policy and Innovation. Houchens, Gupta and Saint are faculty in the Division of Hospital Medicine of the Department of Internal Medicine at Michigan Medicine, U-M’s academic medical center.

Funding/disclosures: The study was funded by U-M and VA resources. The study was also funded by AHRQ grant HS28963-01

Paper cited: "Effect of Clinician Posture on Patient Perceptions of Communication in the Inpatient Setting: A Systematic Review," Journal of General Internal Medicine. DOI: 10.1007/s11606-024-08906-4

Sign up for Health Lab newsletters today. Get medical tips from top experts and learn about new scientific discoveries every week by subscribing to Health Lab’s two newsletters, Health & Wellness and Research & Innovation.

Sign up for the Health Lab Podcast: Add us on SpotifyApple Podcasts or wherever you get you listen to your favorite shows.


More Articles About: Health Care Delivery, Policy and Economics Internal Medicine Hospitals & Centers
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of health care news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Related
zoom screens with 7 different backgrounds and doctor silhouettes outlined in each
Health Lab
The doctor is in…. but what’s behind them?
A study reveals that what a doctor has behind them during a telehealth visit can make a difference in how the patient feels about them and their care.
Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories On left, a young boy in a wheelchair has his doctor standing to his left and his parent is standing to his right in a show of support. On the right side of the image, the boy is now an adult and is wondering about the cost of his care and if his questions will be answered.
Health Lab
Changing the definition of cerebral palsy
Cerebral palsy is defined as a childhood disorder, which fails to recognize adults living with the condition and the lack of care they receive once they age out of pediatric clinics.
floating AI-type images in red and blues and yellow on blue background
Health Lab
Racial differences in medical testing could introduce bias to AI models
Black patients are less likely than white patients to receive certain medical tests that doctors use to diagnose severe disease, impacting artificial intelligence data. But researchers have found a way to correct the bias in these data sets.
family of four sitting on couch in living room looking at an ipad laughing
Health Lab
Grandparents help grandkids in many ways – but the reverse may be true too
A poll shows the many ways (childcare, nutrition, major expenses) that grandparents help their grandchildren, but also suggests a link to older adults’ sense of isolation and their mental health.
woman touching back leaning forward in pain at desk light powder blue button down
Health Lab
Does virtual care mean low-value care? Study says no
The rise of telehealth has come with concerns that it could encourage use of low-value care that’s not needed. But a study suggests this hasn't happened.
clinical team and patient standing together
Health Lab
Planting a tree, and hope, for a heart healthy future
A complex mitral valve repair by Michigan Medicine cardiac specialists helps restore health and happiness to one Michigan patient and his family.
purple background sky colors with times floating patient with pillow brown clothes on moon in sky
Health Lab
Free course shines light on sleep health
An expert-led course on sleep helps educate students about the importance of creating and maintaining good sleep habits for health and wellness.