Healthcare is a rapidly evolving industry, bearing little resemblance today to the system familiar to generations past. While many of the advancements of recent years have help to improve patient care, not all changes have been universally welcomed.
For example, many physicians say they yearn for the days of pay-for-service medicine, when small patient panels meant doctors had time to build strong, long-term rapport with each patient. In contrast, modern healthcare is frenetically paced and enormously complex, involving third-party payers, Value Based Purchasing reimbursements, high overhead costs, and an increasingly market-savvy patient population that expects much from their healthcare provider.
With this escalating emphasis on value and efficiency in healthcare, time shared between physician and patient has become an increasingly scarce commodity. To compensate for lowering reimbursements and higher operating costs, physicians must see more patients by working longer hours or spending less time with each patient – often both.
Less time spent with each patient compromises patient satisfaction, lowers physician satisfaction, decreases the quality of care, and increases the risk of malpractice claims1. Physicians must now strive to give the illusion of spending more time in the room while also effectively and efficiently examining, diagnosing, and communicating.
Interestingly, one approach shown to assist physicians in enhancing communication and the overall patient-physician relationship is taking a seated posture during the care encounter. By attending to posture, physicians can support the perception of having spent additional time with the patient, as well as providing higher quality of care.
Supporting this practice, a recent meta-analysis reported that informativeness, interpersonal sensitivity, and partnership building are the three dimensions of communication most closely correlated to patient satisfaction, compliance, and medical information recall 2. When physicians sit during the visit, patients are more likely to feel listened to, cared for, and included as a partner in their care. By taking a seated posture, the physician shows that they consider the patient an equal who deserves to be treated thus. Sitting also provides the benefit of combating unconscious hurried behaviors such as resting your hand on the doorknob, slowly edging towards the door, or looking outside of the room.
Where body language is concerned, clinicians may be able to learn something from experts in the sales discipline, whose training often focus much on deciphering a person’s core personality archetype and adjusting body language in an attempt to encourage comfort. What these experts have caught on to is the fact that the majority of people respond favorably to a posture that mirrors their own. Those with personality types particularly sensitive to posture during conversation can even be unconsciously offended by someone who stands while they are seated or lying in bed.
While the physician’s primary goal within the exam room is usually not to provide psychotherapy, one key factor for patient compliance and loyalty is how comfortable they feel with you. By adjusting posture, the physician helps to support the patient’s comfort, as well as their satisfaction. In fact, a study conducted at The University of Kansas Hospital showed that a change in posture from standing to sitting can not only increase the patient’s perception of the time their physician spent in the room by up to 44%, but also increase satisfaction by a significant 34% 3.
When patients feel their doctor has spent adequate time with them, they express a better understanding of their condition, greater satisfaction with their care, and higher compliance with their treatment plan. A theme that recurred throughout the interviews conducted as part of the aforementioned study was the perception that seated physicians spent more time in the exam room, listened more closely, expressed more empathy, and answered questions more thoroughly.
In contrast, when describing doctors who stood, patients said such things as, "He was in and out of my room before I even knew what was going on" and "I didn't have time to ask the doctor any questions."
Although studies have shown that a seated posture enhances rapport and evokes a sense of interest, compassion, and increased satisfaction among patients, many physicians remain resistant to adopting this practice. As a justification, physicians often say hospital and exam rooms are not conducive to conversation. There may be few chairs in these rooms, and those available may be covered with clothes or occupied by visitors. Some hospitals have purchased chairs or stools designated for physician use in the hope that it will encourage physicians to sit down with patients.
Resistant physicians should consider the benefits of sitting and be willing to improvise by sitting on a windowsill, the foot of the bed, or crouching down to speak with the patient. By educating physicians with solid studies and providing them with the tools to succeed, hospitals and outpatient facilities can encourage their physicians to adopt the practice of sitting with their patients. This simple posture change can dramatically transform a patients’ perception of the physician and their care, as well as create a feeling of loyalty and appreciation in the midst of this complex, frenetic world of healthcare.
Originally posted on www.avatarsolutions.com
REFERENCES
1. Dugdale, D. C., Epstein, R., & Pantilat, S. Z. (1999). Time and the patient-physician relationship. J Gen Intern Med Journal of General Internal Medicine, 14(S1).
2. Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care 2008; 26:657–675.
3. Swayden, K. J., Anderson, K. K., Connelly, L. M., Moran, J. S., Mcmahon, J. K., & Arnold, P. M. (2012). Effect of sitting vs. standing on perception of provider time at bedside: A pilot study. Patient Education and Counseling, 86(2), 166-171.
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