Shahar Madjar, MD

Every year, The BMJ, short for The British Medical Journal, publishes a special Christmas issue. In their instructions for potential authors who might be interested in publishing their work in this issue, The BMJ writes: “While we welcome light-hearted fare and satire, we do not publish spoofs, hoaxes, or fabricated studies.” BMJ also declares that research papers published in the Christmas issue should “adhere to the same high standards of novelty, methodological rigor, reporting transparency, and readability” as in other, less festive, regular issues of the journal.

The Christmas issue is, then, a serious attempt to address serious medical matters in somewhat light-hearted manner. A clue to the endearing nature of the BMJ Christmas issues can be found in the selection of subject matters and in their titles. The latest Christmas issue, for example, includes articles such as: “Chocolate brownies and calorie restriction: the sweetest paradox,” “Cheers not tears: Champagne corks and eye injury,” and “Bug in a mug: are hospital coffee machines transmitting pathogens?”

This year, one of the articles drew my attention in particular. It was titled: Effect of chair placement on physicians’ behavior and patients’ satisfaction: randomized deception trial.” I considered the title clever and, at the same time, intriguing. After all, I thought, deception is invariably interesting, even if it’s randomized.

In this research study, Ruchita Iyer and her colleagues from the University of Texas evaluated the effect of chair placement within patients’ rooms on the time clinicians spent in consultation and on patients’ satisfaction. The study was conducted in one county hospital in Dallas, Texas.

The patients’ rooms were randomly divided into two groups: in half of the rooms, a chair was placed, in a prominent position, within 3 feet of the patient’s bed. In the control group, on the other hand, the chair was placed in its usual location, concealed inside a cabinet.

The study was defined as a “double-blind deception” trial because some of the information was withheld from the participants in this study. The physicians and the patients didn’t know what the actual purpose of the study was and there was no mention of the “chair component.” Instead, participants were informed that the goal of the study was to observe variation in practice patterns. This wasn’t a lie, of course, but it wasn’t the whole truth either. Did I mention deception?

51 physicians took part in the study and 125 physician-patient encounters were observed (60 in the chair placement group and 65 in the control group).

Here are the results: First, and perhaps not surprisingly, physicians were much more likely to sit down at the bedside when a chair was prominently placed next to the bed. 38 of the 60 physicians in the chair placement group sat down versus only 5 of the 65 physicians in the control group. Christmas or not, this finding seemed intuitive to me: people are more likely to sit down wherever chairs are available.

But when I read the rest of the study’s results, I almost fell off my chair (pun intended). The availability of a chair (and therefore the higher likelihood of physicians sitting with their patients) was associated with higher patient satisfaction. In fact, the odds of scoring a complete (perfect) score when using a HCAHPS questionnaire (Hospital Consumer Assessment of Healthcare Providers and Systems — a tool used to measure patients’ satisfaction) was 5.1 greater for those encounters where a chair was placed prominently.

Things get even more interesting when you consider the following: these improvements in patients satisfaction didn’t result from the amount of time physicians spent in the room (in both groups, the amount of time spent with the patients was similar (10.6 minutes). Nor was the improved satisfaction associated with how much time patients and doctors thought they spent together (physicians thought they spent about 9.5 minutes with their patients while patients thought that they spent more than 13 minutes with their doctors).

What can one learn from a study like that, entertaining as it may be, about human nature. First, in a more concrete way, one can learn from the authors’ conclusion: “Chair placement is a simple, no cost, low tech nudge that increases a physician’s likelihood of sitting with a patient and results in both higher patient satisfaction and communication scores.” But, more generally, it seems that our minds play tricks on us, and that our perception of the interactions we have with others is often influenced by forces that are beyond our initial, intuitive understanding of ourselves.

And sometimes a simple act of kindness — the tone of our voice, a smile, even the act of sitting together to discuss whatever is on our minds — may elevate our perception of an encounter, of our relationships.

EDITOR’S NOTE: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.