Background: Medical students frequently experience a “reality shock” when the patient-centred communication (PCC) skills they are taught at university fail to align with what they see in clinical practice. Primary care physicians therefore play a key role in modelling and teaching PCC in authentic clinical settings. Understanding how they conceptualize PCC is therefore essential, as it influences both their clinical practice and their approach to teaching. Methods: We conducted individual interviews with 18 primary care physicians (GPs and GP trainees) from healthcare centres in the Stockholm region. We used a semi-structured interview guide addressing their understanding of PCC and analysed data using a phenomengraphic approach. Results: The analysis identified four qualitatively different ways of understanding PCC: a pedagogical structure, empathetic listening, a whole person-perspective, and a professional responsibility for patients and society. These categories are hierarchically related, with each higher category encompassing and extending the awareness represented in the less complex ones.  Conclusion: The ways of understanding PCC ranged from focusing on information transfer to holistic, ethically grounded professional responsibility. Progression toward the higher categories was reflected in patient–physician relationships characterised by trust, combined with an awareness of how to balance patients’ preferences with long-term patient benefit and the pursuit of sustainable healthcare. Implications: These findings suggest that medical schools may prioritise opportunities for continuity in patient encounters and training on ethical and emotional challenges, as these conditions could help support deeper PCC competencies. They may also help policymakers and clinical leaders understand the value of relational continuity in primary care and the need to support physicians in providing sustainable care.