Do You Sit or Stand?

[docB]

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So the consensus is that sitting down while doing your history helps with patient satisfaction and reduces lawsuits. There are barriers to sitting such as not having chairs in every room and the perception (probably false) on the part of EPs that it takes longer.

So do you sit or stand? To keep the poll simple (sit vs. stand) pick sit if you usually sit and stand if you usually stand.

 

[EctopicFetus]

depends for me.. i do a little of both

 

[anonymousEM]

I tend to sit if there is not a family member, purse or wadded up underwear (in the miracle that a belly pain patient actually put on a gown in the first place) on my seat. Sometimes with kids I'll sit on the edge of their beds.

 

[EM_Rebuilder]

I typically stand.... sometimes really early in the morning though, a guy just has to sit to not make a mess.

Reality of the situation is that this is the pure reason I love living in the country. Outside, sit or stand, cause aim no longer becomes an issue...



<Ok, so I am a sitter. I like taking a load off, if I go into a room, the first thing I do is eye the chair. What I have found funny is that oftentimes if a family member is in the chair and you eye the chair (you have to really give it a hard look...that look on your face like darn someones in my chair), they jump up saying sorry doctor.....in such a situation, I do stand and ask them to please keep the chair....its just a little fact I have noted. Dont eye the chair, they dont offer...anyways, thats late night babbling now. So, sit unless there is someone else in the room who obviously needs the chair worse than I do.>

 

[WallowaWanderer]

I hate standing, but since I have been rotating at an old county program recently there is only a chair about a quarter of the time. When I'm standing, I feel like I'm towering over the patient. Also, I like to rest my legs a bit.

 

[Apollyon]

I will sit on the rolling stool (a difference from the chairs - subtle, but there) when I come in. However, if someone is already sitting on the stool, unless I need it for a procedure, I don't bounce the person off it. I NEVER sit in the chairs. If the stool is unavailable, I get close while standing, but lean on something - never standing up, especially not with my hands on my hips. At the very least, in the chance there's NOTHING to lean on, I clasp my hands behind my back.

Likewise, I've taken to saying to the patients, "I read the nurse's note, but I'd like you to tell me, in your own words, what brought you to see us here today."
So far, haven't had anyone balk.

One thing I don't do while sitting, though, is examine the patient. Once I get that far, I stand up. Only exception is with peds, where I have the parent sit down, and I sit on the left, and examine the pt in the parent's arms.

 

[deleted77919]

You guys have chairs in your ED's? And they are near the patient beds?

I don't know if people in the ED here could sit even if they wanted to, maybe if you sat on top of the patient next to them . . .

 

[FISKUS]

When are you talking about? Work or when I pee ?

 

[southerndoc]

I sit when possible. If a chair isn't available, I sometimes sit on the trash can lid.

 

[kungfufishing]

Depends on the complaint. Most of the time, I sit. If they have a straightforward problem/nonproblem, I stand. Next!

 

[docB]

When are you talking about? Work or when I pee ?

The poll ? was about work. If you pee while while taking histories then both.

 

[deleted6669]

Sit Most Of The Time.
Exceptions:
Really Sick Pt(duh)
No Brainer Quickie D/c (dysuria With + Ua, Nom Fever, No N/v And No Abd Pain)

 

[Wackie]

I think once or twice I've been able to sit while doing the HPI. But I'm not actually providing patient care, just documenting the conversation between the doc and patient. 😀
The docs I work with rarely sit. A few of them will sit for psych cases or for patients who have previously filed complaints.

 

[Seaglass]

Sit on whatever is available - trash can, chair, or edge of bed.

 

[GeneralVeers]

Sit on whatever is available - trash can, chair, or edge of bed.

Always stand. Usually the family members are seated, and if I stand, it gives me a better view of what's going on.

Those with severe ADHD hate to sit....

 

[Jeff698]

Since someone's already addressed my first thought on reading this poll...

I sit whenever possible. I also take a deep breath and give the patient 1-2 minutes of uninterrupted blabbering time before I start interupting with my yes/no questions.

Greg Henry has a great lecture that's theoretically about liability but really about how to be a better doctor as perceived by your patients. It's available to EMRA members on EMRAP. He recommends sitting, formally introducing yourself, shaking hands and bitting your tongue for a while with every patient.

Take care,
Jeff

 

[deleted77919]

In German the term sitzpinkler is derogatory, the equivalent of being a wimp. Couldn't help but throw that out there.

 

[nvmd]

If there is a chair available and if it's appropriate I will sit, otherwise I'm on my feet. I've found that pt's are more relaxed when you sit.

 

[ditch doctor]

Sit...

 

[Chronic Student]

I will second or third the thought that this was a thread about peeing.

-Mike

 

[ERMudPhud]

Unless the patient is critically ill or obtunded I will go out of my way to drag a stool in from another room just so I can sit. I spend more time on the history that way and its the only chance I get to rest most shifts

 

[The White Coat Investor]

I sit when possible. If a chair isn't available, I sometimes sit on the trash can lid.

Ha ha...me too.

Don't stand if you can sit, don't sit if you can lie down. Don't lie down if you can sleep. Sleep when you can, eat when you can, pee when you can. It's a great way to live.

 

[GeneralVeers]

So many sitters. Your are all a bunch of women. (not that there's anything wrong with that)

 

[southerndoc]

So many sitters. Your are all a bunch of women. (not that there's anything wrong with that)

Prevents trauma from micturition syncope. 😉

 

[substanceP]

rarely a chair/stool available, so stand by default.

 

[wanabdoc]

oooooo, this question was about patient care.,,

 

[docB]

New article in Annals says the whole sit vs. stand thing may not make that much difference.


To sit or not to sit?
Annals of Emerg. Med. – Vol. 51, Issue 2 (Feb. 2008)
Abstract:

STUDY OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.Citation:

To sit or not to sit?
Johnson RL - Ann Emerg Med - 01-FEB-2008; 51(2): 188-93, 193.e1-2
From NIH/NLM MEDLINE
NLM Citation ID:
17597254 (PubMed ID)
Full Source Title:
Annals of emergency medicine
Publication Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
English
Author Affiliation:
Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA. [email protected]
Authors:
Johnson RL; Sadosty AT; Weaver AL; Goyal DG

 

[GeneralVeers]

CONCLUSION: 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.[/B]Citation:

Therefore I shall continue to stand.

BTW 8.6 minutes per encounter is a LONG time.

 

[Annette]

I sit for both. 😉

My ED labled all the rolling stools as "Doctor's Chair" and most pt families don't use them any more.

Did the study randomize which providers sat/stood during which encounters? I think that could be a confounding factor. Also, how do they explain the other studies showing that the percieved time spent with a pt influences likelyhood of a suit when something goes wrong?