Rule 2: Sit down when you talk with patients
A comedian and a prizefighter show us how powerful sitting can be.
Standing vs Sitting
When’s the last time you’ve sat and had a meaningful interaction with a stranger?
Probably not recently, maybe never. Though we stand among strangers all the time—on the subway, at the grocery store, in line at the coffee shop—but never with them. We don’t sit with people we don’t know; we stand. Put differently, we sit with people with whom we have a relationship. This is the meaning behind Dr. Meador’s second rule: that sitting conveys relationship. Since doctor and patient share a special bond, it is best for a doctor to convey that by sitting.
To dig into this, let’s look at its negative. What if Meador’s rule was stated as “don’t stand when talking with patients.” It implies that there is a meaningful difference between sitting with someone compared to standing. This is especially true in the case of a doctor visit, where one person (the patient) is always sitting or lying in bed… never standing.
Without meaning to, we create a power dynamic when speaking to a patient while standing. We create an environment where it is easy to slip into lecture mode, with patients being spoken down to (both literally and figuratively). This is especially true with sick, ailing, and anxious people lying in hospital beds. Even if our intention is to build rapport and not condescend, standing lowers the threshold to be perceived otherwise. Speaking as a former patient, the natural tendency is to feel “loomed over,” which isn’t exactly caring or inspiring. In fact, it’s intimidating. It can be claustrophobic.
In this context: where sitting builds, standing undermines.
Standing and Sitting
To see this dynamic in action, let’s turn to the world of cinema.
The Godfather Part II is largely considered one of the greatest films ever made. Al Pacino, Robert De Niro, Robert Duvall, and John Cazale put on an acting masterclass. The film score is iconic. The cinematography is foreboding and the set design is visionary. With that being said, I want to use one particular scene to flush out this rule, a scene in which two characters talk.
One standing, one sitting.
I’m not going to set up the scene. What I’d like you to do is first watch the scene without sound. What can you glean from the characters’ interactions? What is their relationship like? How do their positions in the room inform their relationship? Who do you feel has the authority? After watching it without sound, watch it again with sound. See how accurate you were. (Warning: SPOILERS for a 50 year old movie that you should’ve seen already because it’s fantastic).
In a nutshell, Michael and Fredo are brothers. Michael is younger and runs the family criminal empire. Fredo worked with a competing criminal family and betrayed Michael. Underpinning Fredo’s betrayal is his anger about being “passed over” for promotion within the family.
Plot aside, a clear dynamic is conveyed from Michael standing and Fredo sitting. Michael has authority… Michael is the authority. Michael, not facing Fredo for much of their interaction, clearly wants nothing to do with him. A fact made plain when he eventually disowns him. By standing, Michael asserts his authority with ease – he dominates the conversation and, by extension, his brother.
Now, replace the mafia don and his brother with a doctor and their patient.
There is no teamwork in that dynamic. There is no empathy expressed. There is no care given, no counsel offered. There is no level playing field or shared perspective. There is only authority. And though doctors do have authority because of our professional knowledge and skillset, we must wield it in service of our patients, not in service of our position. In other words, physicians function best relationally, NOT positionally.
Sitting and Sitting
What is it about sitting that makes it better than standing?
We can find the answer in a podcast called “This Past Weekend.” Hosted by a comedian named Theo Von, This Past Weekend has evolved into a podcast known for off-the-wall, funny, and sometimes surprisingly insightful conversations. Theo is known for his quick wit, imaginative jokes, and vulgar humor. He’s had a variety of guests on his podcast, ranging from Tony Robbins to Hulk Hogan to simply “a coroner.” One such guest was a man named Sean Strickland, a mixed martial artist and former UFC Middleweight champion.
Strickland is a controversial figure in the professional fighting world. He is politically incorrect and unabashedly so. He has gotten into public brawls. He is loud, brash, vulgar, and his conversation with Theo does not disappoint. Suffice it to say - and Strickland himself admits this - he is volatile.
But is a person just naturally volatile? Maybe… but unlikely. In an unforeseen turn of events, Strickland opened up about his childhood while on the podcast. Strickland’s less-than-rosy upbringing is common knowledge – he has discussed his abusive father before – but with Theo he did so in more detail. The upcoming video clip serves as a comparison to the previous one and it hits harder because it’s actually real.
