The other day, I was listening to the radio when I heard someone described as “transactional.” This word caught my attention because it described a concept with which I was completely unfamiliar. Perhaps “unfamiliar” may not be the correct description. Rather, this is something all of us experience in some of our relationships but don’t necessarily label. At 45-years-old, I may be naïve that I hadn’t paid any attention to this concept, but learning about the transactional relationship model was somewhat of an epiphany. After learning this new terminology, I started thinking about my interpersonal relationships and those around me.

For myself, I’ve generally lived my life somewhat unconscious of the labels applied to the relationships I’ve had, running on autopilot and letting these relationships evolve somewhat naturally. For example, I didn’t consciously decide what kind of wife I wanted. Rather I just met my wife, we fell in love, and got married – much like anyone else, I imagine. The same is true for my friends. I don’t look consciously for people to satisfy some specific need. Rather, I meet a person, like them, and we become friends.

However, it is instructive to think about this in a more formal manner and consider how we can label types of relationships. We may then be forewarned when interacting with others.

In general, consider two types of interactions: transactional and relational. In a transactional relationship, the participants are trying to get something out of each other. There is an exchange of products or services in a timely manner. For example, if I go to the grocery store to purchase food, my relationship to the cashier may be transactional in that we exchange my money for the store’s food products. The human interaction may be professional and go no further. This is normal and expected.

On the other side, we have relational interactions such as those between family members. This typically appears as a more friendly and personal interaction in which participants have a mutual emotional interest in a less competitive fashion. The obvious example of this is many parents’ unconditional love for their children.

Obviously, I’ve shown two extremes of these relationships, but what about other situations that lay somewhere in between? What happens when interactions that should be relational are actually transactional instead? Does this have an effect?

I go to the barber about every three weeks because my hair grows pretty fast. As a result, I don’t like to spend too much money on a haircut, so I go to a place down the street from my home that advertises $8 haircuts. I like the price, of course, but I’ve always been a little uncomfortable going there because the interactions are very transactional. I sit down, tell the barber what I want, and that ends our conversation until the end when I pay him. Now, I’ve gotten exactly what I paid for – a haircut – so I shouldn’t expect more right? I’m not so sure.

On the flip side of this coin, a few months back I took my very gregarious 6-year-old daughter to her first official haircut. We went to a different local hair place that provided a good haircut. However, the hair stylist that took care of her was very warm, talkative, and appreciated my daughter’s excitement. She remembered her name, talked, laughed, and created a very pleasant experience. She was highly relational.The difference between these two situations is the creation of a highly relational rather than transactional interaction. The second hair stylist established an emotional bond with my daughter that I would interpret as superior service.

This exact quality is what separates good service from poor service in almost every situation. Think of the times when you’ve eaten at a restaurant, for instance. Servers who create a relational situation through friendliness and concern for their patrons generally are rewarded with better tips. Yes, you’re still going to leave some tip (that’s the transactional part), but you want to feel that person made the effort to more than simply serve you food. Better service is demonstrated by an authentic caring for the patron’s dining experience. Smiles, a friendly tone, some chatting about topics unrelated to food, and demonstrating actual care for others establishes a relationship beyond the surface food-for-dollars interaction.

Medicine is no different. It may be true that patients come to their providers looking for the treatment of what ails them, but that doesn’t mean that’s all they want. Humans are social beings, and we want to have relationships. We want our care providers to actually care. This is often the criticism of the surgeon-as-technician stereotype. The surgeon doesn’t actually care about the patient, just the procedure, or just the outcome. This, of course, is patently false for many surgeons. I have met many who also care deeply about their patients.

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“Humans are social beings, and we want to have relationships.”

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But it does take work for anyone providing a service to create a relational rather than transactional experience. First, it takes time to learn about patients. Listening to their story without interruption, while other patients await care next door, can create pressure to shortchange the encounter. Providers must also demonstrate authentic concern for their patients’ wellbeing. One method I learned years ago was when walking into the room do not discuss the issue the patient came in for. Instead, ask how the patient is doing and strike up a short conversation and then redirect the visit back to the medical complaint. This establishes early rapport while helping the doctor learn about who the patient is as a human being. True empathy goes a long way to building the very important trust needed for the relational interaction.

Transactional relationships work for the short-term superficial interactions, but beyond that most other interactions work much better when they are relational in quality.