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INCIDENT REPORT Patient-Doctor Gets Dinged on Wards The response to the incident below was written by Jennifer Potter, HMS assistant professor of medicine at Beth Israel Deaconess Medical Center and an Academy scholar. Incident: A third-year medical student reports that the rules change dramatically between Years II and III--for example, the Patient-Doctor course is openly ridiculed. During psychiatry rotation, someone once said to her: "Oh, you have to leave to go to that 'touchy-feely' class." Response: This vignette illustrates the idea that specific focus on the doctor-patient relationship is unnecessary because it is not "real medicine." In fact, the quality of our interactions with patients provides the foundation for everything we try to accomplish as caregivers. Studies show that patient satisfaction with care, adherence to recommended treatment, and clinical outcomes themselves all depend upon physician-patient communication. The doctor-patient relationship is enormously complicated. Both physicians and patients bring multiple contextual factors--age, gender, sexual orientation, culture/ethnicity, spirituality/religion, socioeconomic class, and language/literacy--to each encounter. We have numerous responsibilities: creating an atmosphere of safety and trust; negotiating a consensual agenda for the visit; obtaining a comprehensive history that often includes sensitive information; providing culturally relevant counseling; and formulating a mutually agreeable plan of care. We have to learn to balance our wish to be warm, caring, and connected with our need to maintain professional distance in the face of hearing intimate details about patients' lives and performing physical examinations that breach usual social boundaries. We must also develop the capacity to set limits with difficult patients, to deliver bad news, and to cope with the death of patients. Last but not least, we are forced to attempt all of this under serious time constraints. It is not surprising that we often prefer action-oriented tasks, such as those found on the wards during the transitions from Year II to Year III and from Year IV to internship. No wonder we are tempted to ridicule, and thereby distance ourselves, from emotionally difficult challenges. However, we will grow and succeed as empathic clinicians only if we make a lifelong commitment to give our doctor-patient interactions the attention they deserve.