To sit or not to sit?

We prospectively examine whether provider posture (seated versus standing) influences patient and provider estimates of time spent at the bedside relative to actual time and patient perceptions of the provider-patient interaction.

A convenience sample of consenting adult patients presenting to an academic tertiary care emergency department between September 7, 2005, and September 25, 2005, were eligible for inclusion in this randomized, controlled trial. Providers (emergency medicine attending physicians, residents, physician assistants, and medical students) were randomly assigned to sit or stand during the initial encounter, after which, participants completed questionnaires about their perceptions of provider-patient interactions and time spent therein. Actual encounter length was measured. Data were analyzed to determine whether patient and provider perception differences existed, using a multilevel regression model that was adjusted for patient-level and provider-level covariates.

Two hundred twenty-four consenting patients met inclusion criteria (239 approached; 15 excluded). Data from 36 providers were collected. The mean length of encounters in both study arms was 8.6 minutes (SD 4.8; range 1.5 to 34.1). Patients involved in seated interactions overestimated time providers spent performing initial encounters by an average of 1.3 minutes (SD 4.3 minutes), whereas patients involved in the standing interactions underestimated time by an average of 0.6 minutes (SD 4.3 minutes) (P=.001). Conversely, providers overestimated time spent with patients in both study arms (P=.85; mean [SD] 0.5 [3.6] versus 0.3 [3.2] minutes). Patient perceptions of the quality of patient-provider interactions were not affected by provider posture.

Although provider posture during the initial interaction affects patient perceptions of time spent at the bedside, it does not influence patient perception of the provider's bedside manner, sense of caring, or understanding of the patient's problem.