The time crunch and complexity of care has left the doctor-patient relationship in tatters. And this makes a difference. Numerous studies have found a link between how well the doctor and patient communicate and the patient’s sense of well-being, his number of symptoms, and his overall health. For example, Canadian researchers audiotaped more than 300 office visits with 39 different primary-care doctors. Patients were then asked to rate the visit in terms of the relationship with their doctors. Then the researchers looked at how the patients’ health fared over time. When patients reported that their doctors focused on their feelings and worries and listened to them carefully, they not only felt better but objective measures showed they had fewer symptoms of disease.

Good doctors have always known this, says Howard Brody, but only in the last few years have researchers begun to tease apart the particular ingredients that are necessary for this “therapeutic relationship,” as it’s called. Patients need a doctor who listens, he says, “and who offers an explanation for what’s happening that makes sense to them.” Truly caring about the patient is also crucially important, and touching the patient during a physical exam helps convey that concern. Finally, he says, “The doctor should help the patient feel more in control of what’s going on.” When some or all of these ingredients are missing in medical encounters, patients may undermine their own health. Doctors often complain about “uncompliant” patients who stop taking their medications or who fail to make recommended changes in their diet or bad habits like smoking, but the problem really may lie with the doctor-patient relationship.

James Rickert, an orthopedic surgeon in Bloomington, Ind., says he learned this lesson five years ago when he suffered a relapse of non-Hodgkins lymphoma, a potentially fatal form of cancer. His oncologist told him there were two types of bone-marrow-transplant treatments for his relapse, both of which posed serious, sometimes even fatal, side effects. The doctor strongly recommended one type, but when Rickert asked him to explain his reasoning, the oncologist seemed unwilling or unable to elaborate.

“I walked out of his office very upset,” says Rickert, now 50. “He either wouldn’t or couldn’t explain, even with me being a doctor. Because of that interaction, I didn’t have the amount of trust I should have.” Rickert ultimately decided to go with the recommended treatment, but he began seeing a different doctor, whom he likes and trusts. After being hospitalized twice last spring with pneumonia that was caused by a drug he was taking, he emailed his new doctor to tell her he wanted to go off the medication. “She called me immediately and explained why I needed to stay on the drug,” says Rickert. He stuck with his regimen and has recently been able to taper the dose without another case of pneumonia.

This therapeutic relationship matters even when the patient isn’t really ill. Many patients, says Vikas Saini, a cardiologist and president of the Lown Cardiovascular Research Foundation in Brookline, Mass., are more anxious than sick, but sometimes “the worried well” can be the most difficult to reassure. That’s partly because Americans have come to equate feeling cared for with being given a test or prescribed lots of medications and procedures. “More care is better in the patient’s mind,” says Saini, and more technological care is best. Any effort to dissuade patients that a drug or test is unnecessary is often interpreted as a sign of a neglectful and uncaring doctor.

“If a patient comes in complaining of vague chest discomfort, saying her heart is ‘fluttering,’ I can often tell there’s nothing seriously wrong in the first few minutes,” says Saini. Even so, he may spend an hour carefully taking the patient’s history and doing a physical exam before attempting to calm her fears. “As a patient,” he says, “if I’m not sure you’ve listened to me, how can I trust that you’re giving me the right drug or the right test?”

despite all the problems, people are not willing to change doctors or even to criticize the medical profession. In poll after poll asking respondents whom they trust, doctors consistently rank at or near the top. In a series of focus groups led by GYMR Public Relations for the Robert Wood Johnson Foundation, patients repeatedly said that even if their relationship with their doctor was poor, they would not want to switch physicians.

The good news is policymakers and doctors have begun to recognize the importance of the therapeutic relationship and devise ways to mend it. Medical schools have traditionally put a premium on recruiting students who test well, but testing well doesn’t guarantee the social skills to listen to patients, says Michael Wilkes, a primary-care physician at the University of California, Davis’s School of Medicine. “Students who do well on tests and exams don’t necessarily make good doctors,” he says. Twenty years ago, Wilkes introduced the “Doctoring Curriculum,” a series of courses and seminars that teaches med students to communicate with patients, use critical reasoning when looking at medical studies, and help their patients make decisions about the care they would prefer at the end of life. Most medical schools have not adopted this method, but a few are starting to recruit a different breed of student using a series of short interviews designed to test prospective students’ people skills (think speed dating, but without the romance).

Also underway are efforts to reach doctors who are already in practice. A centerpiece of the Patient Protection and Affordable Care Act of 2010 would offer primary-care physicians a little extra pay to act like the quarterback, keeping track of and directing all the care patients get from their various doctors. This model, says the University of California’s Bodenheimer, looks very different from the average practice of today. Doctors work with teams of other clinicians, including physician’s assistants, nurse practitioners, pharmacists, and care coordinators, leaving doctors with more time to spend with the patients who most need them. “Fifty percent of what we [doctors] do can be done by someone with a lot less training,” he says. This so-called medical home model also encourages doctors to use the phone and email to communicate with patients when they don’t need to come in—which can free them up to spend quality time with their patients when they do.

Another potentially transformative effort to improve doctor-patient relations is “shared decision making,” a formal process for helping patients understand treatment options. For example, women who have been diagnosed with early-stage breast cancer can choose lumpectomy with radiation or mastectomy, surgical removal of the entire breast. Each has pluses and minuses, and patients need to understand the tradeoffs. A brochure or video, called a patient decision aid, can help, but the patient often needs a good communicator, a doctor or other clinician, who can guide her through the choice.

In an age when surgeons use robots and medicine is growing increasingly technological, time turns out to be one of the doctor’s most precious gifts to patients. Just showing up in the hospital room or calling a patient at home a couple of times during the week after an office visit can make a big difference in how patients feel, says UC Davis’s Richard Kravitz. With a few small gestures, even a fraught relationship can be smoothed out. After that, he says, “You and the patient are bonded forever.”