Welcome to the latest essay in our “On Healing” series, where Dr. Wayne Jonas explores whole person care and the deeper dimensions of healing.Relationships and Healing
In modern medicine, we often focus on pills, procedures, and protocols. Yet beneath the surface of every successful treatment lies something more difficult to measure but just as powerful: human relationships.
As a family physician for decades, I’ve witnessed firsthand how healing doesn’t happen in a vacuum. Rather, it occurs in the context of trust, connection, and continuity. Relationships aren’t just supportive—they are therapeutic and salutogenic (health creating). They not only help people tolerate illness but create whole person healing and health. Here, I want to share three stories about how I’ve seen this work and discuss how it can work for other patients and clinicians.
How Trust Led to Medication Adherence
My patient James, a 42-year-old man living with HIV, had a long history of intermittent adherence to his antiviral medications. When he was first diagnosed, he tended to miss appointments and didn’t take his medications regularly. Of course, this led to a dangerously low CD4 count.
Over time, however, I watched James build a healing relationship with his primary clinician. She not only cared for his physical health but acknowledged his mental and emotional needs in regular conversations, shared decision-making, and text check-ins. Slowly, James began to trust her. As he did, he became more diligent about taking his medications and attending appointments. Within a year, his viral load was undetectable. When asked what changed, he said simply, “She saw me as a person, not a patient.”
Adherence to prescribed medications is only around 50% for many conditions. In my practice, I have seen that compliance issues often stem from a lack of trust or engagement between patient and clinician. In other words, it isn’t enough just to prescribe the right medication. We need to learn what matters to our patient, whether they understand the treatment plan, and the barriers—financial, mental, emotional—they face. When we take the time to understand, adherence often follows.
How Purpose Helped Heal Chronic Pain
I once treated a woman who had chronic pain, constipation, depression, and anxiety. She had spent years cycling through medications, procedures, and counseling with little improvement. In addition, she was living in an abusive relationship. At one of our visits, I asked her, “What matters most to you?”
What emerged was, “I love writing.” She had wanted to write a book and had even started it a couple of times. She had multiple reasons why she couldn’t complete it—her job made it impossible, her family was “a mess,” she was dealing with other issues, and so on. At her follow-up visits, I started to ask, “How is the novel coming?” After a few visits, I was delighted to hear that she had purchased a new laptop, outlined the book, and begun writing again. As her novel developed, she began to sleep better at night. Her stress levels went down. Her whole life began to change, and eventually she gained the confidence to leave her unhealthy relationship.
In moving toward what mattered most to her, my patient began to change the underlying psychosocial factors that had been complicating her physical symptoms for years—something the previous focus on anxiety and sleep medications had never accomplished. This case taught me how relationships that honor a patient’s deeper aspirations can catalyze healing beyond what conventional medical approaches can achieve.
How a Personalized Plan Provided Safety in the Pandemic
During the COVID-19 pandemic, I cared for a woman in her late 80s who lived in an assisted living center. She had multiple chronic conditions: high blood pressure, arthritis, diabetes, and most concerning, fairly advanced congestive heart failure. Typical of people with this condition, she had an enlarged heart and breathing was sometimes difficult.
When my patient experienced severe shortness of breath at the assisted living center, their protocol was to call 911 and send her to the emergency department. This posed a potentially fatal risk during COVID, when hospital resources were strained and visitors were not allowed. When elderly, frail patients are hospitalized without family support, their condition often deteriorates rapidly. Because of our established relationship built over years of home visits and during the pandemic, we interrupted this dangerous cycle.
I gave my patient a medical alert wristband with instructions to contact me immediately if she arrived at the emergency department. We repeatedly practiced what she should say: “Call my family doctor right away.” This relationship-based intervention allowed me to speak directly with emergency staff, often preventing unnecessary admissions and tests by clinicians who had never met her and were alarmed at her frailty. I could explain her complex history and baseline status and often manage her care remotely by prescribing diuretics when needed. This approach saved her from the trauma of unnecessary care and likely saved her life during COVID.1
Knowing my patient personally, understanding her needs, and having relationships with her children who shared in decision-making helped mitigate the stress, cost, and complications of her congestive heart failure. This is the power of relationship-centered care—it creates a web of knowledge and trust that protects patients from the hazards of fragmented health care.
