For centuries the clinician-patient relationship could be described as autocratic, meaning the doctor/therapist was the “dictator” and would simply give orders to the patient, who was to be an obedient server. There is no question that this autocratic relationship is shifting to be more of a partnership between the patient and the clinician. This partnership is paramount to the building of therapeutic alliance (TA).


There is now growing evidence that the strength of the TA between the patient and the health care provider determines patient satisfaction, adherence to medical treatments and the perceived quality of care they are receiving.


What factors determine the patient perceptions of a clinician’s empathy?


1) Time spent with the patient: Longer time is associated with greater TA


2) Number of social touches: Two seems to be ideal, more than that appears to have a negative effect


3) The percentage of time spent having eye contact: This was of greater importance during short visits


A poor physician communication skill was the number one reason given by patients who admitted to either changing or were considering changing their physician (Cousins 1985).


References: Montague E. Et al. Nonverbal Interpersonal Interactions in Clinical Encounters and Patient Perceptions of Empathy. J of Participatory Med Vol. 5, 201; August 14, 2013

Cousins N. How patients appraise physicians. The New England journal of medicine. 1985;313(22):1422.

Non-verbal Communication

Iatrogenic 2
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