Small talk, big impact: Putting relationships at the center of orthopaedic care

Editor’s note: The Final Cut is a recurring editorial series written by a member of the AAOS Now Editorial Board.

Orthopaedic surgeons are familiar with the concept of patient-centered care, which respects patient wishes and goals while closely involving them in the decision-making process. However, there is another paradigm they may not be aware of: relationship-centered care (RCC).

All relationships in an orthopaedic practice are of critical importance: the physician-patient relationship, the relationships between the orthopaedic surgeon and colleagues and staff, and even the relationship with oneself. RCC, first described by the Pew-Fetzer Task Force on Advancing Psychosocial Health Education and further defined by Beach et al, acknowledges the importance of relationships and provides a framework to incorporate them into practice.

RCC has four principles:

1. Relationships in healthcare should include the personhood of the participants.
2. Affect and emotion are important.
3. All healthcare relationships involve reciprocal influence.
4. Relationships in healthcare are morally valuable.

Relationships should include personhood
Who is the patient? That person is more than just a name or condition, more than “the calf guy” or “the hip fracture in the emergency department.” That person has a story. That person has emotions, hopes, dreams, goals, and plans that may have just been derailed by an injury or illness.

One way to honor the personhood of each patient is to write something in the chart about who the patient is — maybe about vocation, such as “75-y.o. Army veteran,” “33-y.o. elementary school music teacher,” or “50-y.o. plumber.” Perhaps include something about what the patient does for recreation or as a hobby — “likes to paint” or “plays pickleball.” We could include something about the patient’s goals for care, such “would like a cortisone injection before cruise vacation.” On a follow-up visit, we could enhance the physician-patient relationship by asking, “How did your knee hold up on that cruise this summer?”

Many of our patients’ lives are closely involved with their pets. Someone may have been injured while walking a rambunctious dog. Write the dog’s name in the chart! A patient of mine smiled when on a return visit I asked about her dog. “So how is Barney doing?” “Misbehaving as usual!” she responded.

Some “small talk before big talk,” such as a brief discussion of something nonclinical that connects us, may be helpful. Consider asking something like, “What do you think of this rain we’ve been getting?” or “Did you see the game this weekend?” A new patient recently presented to the clinic wearing a Baltimore Orioles cap, and we had a brief chat about how the season was going before discussing symptoms.

Affect and emotion are important
As the adage from Sir William Osler goes, “The kindly word, the cheerful greeting, the sympathetic look, trivial though they may seem, help to brighten the paths of the poor sufferers and are often as ‘oil and wine’ to the bruised spirits entrusted to our care.”

Physicians who truly empathize with their patients, rather than just playing a role, may be more likely to provide excellent care. And perhaps, as Osler said, the kindness and empathy the patient experiences are outcomes in and of themselves. In orthopaedic practice, we can connect with our patients by listening to their stories, providing space for them to share emotions, and supporting them as needed.

Sometimes patients become tearful in the clinic. Have tissues available in the room and offer them to patients. They are typically appreciative of that kind of gesture. A recent patient of mine recounted that her husband had passed away six months prior, and that memory prompted her to start crying. In my desire to provide comfort, I looked around the room for a box of tissues. Finding none, I hastily left without saying anything and quickly returned with some tissues, which I provided to the grateful patient. When she was more composed, she started laughing. “When you left so fast, I thought you didn’t want to deal with a crying patient!” I chuckled, too, apologizing for not explaining why I left. We ended up sharing emotions over her grief and then some comic relief at my clumsy attempt to empathize.

As practitioners, although we want to keep the main focus on our patients, we can recognize and acknowledge our own affect and emotions. Practicing orthopaedics is far from easy. I recall completing a particularly challenging operation, an amputation for osteosarcoma of the tibia in a young man, and going out to speak to his family in the surgery waiting room. When I finished explaining about the procedure, that patient’s sister unexpectedly asked, “Doctor, may I give you a hug?” Surprised, I thought for a second and responded, “Yes, thank you, I could use one.” Cherish those moments when patients or their loved ones wish to connect with us on an emotional level.

Reciprocal influence
The idea of reciprocal influence is particularly important in the teamwork that is needed for orthopaedic surgery. Having strong working relationships with our staff members and colleagues can help build trust and collaboration. Just as with our patients, some “small talk before big talk” with our coworkers could enhance our working relationships. Addressing our partners as well as the administrative and nursing staff and asking about their weekend plans or how they are feeling may help develop those critical working relationships. Maybe there are opportunities to socialize with our coworkers. We can have collegial discussions during patient care conferences. All of these work connections can increase our own satisfaction. Likewise, they can have a positive effect on our coworkers.

We are also influenced by our patients. It can be very gratifying to us as surgeons when they have good outcomes, are able to get back to work or the recreational activities they love, or heal from a severe injury. On the other hand, sometimes the outcome is not as clinically successful, such as when there is a surgical complication. We may feel badly for the patient. Beach et al suggest that “allowing a patient to have an impact on the clinician is a way to honor that patient.” Our feelings show that we care and we can demonstrate that to the patient while we address the complication. Some may consider journaling or sharing feelings with a trusted colleague as a way to reflect on and honor the patient.

Genuine relationships are morally valuable
Having good relationships in medicine is important, and not just for the bottom line. It’s not just customer service or a transaction. There are moral benefits to patients, providers, and staff to practice in a humanistic manner. A surgeon may be seen as more genuine by a patient rather than acting out a role, and the patients may be more comfortable with the care plan and treatment as a result.

When we can have genuine working relationships with our patients, it can result in clinically excellent care as well as make us feel fulfilled. In addition, according to Augustus White III, MD, PhD, it can help society as well. It can result in a “win, win, win.” Practicing humanitarian medicine can provide “a model for the spirit of community and mutual care that we so urgently need, and so lack, in our increasingly splintered and sectarian world.”

Dr. White always begins his lectures by addressing his audience as “my fellow humans.” Thinking about patients, colleagues, and ourselves as fellow humans can help us develop genuine relationships. Although patient-centered care is important, try practicing relationship-centered care. It can be rewarding for all involved and contribute to clinically excellent care.

Richard A. Schaefer, MD, MPH, FAAOS, is an orthopaedic surgeon at Johns Hopkins and a member of the AAOS Now Editorial Board.

References

1. Tresolini C, Pew-Fetzer Task Force. Health Professions Education and Relationship-centered Care. Published December 1, 1994. Accessed July 16, 2025. https://healthforce.ucsf.edu/publications/health-professions-education-and-relationship-centered-care.
2. Beach MC, Inui T. Relationship-Centered Care Research Network. Relationship-centered care. A constructive reframing. J Gen Intern Med. 2006;21 Suppl 1(Suppl 1):S3-S8. doi: 10.1111/j.1525-1497.2006.00302.x
3. Vander Veer JB, Bryan CS. Osler for white coat pockets. American Osler Society. Masthof Press; 2017.
4. White AA III, Chanoff D. Seeing Patients: A Surgeon’s Story of Race and Medical Bias. Harvard University Press; 2019.