Rapport and the hospitalist.

One key issue in the hospitalist movement is the need for hospitalists to establish rapport and maintain relationships with their patients. Rapport is critical in obtaining a thorough history, and then effectively negotiating the diagnosis and treatment plan with patient and family. This article summarizes both the challenges to establishing rapport and the opportunities unique to hospital-based practice. It presents a basic framework for communication skills using the mnemonic PEARLS (partnership, empathy, apology, respect, legitimation, self-efficacy), and a detailed discussion of techniques for use in difficult relationships. The importance of the physical setting and of nonverbal skills cannot be underestimated. Rapport-building techniques can be learned but require practice.