The chair sign

I have noticed in the past that if I do not remain visibly near my consulting room door when I call patients they go astray with regular monotony. I have even observed one patient stand up, turn 180 degrees, and head out of the building. By way of welcoming in new patients I ask them “to come and take a seat.”

I was therefore a little taken aback a year ago when one patient proceeded quite casually to sit in my seat (a rather comfortable swivel chair) and explain what he had come to see me for. The patient had a flat affect and a history of psychosis so I conducted the rest of the consultation from the more miserable and tatty chair I usually reserve for patients.

Six weeks later a well dressed, polite patient said, “Good afternoon doctor,” walked straight to my chair, and sat down in it comfortably. I wondered if this was a joke. I made a lighthearted reference to the large computer needed for printing prescriptions, the desk, prescription pad, and records. He just smiled. I asked him if he would prefer to sit in the other (tatty) chair. He looked disappointed. I lost my temper and demanded my chair back. He acquiesced. He had come in for a repeat prescription of antipsychotics and sleeping tablets.

Sitting in the doctor's chair by mistake can be a bit embarrassing for patients if it is not handled sensitively. I decided to conduct an observational study on new patients who used my swivel chair. Patients who first asked me where they should sit were excluded, along with those 3 year olds who were not big enough to climb up. Over the next nine months, eight new patients came in and sat in my chair. Seven had a diagnosis of schizophrenia or chronic psychosis and were receiving antipsychotic medication. The remaining patient consulted for a minor postoperative complication but had no psychiatric history. (One 5 year old also met the admission criteria but he needed the chair to check if the computer had the Lion King game on it.) I found the result of the postoperative patient a little disappointing and at this stage I resolved to discontinue the study. This week, however, a young man walked in, impeccably dressed and looking very well. He sat straight down in my chair and looked at me. “How can I help?” I asked from the tatty chair with a feeling of resignation. “I'd like some more olanzapine,” he replied.

I admit that I am sometimes too hassled to read thick sets of notes before calling in new patients. Patients new to the practice will initially not have any records (until they arrive from the health authority). Either way, I was blinded to the diagnoses and drug histories before these patients sat down. Eleven patients have used my chair in the past year and 10 of these (91%) were taking antipsychotic medication. They were all men. The chair sign may be associated with psychiatric illness. It needs to be formally validated. We could study all new patients at the practice and in different consulting rooms. If all the partners were involved and were properly blinded to all patients' diagnoses and drug histories our practice manager could be overwhelmed with complaints. I worry about the long term implication of my findings. After all, I often walk into consulting rooms and sit in the comfortable looking chair.