The physician-patient relationship is in trouble. What was once a close and trusting relationship is now becoming distant and suspicious. That is unfortunate and quite troubling. For physicians, a close, helpful and trusting relationship with patients is one of the main reasons most choose to become doctors in the first place. For most of us, it is a physician who first touches us when we are born and it is a physician who is often the last to touch up before we die, Between these two bookends of life, we experience a multitude of encounters with the men and women of medicine who help us regain, as well as, maintain our health and well-being.      There are many reasons for this fractured relationship between doctor and patient: millions of Americans without health care insurance, overcrowded emergency rooms and doctor offices, too little time available to spend between doctor and patient, patient safety issues, a disparity of medical outcome for minorities, a malpractice environment which leads to defensive medical practices, suspicious doctors and skeptical patients. At the root of these reasons lies an important common denominator, the lack of communication between patient and doctor. To improve communication, we must use the family doctor model.      Not so long ago, doctors went to the home to dispense care. During those visits family and doctor got to know each other. They often shared a piece of cake or a cup of coffee during the visit and slowly, but surely, over the years patients knew much about "their doctor" and doctors knew much about "their patient". With so little time now available for doctors to visit with patients, we must do something to enhance this critically important and necessary relationship.        In my first book, "Doctors Cry, Too: Essays from the Heart of a Physician", I shared much of my personal life as well as profound medical experiences with many of my patients in an attempt to reveal the heart of one physician. It was my hope that by understanding the heart of one physician, readers would better understand the heart of their own physician. "Building Patient / Doctor Trust", comprised of my columns written for the Nashville Tennessean over the past 12 years, gives my opinion on a host of subjects related to medical care and politics. It continues my effort to help patients understand more about the world in which doctors live.      There is more to medical care than merely dispensing medical care. Medical care also involves the sharing of life's experiences and opinions between patient and physician. This sharing can lead to a patient feeling trust and with this trust comes a sense of peace and tranquility as well as a feeling that their doctor cares what happens to them.      It is my hope that "Building Patient / Doctor Trust" will help you understand that in addition to your immediate medical problems, there is a wealth of other issues that can be discussed with physicians in attempt to enhance communication and there-by improve the doctor-patient relationship. Doctors have many opinions on how to best treat patients as well as on a host of other issues surrounding healthcare. What follows here are many of mine.