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The day-to-day tasks of family medicine are accomplished through the interaction of patient and clinician during a visit, the “essential unit of medical practice.”1 Coursing like a river underneath these discrete visits, however, is the ongoing relationship, manifesting dimensions more enduring than the qualities of any one visit, dimensions such as trust, caring, feeling, power, and purpose. Medical, nursing, and psychotherapeutic literature contains references to processes that have as a goal a strong patient-clinician relationship: a working alliance,2 a guarded alliance,3 or a therapeutic alliance.4

Continuity, Care, and Commitment: The Course of Patient-Clinician Relationships