Blog | Thursday, September 6, 2018

A scientific reason why 'the Right' is the best approach


I feel honored to have gone to medical school in the United Kingdom. It really wasn't all that long ago, and while I cannot speak for how the system may have changed over the last few years, I do feel somewhat blessed that I was trained in a somewhat old-fashioned way—that I'm sure many Americans of my generation would think sounds rather stuffy! My clinical rotations were dominated by old-school professor Attendings who would truly put us to the test. They would make absolutely sure we knew our stuff, coached us thoroughly on how to do a proper history and physical, and would be very blunt with us if we stuffed up (we dare not).

I even remember some older physicians who would literally man-handle any of the males who were rounding if they ever saw us slouching or putting our hands in our pockets, and literally grab our arms and back gently, tell us to stand up straight and look professional!(1) I can imagine people reading this today, might think it sounds a bit much and maybe inappropriate, but I can tell you that this was all conducted in a uniquely British stiff-upper lip and fair way, that none of us ever complained about, or were upset or offended by. On the contrary, we held our Attendings in the highest respect, and loved learning from them. I wouldn't have had it any other way.

Our clinical exams were pretty intense, as we were heavily scrutinized and tested in front of our professors. One of the things that was an “instant fail”, and a big No-No, was if we ever approached a patient from their left-hand side. This was told to us from the beginning; “Always approach from the Right”, so became a normal way to examine patients. Over the years, I've recounted to medical students and residents that I've taught, how we did things in the UK. I consider it standard practice to always be on the right side of the patient, it just feels normal, and have continued to do so—whether I'm in the hospital or in the office. I believe it is taught in the U.S. as well, but not in as strict and unforgiving way.

There is however, a scientific reason that I only recently discovered that may back up this convention. When we listen to people, most of us by default favor our right ear. When you are struggling to hear someone, do you by default tilt your head slightly to your left, to allow sound into your right ear? The answer is probably yes. The answer is probably yes (just said that a second time in case you didn't hear—okay, okay, really bad joke).

There is a reason why we may do this. Our right ear feeds to the left side of our brain, which for most of us is the side involved in linguistic processing and logic. There have been fascinating studies done that have shown that people are anything up to 40% percent more likely to remember what you say, if you speak into their right ear(2) (lots of people may want to know this for especially their spouses and children). Other research conducted in a nightclub, showed that people were also more likely to follow instructions and be persuaded to do a favor for them (unfortunately in this case give them a cigarette) when asked in their right ear versus their left ear(3). You are therefore, also more likely to be persuasive if you do this one simple thing. By the same token, if you really want to hear what the other person is saying when they are communicating with you, continue to tilt your own head slightly to the left.

Well, surely you can see now why this is important for a physician. We want to give ourselves every advantage possible. Interestingly, whether by accident or design, most exam rooms are already set up so that the doctor is facing the patient from their right anyway.

I encourage you to all think about this more in your future interactions.

Disclaimer: there is no magic bullet here either professionally or personally—some people will never, ever do what you say—but life is always a numbers game of increasing ones' odds … so let's get this right.
1. Those Attendings may have also had some science backing up that insistence on standing to attention. A large body of research shows that the more upright you are, not only does it boost your own presence and communicates confidence, but also makes you more likely to remember information
2. https://www.sciencedaily.com/releases/2017/12/171206090611.htm
3. http://news.bbc.co.uk/1/hi/health/8116321.stm

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.