As a physician, I have many responsibilities. The most obvious responsibility is to the patient but I am also very involved in responsibility to the patient's family, to the community I serve, to the public and to the profession. All of these responsibilities are often addressed together but occasionally there can be conflicts among all of these commitments. For that reason, and many others, it is essential that my relationship with patients is a two-way commitment that is based on trust, respectful communication and honesty.

From the beginning of my journey into medicine, my patients have been teaching me how to be a better physician and a better partner in the patient-physician relationship. So what I am going to share in this Physician's Corner is what they were willing to share with me about what makes up a medical home for them that is relationship centered.

First, they have asked me to be honest with them. To tell them what I am thinking and why I think this or that recommendation for their health is important. Most patients want to know the truth without a lot of sugar-coating and they want to know how we (emphasis on the 'we') are going to approach the issue. Whether it is something as straight forward as health prevention measures (exercise, healthy diet, immunizations, healthy habits, etc.) or facing the difficult decisions concerning cancer therapies or family problems; patients want to know what you think they should do next but they want to make those decisions in collaboration with their physician.

Second, patients want to look at the patient-physician relationship as a partnership. We each have our responsibilities and we need to be open and honest with each other if some of those responsibilities are not being met. But the discussion about unmet responsibilities needs to be done in a manner that is collaborative, not accusatory. Maybe you really wanted to quit smoking and you did quit and then you lost your job. Quitting smoking takes time, commitment and the knowledge to quit that addiction. But losing a job is an emotional roller-coaster and to get back on track both of us need to be committed to that goal without recriminations and without blame. Relationship centered care means caring for the relationship in a way that leads to a healthy patient.

The third essential is respect. As physicians and patients, we come from a variety of backgrounds. No particular culture, ethnic background, religion, education or heritage has a corner on being the best. Respecting each other simply takes acknowledging the vital role each plays in the relationship and respecting the human being that is the patient and the physician. Talking respectfully to each other on all visits, trying to understand various points of view and asking questions of each other that clarifies issues is all part of the respectful nature of this relationship. What physicians try to remember is simply that often a patient comes into the office when they are sick and when you are sick sometimes things are said and done that are not respectful of the physician. On the other hand, physicians are human beings, too. So we can have a difficult day and find ourselves stressing the relationship. When the patient and the physician respect each other, bad days are allowed and short tempers are forgiven. But again it is a two-way street and, when you include all members of the healthcare team, in can be a many-way street.

The fourth thing that patients have taught me over the years is how they like to be seen by their physician as multi-dimensional. They don't want to be defined by their disease, by their occupation, by their age, by their gender or any other single focus. They want to be treated in mind, body and spirit and in light of their many dimensional lives. That is probably why I enjoyed house calls so much. There I would see pictures of their wedding day, their relatives, the trips to other countries and all of the treasurers of their lives. I better understood what was important to them and what was not. But, more often than not, when an elderly patient died and I went to the funeral home; I would find out things I never knew about them, other facets of their lives that we hadn't explored. Even at the end, there was something to learn.

One more thing before I close this essay (but I will definitely continue with lessons from my patients in April), and that is simply that patients ask us to care about who they are as human beings and to be compassionate in our everyday approach to their lives. To hold their hand, to give a hug at the end of the visit, to understand when things aren't going right and to truly care about each person...that is what it takes to be a physician. It isn't a lot to ask but it means the world to those we serve.