Beyond the Chart: Building Rapport in an Age of AI

Throughout our time at the Bradley Free Clinic, we (Jesse and Anthony) have been fortunate to scribe and care for patients alongside truly amazing physicians. From the start, it struck us how effortlessly they built rapport and established a sense of trust with their patients, even on the first visit. These moments of connection, however subtle, profoundly changed our attitudes and approach to clinical medicine. 

Building rapport begins immediately as a patient walks through the doors of one’s office. They bring with them not just their “chief complaint” but also an amalgamation of feelings, aspirations, and experiences. Being attentive to them and their needs goes beyond addressing the headache or anxiety noted in the chart—it requires a clear and concerted effort to understand the individual obscured behind the chart. We are entering an era soon to be defined by Agentic AI—systems capable of decision-making, diagnosis, and even longitudinal treatment coordination with operating capabilities poised to evolve at a parabolic rate over the next decade. However, the construction of rapport with the patient must remain a distinctly human responsibility. Philosopher Thomas Nagel famously said that for a being to be conscious, “there is something that it is like” to be that being. In essence, one’s subjective experience, whether it be receiving a difficult diagnosis, buying a cup of coffee, or just sitting down after a long day of work, can be understood by someone else who experienced a similar situation. This shared, subjective understanding—an amalgamation of physical and emotional sensations combined with a subjective reflection of the experience—is a core aspect of our humanity and is what makes us able to relate to one another despite many inherent differences in the vantage point of our lived experience. In the practice of medicine, we find this distinction to be crucial. A patient’s experience—marked by emotions such as joy from achievement, grief over a loved one’s illness, or the heartbreak of loss—is uniquely human. Even if an AI system can make life-saving medical decisions, communicate those decisions in an ethical and empathetic manner, and carry out a procedure in question, it will never understand what it is like to suffer, to hope, or to heal.

 A recent article in JAMA wrestled with the uncomfortable reality that an AI-enhanced chatbot can deliver a more empathetic string of sentences than a hurried doctor can. Does this mean that the chatbot has superseded the ability of a doctor to be the empathic healer that they are meant to be? We argue no; what our patient perceives as “empathy” from an AI-generated response is the association of empathy with a series of words that evoke the feeling of being understood. In that moment, the patient is reading AI-generated text as if it were being said to them as another human that, in the spirit of Nagel, they are like. No matter how advanced AI becomes, it will never be able to completely replicate a human in an ethereal moment of giving or receiving true empathy.

One recent Thursday, a patient presented at the Bradley Free Clinic with complaints of heart palpitations, and Jesse and I (Anthony) went over the chart quickly before seeing him in the clinic. He was Spanish speaking, and the strong smell of tobacco smoke hit us as we walked into the room. He spoke rapidly and pointedly with occasional short thoughtful pauses, describing a pounding in his chest that seemed to come out of nowhere several times a month. As Jesse typed away on the laptop, I asked him about his diet and caffeine intake. He smiled slightly as he described eating his favorite dinners of seasoned rice, beans, and pork carnitas. Then, gesturing to me as if presenting a large bottle, he remarked, “I have one of these Thermos things a day” for his coffee intake. Our initial tension of “what if this man has an arrhythmia?” faded. In his culture, strong Cuban coffee, drunk slowly throughout the day with hearty amounts of cream and sugar, was the norm. How similar that suddenly seemed to our own overconsumption of coffee on the journey to and in medical school, where my peers and I get the well-known headaches and palpitations as we desperately try to stay awake for just one more hour of studying. Without saying anything, with just the rueful smile of people who have, in different yet tangibly similar circumstances, experienced something very similar, we were able to understand where this patient’s symptoms may have been coming from. Our attending ordered an EKG, which fortunately showed no arrhythmias, and counseled our patient on reducing caffeine intake. 

So many of our intentions are communicated without words. A warm, reassuring smile that reaches the eyes can work wonders, creating an immediate sense of comfort. We have noticed first-hand how calming a seated position and inviting body language on the part of the physician speaks volumes to a patient who may be nervous or hesitant to discuss treatment options. The best physicians at the Bradley Free Clinic always sit beside patients and address them at eye level or below in a warm and encouraging manner—as if they were a family member or close friend with whom the patient would feel free to confide in. This approach, far removed from the sterile and paternalistic offices of yesteryear, fosters a sense of trust and understanding. In doing so, it becomes possible to build an atmosphere of collaboration and mutual respect between patient and physician. Through these moments, the physician empowers the patient to become an active partner and stakeholder in the journey toward better health.

While AI will undoubtedly revolutionize medical practice, human physicians must remain irreplaceable as the bridge between clinical expertise and the shared experience of being alive. The trust, empathy, and profoundly personal nature of healing must be guided by those who have lived through many of the same joys and sorrows as their patients. As technological breakthroughs push us farther down the uncertain road of discovery, we hope that human connection remains a core tenet of medicine. May the entities which are in the world (Artificial Intelligence) see their roles enhanced and enable those of the world (Humanity) to enrich patient care and interaction.

Citations

Harris, S. (2011, February 6). The mystery of consciousness II. Sam Harris. https://www.samharris.org/blog/the-mystery-of-consciousness-ii

Hswen, Y., & Rubin, R. (2025). An AI chatbot outperformed physicians and physicians plus AI in a trial—What does that mean? JAMA, 333(4), 273–276. https://doi.org/10.1001/jama.2024.23860

Nagel, T. (1974). What is it like to be a bat? The Philosophical Review, 83(4), 435–450. https://doi.org/10.2307/2183914

Shen, J., Mire, J., Park, H. W., Breazeal, C., & Sap, M. (2024). HEART-felt narratives: Tracing empathy and narrative style in personal stories with LLMs. Proceedings of the 2024 Conference on Empirical Methods in Natural Language Processing, 1026–1046. https://doi.org/10.18653/v1/2024.emnlp-main.59