Being a doctor is about more than diagnosing illnesses or prescribing medications. It is about more than knowing the latest research, the right drug dose, or the most effective treatment plan. Those things matter (of course they do), but they are just part of the job description.

The reality is more human, more vulnerable, and more complex.

Imagine what it is like to sit in the waiting room before your appointment. You are holding onto questions you have been rehearsing in your head for weeks, maybe months. You are worried about the test result that came back “abnormal.” You are nervous to talk about the chest discomfort you have been ignoring. You are carrying the weight of something you have not told anyone (not even your spouse). And now, you are about to walk into an exam room and lay it all on the table for someone you may barely know.

That is a lot to ask of anyone.

I have never forgotten that reality. In every encounter, I try to remember what it feels like to be on the other side of the desk. That is why I work to make the relationship personal from the very beginning. I make it a point to know my patients beyond their charts. I want to know what they do for work, how many kids or grandkids they have, where they are from, and what their lives look like outside the exam room.

It is not about making small talk. It is about building trust.

Because here is the truth: When someone feels comfortable with you, they will open up. They will tell you the details you need to make the right decisions for their health. They will trust your recommendations, even when the news is not what they hoped for. And they will feel seen (not as a case, not as a diagnosis, but as a person).

The first 30 seconds

I believe the first thirty seconds of any patient interaction can make or break the connection. It starts the moment I walk in the door.

If I am smiling, relaxed, and genuinely happy to see them, it shows. If I greet them by name and recall something they told me last visit (maybe how their daughter’s wedding went or how they have been adjusting to retirement), they know I have been paying attention.

But if I rush in, eyes glued to the computer screen, asking questions without really looking at them, the opportunity to build that trust slips away. Patients can sense when you are just going through the motions.

I try to set the tone immediately:

• If they are nervous, I acknowledge it and make them feel safe.
• If they are in pain, I validate it before launching into the next step.
• If they are worried, I listen before I speak.
• If they are closed off, I try to break down the wall with humor, kindness, or simply patience.

Sometimes that connection happens in seconds. Sometimes it takes the whole visit. But if you get it right in the beginning, the rest of the encounter becomes easier for both of you.

Beyond the stethoscope

In primary care, these relationships can span years, even decades. I have seen patients through marriages, divorces, job changes, cancer diagnoses, recoveries, births of grandchildren, and deaths of loved ones. I have been the first person they have called with good news and the one they have turned to in moments of devastation.

But connection is not just for long-term relationships. Even in specialties where you might only see a patient once or twice, you still have the chance to leave an impression. You still have the opportunity to be the doctor they remember as the one who listened, who explained things clearly, who treated them like a person instead of a chart.

I have had patients tell me, “You are the first doctor who has ever explained it to me in a way I could actually understand.” That always stops me in my tracks. Because that is not about intelligence, it is about communication.

Honesty matters in medicine. But honesty without clarity can sound like a foreign language. I try to explain things in a way that is not only accurate but relatable. If a patient can walk out of the room and explain their condition to a friend in plain language, I know I have done my job.

The weight of expectations

Patients come to us with high expectations (and rightly so). When they walk into my office, they are trusting me with their health, their future, and sometimes even their life.

They expect me to be the expert.

They expect me to be confident.

They expect me to have the answers (or at least to find them).

But they also expect something deeper. They expect me to care.

That expectation is harder to measure, but it is every bit as important as prescribing the right medication or ordering the correct test. It is why a patient will follow through with a treatment plan (or why they will not). It is why they will be honest about their symptoms (or why they will hold back).

The trust between a doctor and a patient is not built on clinical knowledge alone. It is built on a sense of safety, respect, and genuine connection.

Seeing what they see

One of the things I have learned over the years is that patients are observing us just as much as we are observing them.

They notice how we walk into the room (whether we stand tall or slump from exhaustion). They notice if we make eye contact or keep glancing at the clock. They notice if our tone is warm or flat.

We are trained to take in every detail about our patients (their expressions, their posture, their choice of words), but we sometimes forget they are doing the same with us.

That means every visit is a two-way mirror. I am assessing them, but they are also deciding (sometimes in seconds) whether they can trust me, whether I am really listening, whether I am worth opening up to.

A lesson from the exam room

I will never forget one patient who came in for what seemed like a routine visit. She was quiet, polite, and gave short answers to my questions. Her blood pressure was fine. Her labs from last month were normal. On paper, she was healthy.

But something did not feel right.

Instead of moving on to my next patient, I paused. I asked how she was really doing. Her eyes welled up. She told me she had recently lost her husband and had been feeling completely alone. She had not planned on bringing it up (it was not on her “list” for the visit), but she admitted she did not know who else to talk to.

We ended up spending most of the appointment talking about grief, loneliness, and support systems. I connected her with a counselor and encouraged her to reach out to a neighbor she had mentioned in passing. A few months later, she came back and told me that conversation had been a turning point.

That experience reminded me that sometimes the most important thing you can do as a doctor has nothing to do with a prescription pad. Sometimes it is simply noticing what is unsaid.

The bar we set

Every patient encounter is an opportunity to set the bar for what a medical relationship should look like.

For me, that means walking in with presence, listening without rushing, being honest without being cold, and making sure my patients know I am on their side.

It also means remembering that we are human too. We have our own worries, our own fatigue, our own challenges outside of work. But when I step into that exam room, my role is clear. My patient deserves my attention, my expertise, and my compassion (no matter what is going on in my own life).

The truth in medicine

Medicine will always be about science, evidence, and skill. But the truth in medicine (the part that patients remember long after the visit) is the human connection. It is the smile, the pause, the willingness to sit in someone’s discomfort with them. It is the ability to see beyond the chart to the person sitting in front of you.

Because in the end, the best care does not just come from knowing the medicine. It comes from knowing the patient.

Ryan Nadelson is chair of the Department of Internal Medicine at Northside Hospital Diagnostic Clinic in Gainesville, Georgia. Raised in a family of gastroenterologists, he chose to forge his own path in internal medicine—drawn by its complexity and the opportunity to care for the whole patient. A respected leader known for his patient-centered approach, Dr. Nadelson is deeply committed to mentoring the next generation of physicians and fostering a culture of clinical excellence and lifelong learning.

He is an established author and frequent contributor to KevinMD, where he writes about physician identity, the emotional challenges of modern practice, and the evolving role of doctors in today’s health care system.

You can connect with him on Doximity and LinkedIn.