Study shows eye-level interactions improve patient trust and outcomes

A study suggests that sitting or crouching at a patient’s bedside can significantly enhance trust, satisfaction, and even clinical outcomes. This new review of evidence, conducted by researchers from the University of Michigan and VA Ann Arbor Healthcare System, illustrtes the impact of engaging with patients at eye level.

Published in the Journal of General Internal Medicine, the study's systematic review examined how physician posture affects patient care and perceptions. Despite variations in interventions and outcomes, the findings indicate that when doctors sit down, patients report feeling more trust and satisfaction with their care.

The research team, led by Nathan Houchens, M.D., a faculty member at the U-M Medical School and VA hospitalist, emphasized the importance of non-verbal communication in medical settings. Houchens noted that the power dynamics and hierarchy within hospital care can be softened when doctors meet patients at eye level, fostering a more equitable relationship.

The review identified 14 studies that met the criteria for evaluation, including only two rigorous experiments. These studies measured various outcomes, from the duration of patient encounters to empathy and compassion scores, as well as overall patient evaluation scores using standardized surveys like the federal HCAHPS survey.

The data generally showed that patients prefer clinicians who sit or get to eye level, though this wasn't universally true. Challenges such as the lack of dedicated seating and concerns about infection transmission sometimes hindered this practice. However, evidence suggests that sitting does not prolong interactions unnecessarily, addressing a common concern among busy clinicians.

The researchers advocate for simple changes, such as providing folding chairs or stools in patient rooms, to facilitate more seated interactions. The VA Ann Arbor has already taken steps to implement this by installing folding chairs in many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.

A newly launched study by VA and U-M, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, aims to explore further the effects of physician posture. This study includes a bundle of interventions designed to create a more healing hospital environment, such as warm greetings and engaging patients about their priorities and backgrounds.

Houchens hopes their findings will prompt clinicians and hospital administrators to recognize the value of sitting and encourage its practice. Senior physicians acting as role models by sitting with patients can also help reinforce this behavior among students and residents. The ongoing research will compare outcomes like hospital length of stay, readmissions, and patient satisfaction scores between units implementing these interventions and those that are not.