What has this got to do with anything you might ask?
Well, I’m referring to where the patient sits in relation to the clinician… and the presence or absence of physical barriers between the individuals.
It was something that I remarked as a patient here in France: the patient sits on one side of a desk, the medical professional on the other. It’s always been that way in France my husband tells me… but accustomed as I was to having no such boundary in my UK consultation rooms, it felt like an unspoken power dynamic had suddenly inserted itself. Why did I feel like that?
Notable environmental psychology studies1,2,3 in the field have demonstrated the impact of such a desk on a consultation: that it establishes a territorial boundary between the clinician and the patient, and signals control. The result? The suppression of spontaneous conversation and the adoption of a transactional tone. Furthermore, patients reported higher internal anxiety and perceived their caregivers as more dominant, authoritative and less approachable.
In the knowledge of these (far from recent) findings and the evolution of medical communication skills teaching, why don’t all clinicians angle their desks and chairs differently to minimise the sensation of interrogation or power?
Were my French clinicians alone in this power engagement, or did this in fact vary from country to country? A more recent global study4 sought to find out, and whether the recency of doctor qualification or their gender might be extra factors…
Read the study below and try and answer the following questions (True/False)
1. The trigger for the study was a group discussion at a WONCA working party.
2. The researchers used a previous questionnaire which had three sections.
3. The questionnaire was distributed by email and social media.
4. Only the qualitative results were analysed.
5. Most of the respondents were Spanish female practitioners.
6. Scenario 3 (face-desk-face) was preferred in Europe.
7. Respondents who graduated after 2010 were most likely to use scenario 3.
8. The study’s principal limitations included participants being concentrated in certain countries and continents.
9. There were no French respondents.
10. The patient viewpoints and preferences were taken into consideration.
Take home points:
- In Floss et al’s limited study, the preference for the patient chair placement was behind the desk, although more recently qualified practitioners preferred sitting next to the patient.
- France is not the only European country where its clinicians sit opposite their patients! Hopefully this will change in time!
Answers: 1.T, 2.F, 3.T, 4.F, 5.F, 6.T, 7.F, 8.T, 9.T, 10.F