It also hits hard for its content. I will say here that there is inappropriate and harsh language used by both parties. Additionally, the topics discussed are just as harsh, if not more so, than the language used. In this sixteen-minute clip, there are graphic accounts of domestic abuse and child abuse. There are mentions of pornography use, racist acts, and hate crimes. Additionally, Strickland himself admits to suicidal, homicidal, and patricidal ideations. This is not a discussion for the faint of heart. Viewer discretion is advised.
Reading this, you may be wondering why I'm including the clip if it’s so graphic. Let me explain my reasoning.
A doctor’s role is to combat disease, of which the worst possible outcome is death. I think we can all agree that death and disease can be categorized as “bad.” Therefore, we can describe a foundational part of a physician’s role as attempting to meet the “bad” with the “good.” This is vague and difficult to grasp, so an appropriate analogy would be to “bring light to the dark.”
Side note: this isn’t something that’s ascribed only to physicians but to people who wish to be good and effective citizens in society.
If we are to engage with the darkness, then we must first be willing to acknowledge its existence. This means jumping into situations that are uncomfortable, unappealing, and uncertain. This means being brave, holding tight to the light, and wading into the darkness with the ultimate goal of healing. Such is the conversation between Theo Von and Sean Strickland, and I put forth here that it’s made possible by sitting.
As you watch it, I will point your attention to how Theo conducts the interview around the 8:30 mark. Though I encourage you to watch the entire clip, if you wish to avoid as much abuse and hardship as possible, tune in from 8:30 to around the 10:30 mark.
There are so many takeaways here…
The fact that Strickland, a hardened fighter, weeps at his unbelief in God
The rotten fruits of perverted fatherhood brought on by rotten men
The trauma behind Strickland's volatile, crass, and nonsensical behavior
The admirable self-awareness and vulnerability of Strickland
The non-judgmental demeanor of Theo Von that brings forth Sean’s vulnerability
The willingness of Theo to go with Sean to some very, very dark places
All of these are true, but the point I wish to emphasize here is that this conversation would NOT have been possible had Theo Von been standing. Remember back to our previous clip with Michael and Fredo. That dynamic, the one with offset perspectives, closes any potential for this level of vulnerability. And, in the medical field, vulnerability is needed because it opens the door to healing.
Sitting promotes familiarity. Familiarity communicates security. Security begets vulnerability. Sitting with Sean, Theo beautifully expresses this concept with one little sentence: “We don’t have to talk, man; I can just sit here with you for a minute." Those few words give Sean the time and space to process his emotions, gather himself, and dive deeper into his own problems—the darkness, so to speak. In doing so, he brings it to the surface, shines light on it, and, as a result, he can begin to heal. We can’t heal if we don’t know from what we need healing.
Closing Thoughts
As I was editing this essay, there was a song playing over and over and over in my head. This happens to me sometimes, but not often. The song was “Stand By Me” by Ben E. King. It’s linked below.
I didn’t understand why it was stuck in my head until I began to sing along.
Drawing on an old gospel hymn, King sings about how he won’t be afraid in the most dire circumstances - in darkness, when the sky falls, when mountains crumble - as long as “you stand by me.” Now in starting from a book, jumping to film, wading into podcasting, and ending with song, the meaningful relationship between sitting and standing was finally made clear to me.
By being willing to sit with people, we also show that we are willing to stand with them.
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Thank you for reading this essay and many thanks to Dr. Meador and his incredible insight. If you enjoyed this article please consider supporting my work by liking, sharing, and subscribing!
Best,
Tyler
Another excellent article. A topic I can honestly say I've never thought about, and yet, so much truth, inspiration, and wisdom in changing one simple body movement! Only proves we should all be a bit more "in the present" during these hectic, anxious, controversial, and difficult lives we all live. Enjoy more special moments with a new acquaintance , or long-time confidante and friend.
This is a heavier article than some of your other blogs that have a more "entertaining" feel...but for those who go the distance and read to the end, you will not be sorry. What a fantastic closing line! There are many hurting people in this world, and trauma of all kinds that need time, understanding and healing. Thank you for the great message that we should remember to be a "light" in this world. It's something we can all try and do. Thumbs up for the Matthew reference.