Sitting at the Bedside: Patient and Internal Medicine Trainee Perceptions

Abstract

Background Sitting at the bedside may strengthen physician–patient communication and improve patient experience. Yet despite the potential benefits of sitting, hospital physicians, including resident physicians, may not regularly sit down while speaking with patients. Objective To examine the frequency of sitting by internal medicine residents (including first post-graduate year [PGY-1] and supervising [PGY-2/3] residents) during inpatient encounters and to assess the association between patient-reported sitting at the bedside and patients’ perceptions of other physician communication behaviors. We also assessed residents’ attitudes towards sitting. Design In-person survey of patients and email survey of internal medicine residents between August 2019 and January 2020. Participants Patients admitted to general medicine teaching services and internal medicine residents at The Johns Hopkins Hospital. Main Measures Patient-reported frequency of sitting at the bedside, patients’ perceptions of other communication behaviors (e.g., checking for understanding); residents’ attitudes regarding sitting. Key Results Of 334 eligible patients, 256 (76%) completed a survey. Among these 256 respondents, 198 (77%) and 166 (65%) reported recognizing the PGY-1 and PGY-2/3 on their care team, respectively, for a total of 364 completed surveys. On most surveys (203/364, 56%), patients responded that residents “never” sat. Frequent sitting at the bedside (“every single time” or “most of the time,” together 48/364, 13%) was correlated with other positive behaviors, including spending enough time at the bedside, checking for understanding, and not seeming to be in a rush ( p < 0.01 for all). Of 151 residents, 77 (51%) completed the resident survey; 28 of the 77 (36%) reported sitting frequently. The most commonly cited barrier to sitting was that chairs were not available (38 respondents, 49%). Conclusions Patients perceived that residents sit infrequently. However, sitting was associated with other positive communication behaviors; this is compatible with the hypothesis that promoting sitting could improve overall patient perceptions of provider communication. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07231-4.

Optimizing Patient Experience to Improve Physician Survey Scores

“…Another proven strategy is sitting at the bedside. [15][16][17][18] A significant difference was found between patients' perception of time and actual time spent at the bedside. 15 In one study, the actual length of time the physician stood at the bedside was 1 minute 28 seconds; however, patients perceived them at the bedside an average of 3 minutes 44 seconds.…”

“…Another proven strategy is sitting at the bedside 15–18 . A significant difference was found between patients’ perception of time and actual time spent at the bedside 15 .…”

Wall‐mounted folding chairs to promote resident physician sitting at the hospital bedside

“…7 Simple, modifiable physician behaviors, such as sitting at the hospital bedside, may improve patient-clinician communication. [8][9][10][11][12][13] Sitting has been associated with improvements in patients' perceived understanding of their condition and with patients perceiving that clinicians spend more time at the bedside, without actually making clinical encounters take longer. 8,11 Despite these potential benefits, hospital clinicians do not regularly sit during patient interactions.…”

“…[8][9][10][11][12][13] Sitting has been associated with improvements in patients' perceived understanding of their condition and with patients perceiving that clinicians spend more time at the bedside, without actually making clinical encounters take longer. 8,11 Despite these potential benefits, hospital clinicians do not regularly sit during patient interactions. 8,9,14 In a recent study at our institution, the majority of hospitalized patients (56%) reported that internal medicine residents never sat at the bedside.…”

“…8,11 Despite these potential benefits, hospital clinicians do not regularly sit during patient interactions. 8,9,14 In a recent study at our institution, the majority of hospitalized patients (56%) reported that internal medicine residents never sat at the bedside. 8 Surveyed residents cited inadequate access to chairs as the biggest barrier to sitting.…”