Relationships That Heal: Historical and Theoretical Foundations
The centrality of relationships in healing is not a new idea. In fact, it underlies the creation of family medicine as a distinct specialty. The concept was formalized in part by George Engel’s biopsychosocial model, proposed in 1977 in an article published in Science.2 Engel argued that illness is best understood through the complex interaction of biological, psychological, and social factors.
Today, I often expand this to what I call the “biopsychosocialspiritual model,” recognizing the role that meaning and purpose play in health. This holistic perspective laid the groundwork for the field of family medicine in the 1960s, distinguishing it from specialty care by its orientation toward whole person care, family context, and the doctor-patient relationship over time and generations.
The development of family medicine addressed a critical gap in health care systems: the need for clinicians trained to see patients in their full context, not just as collections of symptoms or organ systems. This commitment to wholeness finds support in research dating back decades, including the Harvard Study on Longevity, one of the longest-running continuous studies on factors that lead to living a long life.3
This remarkable research has followed participants since 1938 and is now tracking the third generation of subjects. What are the factors that lead to a long and healthy life? We might expect them to include healthy diet, regular exercise, or avoiding tobacco. But the factor that outweighs all others, including genetics, is relationships—whether people have important connections in their community, family, friends, and people with whom they interact regularly and meaningfully. More than any other physical factor, relationships predict health and longevity.
Dr. Starfield’s Legacy: Primary Care as Relationship-Centered Care
Dr. Barbara Starfield, a visionary in health systems research, offered empirical confirmation of what many of us clinicians have observed in practice: strong primary care systems, anchored in relationships, correlate with better health outcomes, fewer disparities, and lower costs. Her framework emphasizes four key features: first-contact care, continuity, comprehensiveness, and coordination.5 At the heart of each is the relationship between patient and clinician.
Continuity—the ongoing connection over time—builds trust. Comprehensiveness and coordination mean patients don’t need to navigate a fragmented system alone. Starfield showed that such relationship-grounded care is not only compassionate but more effective and efficient. Her research convincingly demonstrated that this approach improves outcomes, reduces costs by 10-15% compared to less comprehensive care models, and improves patient satisfaction.6 A Stanford group funded by the Peterson Foundation came to similar conclusions when they examined high-performing primary care clinics around the United States. Their finding? It’s about relationships.
The Evidence Today: Dr. Sinsky’s Report
Some of the most current and compelling evidence on the economic and clinical benefits of relationship-based care comes from research spearheaded by Dr. Christine Sinsky.8,9 This sweeping review of the data on relationships in health care synthesizes findings from diverse settings and demonstrates that relational continuity reduces hospitalizations by 15-20% and lowers mortality rates.
Moreover, the report notes that clinicians in relationship-centered practices experience higher job satisfaction and 30% less burnout. These benefits are reciprocal: patients in such systems are more engaged, more adherent to care plans, and report 25% higher satisfaction with their care.[10] The data clearly show that investing in relationship-centered care creates positive feedback loops throughout the health care system.[10]
Implementing Relationship-Centered Care
Translating this knowledge into practice requires addressing several key challenges.
Time and continuity
Relationship-based care requires protected time and consistent patient-provider connections. Payment models that prioritize volume over value undermine the development of healing relationships. When clinicians are forced to see patients every 15 minutes with no time to truly listen, the foundation of relationship-based care crumbles.
Education in community settings
Medical education must shift beyond hospital-based training. There’s a famous quote attributed to Sir William Osler that captures this perfectly: “In the hospital, diseases stay and people come and go. In the clinic, people stay and diseases come and go.” This fundamental difference must shape our educational approach.
Technology: Friend or foe?
When deployed thoughtfully, such as by using AI scribes to capture notes during conversations, technology can enhance relationships rather than diminish them. Systems that surface key patient priorities and goals at the start of visits facilitate deeper connections.
