Williams et al The physician-patient relationship can itself be therapeutic for the patient, particularly for the older patient who struggles with comorbid conditions, depression, complex treatment regimens, and limited resources. Patients with many medical and psychosocial challenges may seem to have the “deck stacked against them,” but in developing emotionally supportive relationships marked by open communication, physicians can provide a bridge to the achievement of better quality of life for their vulnerable patients. Physicians can provide treatment for depression and other comorbid conditions using strategies focused on the context of the older patient’s life, seeking to address the complexities of biomedical care along with the struggles of loneliness and isolation that can contribute to patients’ emotional challenges. Physicians can help their older patients by simplifying complex treatment regimens, providing helpful strategies such as timers and special pill boxes, and providing assistance in incorporating medication- taking with other daily events. Working with patients to address the practical and logistical challenges of treatment can be essential to adherence. And while evidence exists that the therapeutic offerings to older patients can vary considerable from patient to patient as a function of their ethnicity, income, SES, education level, and mental health, care must be taken to avoid having patients’ characteristics inﬂuence the communication patterns between patients and their physicians. Current research offers various methods for physicians to employ in everyday practice with their older patients. These recommendations, as detailed below, suggest important ways that practicing physicians can care for and support their older patients in facing the challenges of aging and its associated vulnerabilities. This research also suggests a number of important basic guidelines for practitioner behavior, as well as formal programs to improve the psychosocial and biomedical care of patients. Guidelines for improved communication Research on the physician-patient relationship offers some important recommendations regarding the effective management of care for the older patient. First, it is important for health care providers to elicit and document elder patients’ views regarding their future goals and their personal conceptualization of a good quality of life. Exploration of this issue may require the involvement of family members and caregivers, especially in cultures where decision making is a shared responsibility (Chen and Landefeld 2007). 462 Second, physicians should provide opportunities and prompts in the medical interaction in order to help their patients to be the best possible reporters of their own history and current illness experience. Physicians should allow patients to provide an open-ended narrative description of their health status, challenges, and concerns, and encourage patients to be assertive partners in their care (Ashton et al 2003). Through the process of telling their stories, patients can reveal important information that might otherwise be unavailable to the physician. A physician who listens to an older patient will be able to learn about the uniqueness of that patient’s personal history. This physician will be able to convey to the patient that he or she has an earnest interest in the patient as a person and not just as a disease condition (Adelman et al 2000). This style of communicating is in line with the patient-centered, humanistic approach mentioned previously which emphasizes empathy for the patient, as well as an opportunity for the patient to narrate his or her personal story (Greene 1987; Raskin and Rogers 1989; Adelman et al 1992, 2000; Charon 2001; Ashton et al 2003). Third, physicians should regularly evaluate their own communication competence with post-visit questionnaires and/or interviews with patients in order to assess their per- ceptions of the communication process (Ashton et al 2003). Post-visit interviews by the ofﬁce nurse or assistant might add further, detailed information about the patient’s life and about condition-speciﬁc details that the patient may have failed to mention during the medical visit. Physicians might also consider tape-recording selected visits (with patients’ written permission), and reviewing them alone, with a colleague, and/or with the patient in an effort to assess their own communication strengths and weaknesses, and to develop plans for improvement. Fourth, physicians should endeavor to recognize and assess depression in their older patients as thoroughly and as early in treatment as possible. Studies of service delivery models that help to improve the treatment of depression in primary care have shown that the recognition and treatment of depression can be signiﬁcantly improved by training primary care physicians in these skills, integrating the management of mental and physical health concerns, and coordinating team-oriented care that involves primary care doctors and specialists in mental health services (Alexopoulos 2005). Physicians who care for the elderly should receive post-graduate or CME training in the sub-specialty of geriatric medicine, providing them greater familiarity with and understanding of the special issues and Clinical Interventions in Aging 2007:2(3)