Objective To explore the relationship among patient perception of doctors' empathy, doctor-patient communication, and doctor-patient relationship.Methods From November 2019 to April 2020, we used the CARE scale, the SEGUE framework and the PDRQ-15 scale to survey 3,039 patients from 14 provinces in China, ranging in age from 18 to 92 years old.Results 1. The age of the patient, the level and type of hospital, the length of consultation, and the presence or absence of verbal and physical conflict have significant differences in the scores of perceived empathy; 2. There was a significantly positive correlation among patient's perceived empathy, doctor-patient communication, and the doctor-patient relationship (r = 0.65 ~ 0.75, p < 0.001). 3. The patient's perception of doctor empathy can not only directly predict doctor-patient relationship (β = 0.75, p < 0.001), but also influence doctor-patient relationship through the mediating effect of doctor-patient communication (β = 0.56, p < 0.001). Besides, the scores of CARE can effectively explain the variation of each stage of doctor-patient communication skills (R2 = 0.28 ~ 0.37) and the satisfaction (52%) and approachability (54%) of the doctor-patient relationship scale.Conclusion The age of the patient, the type and level of the hospital, and the consultation time affected perceived empathy. Doctor-patient communication plays a partial mediating effect in the influence of empathy on the doctor-patient relationship.Practice implications: Medical institutes should improve the medical environment and carry out humanistic education and patient-centered communication skills training for doctors. These approaches will enhance patients' perceived empathy and therefore improve the doctor-patient relationship.