Abstract: Objective: To evaluate the patient, physician, and visit-related factors associated with patient ratings of positive physician relational communication.Methods: Pre- and post-visit surveys were conducted with 485 patients attending a routine periodic health exam with one of 64 participating physicians. The audio-recorded visits were coded for elements of patient–physician communication including assertive responses, partnership building, question asking, supportive talk, and expressions of concern.Results: Patient reports of positive physician relational communication were associated with patient perceptions of how well the physician understood the patient’s health care preferences and values, a patient–physician interaction outside of the exam room, and physician-prompted patient expressions of concern.Conclusion: In addition to a patient’s perception of their relationship with their physician going into the visit, relatively simple acts like extending the interaction beyond the exam room and ensuring that patients feel invited to express concerns they may have during the visit may influence patient perceptions of physician relational communication.Practice implications: This study offers preliminary support for the idea that relational communication and its associated benefits may be fostered through simple physician-driven acts such as interacting with patients outside of the exam room and encouraging patients to express concerns within the visit.