It’s a stunningly gorgeous day here in New England. A light breeze softly caresses my face. The sun shines brilliantly in a sky painted with fluffy, irregular white clouds. Diminutive birds chirp encouragingly. In the background, a hawk curmudgeonly squawks disapproval of a day that insists vehemently on being beautiful. It would be easy to forget there are any troubles in the world. But, for a few long moments, I do.

Then my mind returns to a few days ago at the doctor’s office. Usually a cheerful, ambitious soul, he was running nearly an hour late on this particular day and bordered on being as much of a curmudgeon as the hawk. We mention doing business in Mexico. He tells of his son in Guatemala needing bodyguards because of robberies on the street and off. I note that poverty is complicated and often rears its ugly head in the form of violence. The poor of Guatemala, Honduras, and El Salvador, were pushed and pulled from their countries, known as Central America’s “Northern Triangle Countries,” and forced to live in dumps or landfills.

“Is that right?” he asks, then quickly complaining about patients who won’t stay off their affliction and remain perfectly still. At this point, the doctor has my full attention as he speaks of an older adult with no one to cook, clean, or do errands for her, so she doesn’t get her surgery. Maybe she lacks resources or hasn’t asked anyone for help, but we don’t know if we don’t have that conversation. Challenges, whether from poverty, lack of knowledge, or access to helpful resources, are invisible without appropriate discussions, and so are their solutions.

Since that conversation, I have thought about previous such discussions. Different locations with different actors, but the theme is the same. We each have frustrations with a system whose inadequacies and inequities we have willfully ignored. Healthcare providers express these frustrations in the form of “If patients would just do as I tell them.” “Patients don’t come back for follow-up appointments. They don’t care.” “My patients don’t take care of themselves.” I understand they are frustrated, tired, and pressured, but I wonder if they stopped to see their patients as more than a gall bladder, a broken foot, or upset stomach, how much better off we all would be. My response is, “Listen without thought. Absorb what your patient has to say and then address their needs.”

In the doctor’s waiting room, there were small boxes of food to take as needed. I left wondering if he even knew why.

Design doctor’s offices as “wellness offices” where patients can access an onsite advocate and supportive non-medical services. This advocate would suggest ways to have food delivered, transportation options so they can come back, in-home care, or initiate other useful conversations. When a patient says my daughter can’t care for me, it may mean they haven’t asked or are embarrassed to need help. My experiences suggest communication is vital. Kindness is wellness and provides space for change.

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