In Reply:

Letters to the Editor regarding the article Communication on Rounds by Flavio Gössi, Christoph Becker, Sebastian Gross, Armon Arpagaus, Stefano Bassetti, and Sabina Hunziker in issue 13/2025

We are grateful for the interest in our article (1) and the valuable addition regarding the seated position as an aspect of non-verbal communication, whose relevance was confirmed impressively in a recent systematic review (2).

The randomized trial reported by Iyer et al. struck us as particularly instructive (3): a readily positioned chair increased the probability that doctors actually sat down during rounds by a factor of 20. Patients rated doctors in a seated position significantly more often by giving top scores regarding “trust in the treatment” and “imparting of information”—two clinically extremely relevant dimensions.

It needs to be borne in mind, however, that the optimal position always depends on circumstances. The prerequisite for sitting down is a seat that enables eye contact in a natural position of the head and at an appropriate distance. If this is not an option—for example, if a patient can only lie flat and would have to turn their head uncomfortably—a standing position may be the better option. What is crucial is that eye contact is possible in a natural and respectful manner and that doctor and patient can see each other clearly and encounter each other in a interested manner.

We agree with Professor Weber that senior clinicians have an important function as exemplars—whether in a seated position or a standing one.

DOI: 10.3238/arztebl.m2025.0166

On behalf of the authors

Dr. med. Flavio Gössi

Prof. Dr. med. Sabina Hunziker

Medizinische Kommunikation/Psychosomatik und Innere Medizin

Universitätsspital Basel, Schweiz

Conflict of interest statement

SH received study support from the Gottfried Julia Bangerter-Rhyner Foundation, the Swiss National Science Foundation (SNSF), and the Swiss Society of General Internal Medicine (SSGIM) (references 10001C_192850/1 und 10531C_182422).

FG declares that no conflict of interest exists.

References

1. Gössi F, Becker C, Gross S, Arpagaus A, Bassetti S, Hunziker S: Communication on rounds: The role of rounds culture and communication in patient care and teaching. Dtsch Arztebl Int 2025; 122: 362–70.

2. Houchens N, Engle JM, Palanjian R, et al.: Effect of clinician posture on patient perceptions of communication in the inpatient setting: A systematic review. J Gen Intern Med 2024; 39: 3290–8.

3. Iyer R, Park D, Kim J, Newman C, Young A, Sumarsono A: Effect of chair placement on physicians‘ behavior and patients‘ satisfaction: Randomized deception trial. BMJ 2023; 383: e076309.