The Core Characteristics of Healing Relationships
For relationships to facilitate healing, they must embody four key qualities:
- Trust: Built through active listening and demonstrated competence
- Mutuality: Patients as active partners in care decisions
- Consistency: Regular contact creating psychological safety
- Comprehensiveness: Addressing physical, emotional, social, and spiritual dimensions
The VA’s Well-Being Signs demonstrate effective measurement of these qualities through functional assessments and relationship inventories.
Global Perspectives
Relationship-centered healing transcends cultural and resource boundaries. While traveling with my daughter in Tanzania, I met a woman with advanced rheumatoid arthritis who left an indelible impression on me. Despite the severe condition that confined her to a hard pallet on the floor, she was remarkably cheerful and positive. She couldn’t rise from her makeshift bed, yet her spirit was undeniably vibrant.
What struck me most was how she was surrounded by family members who lovingly cared for her. She remained fully included in the daily life of her family’s home—conversations flowed around her, children played nearby—despite her physical limitations. When I asked the nun who had escorted me to her home what interventions we could provide, the answer was revealing: “We could get a mattress for her!” There were no advanced medications available, no surgeries, no elaborate medical care—but we could make her more comfortable.
This woman’s wellbeing didn’t come from the relationship between her and a clinician—it flowed from the web of relationships around her that provided meaning, connection, and dignity. This experience taught me that healing relationships extend far beyond the clinical dyad to include family, community, and social systems that provide purpose and support even when medical options are limited.
Conclusion
In medicine, we rightly strive for precision, but we must also remember the power of presence. Relationships are not ancillary to healing—they are at its core. From the patient managing chronic illness, to the woman who found healing through reconnecting with her passion for writing, to my patient with heart failure who stayed safe during a global crisis, stories of healing invariably involve people who care and connect.
The research confirms what these stories illustrate: relationship-based care leads to better outcomes, lower costs, and more humane medicine. If we are to build a health care system that truly heals, we must invest not only in technology and therapies but in the relational fabric that makes them work.
This requires policy and payment changes that allow clinicians sufficient time with patients. It demands educational reforms that move training into community settings where relationships flourish. It calls for technological adaptations that enhance human connection rather than diminish it. And most importantly, it requires that we prioritize and protect the sacred space where healing can flourish.
Healing emerges out of relationships, but only if they have certain characteristics: trust, mutuality, consistency, and comprehensiveness. By designing health care systems that nurture these qualities, we can transform medicine from a series of transactions into a healing journey—one where both patients and providers thrive.
References
- Sinsky CA, Shanafelt TD, Ristow AM. Radical Reorientation of the US Health Care System Around Relationships: Rebalancing the Transactional Model. Mayo Clin Proc. 2022 Dec;97(12):2194-2205. doi: 10.1016/j.mayocp.2022.08.003. Epub 2022 Oct 4. PMID: 36207152.
- Bazemore A, Petterson S, Peterson LE, Phillips RL. More comprehensive care among family physicians is associated with lower costs and fewer hospitalizations. Ann Fam Med. 2015;13(3):206-213.
- Engel GL. The need for a new medical model: A challenge for biomedicine. Science. 1977;196(4286):129-136.
- Waldinger R, Schulz M. The Good Life: Lessons From the World’s Longest Scientific Study of Happiness. Simon & Schuster; 2023.
- Bechel DL, Myers WA, Smith DG. Relationship-centered care in health: A 20-year scoping review. Patient Experience Journal. 2016;3(1):130-145.
- Starfield B. Primary care: Balancing health needs, services, and technology. Oxford University Press; 1998.
- Starfield B. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457-502.
- Peterson Center on Health Care, & Stanford Medicine Clinical Excellence Research Center. America’s Most Valuable Care: Primary Care; 2014. https://petersonhealthcare.org/americas-most-valuable-care
- Toll E, Sinsky C. Trust between patients and clinicians: An overlooked and affordable approach to improving US health care. Am J Manag Care. 2023;29(1):e1-e3.
- Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med. 2014;12(6):573-576.
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