"Physicians are increasingly challenged to provide high-quality care in the limited amount of time allotted for patient visits, and insufficient time with patients is frequently cited as a major cause of poor communication. Researchers report that building a rapport, collaborating on an agenda, and acknowledging the social and emotional concerns of patients can improve quality of care and efficiency, irrespective of the visit length.

Monitoring cues from patients is very important, and acknowledging these cues may allow the physician to manage time and provide healing from suffering. Understanding patients' perspectives on their illnesses, such as beliefs about cause, treatment approaches, quality-of-life priorities, and the side effects of treatment, will help providers create plans that are more likely to fit patients' situations and preferences.

Essential Components: Build the relationship, open the discussion, gather information, understand the patient's perspective, share information, reach agreement on problems and plans & provide closure.

These components focus on the caring and trust required in relationships between physicians and patients, so that ideas and decision-making can be shared when developing the visit agenda, and discussing the nature and meaning of disease, illness, and treatment options. Studies demonstrate that although relationship and communication skills can be taught to physicians, 1 or more of these essential elements are absent in most primary-care encounters.


A strong physician–patient relationship is essential for effective clinical encounters. A warm greeting, eye contact, a brief nonmedical interaction, or checking on an important life event can build rapport in less than a minute.
Mindful practice Attentive observation of the patient and of the physician's own thought processes can guard against cognitive shortcuts and physician domination of the agenda. Being present and critically curious can prevent the premature closure of a topic.

Ptients often want to know their prognoses, and these are not commonly discussed. When these skills are used in face-to-face encounters, they can create trust and understanding, which can, in turn, increase the willingness of patients to work with an expanded healthcare team in person or by telephone or e-mail."

Arch Intern Med. 2008;168(13):1387-1395.