Patient-physician communication has been conceptualized as both a skill and as a way of mindful "being in relation" to the other. Summarizing research and theoretical analyses, the two approaches are differentiated. The skill-focused approach to communicative competence relies heavily on observed behaviors; the mindful being-in-relation approach emphasizes the perceived effects of the relationship on the participants. The distinctions between these two approaches are important to teaching and research. Teaching can, and should, focus on both changing behaviors and on the personal development of mindfulness in the learner. Research methods should routinely include both observer and participant responses. Reconciling these two views supports the thesis that good communication is both a skill and a way of being, that it is both innate and teachable, and that it must be cultivated by integrated methods of teaching and research.