Despite considerable changes in the staffing and provision of acute care, the hospital ward round remains a defining moment for the doctor-patient relationship. The interaction may sometimes be brief, but it has a major impact on building trust, patient satisfaction, and treatment outcomes. Great efforts have been made from medical school education onwards, to foster an empathic “active listening” approach and for clinicians to think carefully about the language they use and avoid jargon. A facet often overlooked in busy hospital care is that of proxemics—how we use the physical space when we’re communicating with our patients.
More and more patients in the ward environment are now encouraged out of their beds. This followed the highly successful campaign to facilitate patients being seated while in hospital (#endPJparalysis), rather than to remain bedbound (i.e. patients are now “fit to sit”). However, the ward is a crowded environment and seldom are there additional chairs available for visitors. Historically, clinicians would sit on the bed, but this is no longer an option following concerns about infection control. The consultation now is frequently conducted with the patient seated, but the clinician standing.
Standing can make the conversation seem hurried even when it is not and symbolises an authoritarian approach to the patient. [1,2] What if clinicians were to sit down and make direct eye contact—thereby signalling their undivided attention to the patient?
The integration of evidence-based medicine (EBM) into clinical practice has been a highly regarded means to improve patient care. Well, perhaps the answer to providing respectful communication is to practice EBM …. albeit in this case “etiquette-based medicine.” This term was coined by Michael Kahn in 2008 following his own hospitalisation (in the USA) and includes the entreaty for clinicians to introduce themselves (showing their ID badge), shake hands if appropriate, request permission to sit down, and explain their role on the team. [3] The otherwise excellent Royal College of Physicians and Royal College of Nursing’s joint document “Ward rounds in medicine: principles for best practice” makes no mention of how we use the physical space available to us, nor of etiquette. [4]
We need an equivalent campaign to that of #endPJparalysis—to ensure that clinicians and patients can sit down together and converse in the personal zone, as it’s called in the field of proxemics. Until then, we are reducing the likelihood of successful, clinical encounters during hospital stays. Let’s “commit to sit.”
Debbie Cooke is a senior lecturer in Health Psychology at The University of Surrey @DebPsych_Surrey
Martin Whyte is a consultant in Diabetes and Acute Medicine and Senior Lecturer at the University of Surrey @mbwhyte1
Competing interests: None declared
References:
- Swayden KJ, Anderson KK, Connelly LM, et al. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ Couns. 2012 Feb;86(2):166-71. doi: 10.1016/j.pec.2011.05.024
- Strasser, F, Lynn Palmer J, Willey J, et al. Impact of Physician Sitting Versus Standing During Inpatient Oncology Consultations: Patients’ Preference and Perception of Compassion and Duration. A Randomized Controlled Trial. Journal of Pain and Symptom Management 2005; 29(5): 489-497
- Kahn MW. Etiquette-Based Medicine. N Engl J Med 2008; 358:1988-1989
- Royal College of Physicians and Royal College of Nursing. Ward rounds in medicine: principles for best practice (2012). https://www.rcplondon.ac.uk/projects/outputs/ward-rounds-medicine-principles-best-practice Accessed 11th June 2019