Background     Many of us in healthcare entered our profession with lofty ideals and practice with good intentions. However, patients often perceive that we are less clear in our communication (1) and less caring (2) than we think we are.  Fortunately, there is research to show that the simple behavior of sitting down at the patient’s eye level can improve the patient’s understanding of their condition as well as their perception of the care received. This Fast Fact summarizes the evidence for sitting down when speaking directly with patients and offers advice on how to apply this skill in everyday practice.

Review of patient satisfaction data     Observational studies have shown that sitting down at the patient’s eye level during clinical encounters is associated with several benefits without significantly increasing the amount of time spent with the patient (3). Compared to clinicians who stand, patients report that clinicians who sit down: 

• Communicate in a more understandable way (3).
• Listen more carefully (3).
• Show more capacity for compassion (4,5).
• Spend more time at the bedside (4).
• Demonstrate more respect and better etiquette (6,7).
• Seem less rushed and less intimidating (8).
• Provide better visual connection and rapport between them and their clinician (8).

Are these findings plausible?   Some clinical studies control for content and time spent with the patient (3,4,9), including a randomized controlled trial in the emergency room which suggest that patients overestimate the amount of time sitting clinicians spend with them and underestimate the amount of time standing clinicians spend with them (9). One systematic review showed that 10 of 14 studies showed favorable outcomes of clinicians who sit (10). Overall, though, it is difficult to eliminate all confounding variables that may influence outcomes in clinical studies.

There is non-clinical communication research suggesting that standing over someone can be “power posing” and may induce increased physiologic stress responses on others (11). Sitting at eye level may reduce power dynamics and encourage both parties to be more present (12). Furthermore, the discomfort of standing may contribute to more hurried discussions (13). For all these reasons, many experts endorse sitting as a simple and effective strategy to improve clinical communication.

Barriers to sitting    Despite the supportive evidence for sitting down during patient encounters, patient surveys suggest that clinicians infrequently do so (8).  Barriers cited in the published literature include: 

• Inadequate or inconvenient access to chairs (3,8).
• Ingrained habit to stand during encounters (3,8,14).
• Clinician attitudes that sitting is unimportant or time-consuming (3,14).
• Observations that other clinicians do not sit (especially if they are clinician leaders) (8).
• Infection control concerns (8).

Evidence-based strategies to promote sitting   Education alone has not been shown to compel clinicians to sit during patient encounters (15,16).  However, certain patient care and system-based strategies have shown effectiveness: 

• Placement of a wall-mounted folding chair in plain sight in the patient care room (15,16).
• Verbal nudging of a clinician to sit (15).
• Use of a portable stool which clinicians carry with them into patient rooms, following infection control protocols (17).
• Employment of a quality improvement project committing all clinicians to spend 3-5 minutes sitting with patients in which they check in, listen, and provide uninterrupted attention (18).
• If no chairs are available in the room, squatting or sitting on the edge of the patient’s bed (with permission) can be acceptable alternatives (8).

Summary   In isolation, sitting is not going to repair other clinician communication deficits. However, sitting down during patient encounters is a relatively easy-implemented behavior which can augment the reported patient- and family-satisfaction of the encounter (5,10).

References: 

1. Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010 Spring;10(1):38-43. PMID: 21603354; PMCID: PMC3096184.
2. Thomas E, Shenod S, Madhu, B. Empathy in practice: comparing physicians’ self-assessment and patient perceptions using the Jefferson Scales. Pre-print. 2024. Available at:  https://doi.org/10.21203/rs.3.rs-5041703/v1.
3. Merel SE, McKinney CM, Ufkes P, et al. Sitting at patients’ bedsides may improve patients’ perceptions of physician communication skills. J Hosp Med. 2016; 11(12):865-868.
4. Strasser F, Palmer JL, 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. J Pain Symptom Manage. 2005; 29(5):489-97.
5. Bruera E, Palmer JL, Pace E, et al. A randomized, controlled trial of physician postures when breaking bad news to cancer patients. Palliat Med. 2007; 21(6):501-5.
6. Tackett S, Tad-y D, Rios R, et al.  Appraising the practice of etiquette-based medicine in the inpatient setting. J Gen Intern Med. 2013; 28(7):908-913.
7. Kahn MW. Etiquette-based medicine. NEJM. 2008; 358(19):1988-9.
8. Golden BP, Tackett S, Kobayashi K, et al.  Sitting at the bedside: patient and internal medicine trainee perceptions.  J Gen Intern Med. 2022; 37(12):3038-3044.
9. Johnson RL, Sadosty AT, Weaver AL, et al.  To sit or not to sit?  Ann Emerg Med. 2008; 51(2):188-193.
10. Houchens N, Engle JM, Palanjian R, et al.  Effect of clinician posture on patient perceptions of communication in the inpatient setting: a systematic review. JGIM. 2024; 39(16):3290-8.
11. Laborde S, Strack N, Mosley E.  The influence of power posing on cardiac vagal activity. Acta Psychologica. 2019; 199:102899.
12. Guyer JJ, Brinol, Petty RE, et al.  Nonverbal behavior of persuasive sources: a multiple process analysis. J Nonverbal Beh. 2019; 43:203-231.
13. Mansfield L, Hall J, Smith L, et al.  “Could you sit down please?” A qualitative analysis of employees experiences of standing in normally seated workplace meetings.  PLoS One. 2018; 13(6): e0198483.
14. Siddiqui Z, Qayyam R, Bertram A, et al.  Does provider self-reporting of etiquette behaviors improve patient experience? A randomized controlled trial.  J Hosp Med. 2017; 12(6):402-6.
15. Orloski CJ, Tabakin ER, Shofer FS, et al.  Grab a seat! Nudging provider to sit improves the patient experience in the Emergency Department. J Patient Exp. 2019; 6(2):110-116.
16. Golden BP, Tackett S, Kobayashi K, et al.  Wall-mounted folding chairs to promote resident physician sitting at the hospital bedside. J Hosp Med. 2024; 19(5):356-7.
17. Draelos R.  Surviving the wards while pregnant: bring a chair on rounds and other tips.  Glass Box Medicine. 2022. Available at:  https://glassboxmedicine.com/2022/09/23/surviving-the-wards-while-pregnant-bring-a-chair-on-rounds-and-other-tips/#:~:text=Tip%20%231:%20Bring%20a%20portable,I%20just%20needed%20to%20rest.  Last accessed October 24, 2024.
18. George S, Rahmatinick S, Ramos J.  Commit to sit to improve nurse communication. Crit Care Nurs. 2018; 38(2):83-85. 

Conflicts of interest: The authors have disclosed no relevant conflicts of interest.
Institutional affiliations: Medical College of Wisconsin, Milwaukee, WI.
Version History:  originally edited by Drew A Rosielle MD; first electronically published in June 2025.