Tuesday, February 6, 2018

Anticipatory Kindness

As a child growing up in Northeast Ohio, going to Cleveland was a really big deal.  It meant driving along the Shoreway which was the one East-West highway with 6 lanes, 3 in each direction. My mother hated the merging traffic and the dire threat of getting lost Downtown.  So we did not go to Cleveland often, and it was a special occasion filled with excitement and intrigue, when we did.  Lucky for me, the Indians played ball on our side of town.  We also made it to the West Side Market twice a year, at Thanksgiving and Christmas, to shop for clementines, sour lemon drops, bulk nuts and chicken hearts.  

When my mother called to say that Dad was being referred to the Cleveland Clinic, I was already a young doctor in training.  He would need to see the cardiac surgeon for possible bi-pass surgery.   My mother never asked me to come home, but I did.  I knew she would need support, and a driver to get to and from Cleveland.

Dad’s dementia had become more apparent and his mobility was shaky at best.  Both of my parents perseverated about what the doctors were going to say and what was sure to happen.  My father, God rest his soul, was the ultimate pessimist, and mom the fatalistic denier.  The drive to Cleveland seemed the least of our worries, but my dutiful mother spread a giant map across the dining room table to plot our course.  I love maps so this was fine with me.  I was also quite grateful to discover the simple driving directions provided in the welcome packet that accompanied the letter confirming their appointment. 

I was living in Boston at the time.  I had lived and worked in metropolitan New York City, and I actually knew my way around London, but I felt like a kid again when we started off for Cleveland.   Turns out, Cleveland is pretty easy to navigate as an adult.  Still, I worried about finding our way around a vast hospital complex with parking, labs,  X-rays and multiple appointments, all potentially in different buildings.   And there would be the decision-making, the need to translate doctor-speak, and the anxiety of my parents to contend with.

Can you imagine my relief when we rolled up to the hospital entrance, and a friendly man in a bright red coat opened the passenger door, introduced himself, and suggested I allow the valet to park my car?  “Yes sir,” I said. “Thank you very much.”  When I showed the red-coated man our appointment notice and asked if he could direct us to our first stop, he smiled and said he planned to show us the way.  This friendly man in a bright red coat produced a wheelchair for my dad, and we were off through the halls of the Clinic, comforted by his jovial conversation about our drive into town.  He showed us the cafeteria along the way and before we even knew what had happened we were in a waiting area with abundant natural light, thanking our guide for his kindness.

This is what I call institutional kindness.  It is also an example of anticipatory kindness.  My guess is that nearly everyone arriving at the Cleveland Clinic is nervous or worried about something.  Offering a wee touch of kindness, let’s say in the form of a jovial man in a bright red jacket, is bound to improve the overall patient experience.  Kindness helps to put us at ease, and allows us to be less anxious, maybe even a bit more open and focused on the decision-making that lies ahead.  The institutional kindness offered that morning at the Clinic worked for me, and has remained an indelible, positive memory of health care.

Anticipatory kindness is akin to what we call anticipatory guidance in pediatrics.   When parents bring their children to me, they expect to talk about the child’s growth and development.  They look to me to help them interpret the child’s behaviors, and forecast what is to come. We talk about sleep, and tantrums, and separation anxiety, dietary preferences and teenage autonomy BEFORE they have become a problem.  I try to anticipate their needs, while guiding a path forward. 

So too, our challenge is to anticipate the need for kindness.  The Cleveland Clinic has chosen to post friendly folks in bright red coats at the entrance to their hospital, to serve as literal guides and certainly as ambassadors of kindness.  At the University of Virginia, the lobby is newly decorated with giant murals of inclusion and welcome. Therapy dogs visit the units and rest near the cafeteria.  Quite often I hear someone playing the grand piano in the main lobby, next to the surgical waiting area.  It's all a great start toward offering institutional, and anticipatory kindness.  

My wife had a terrific idea to increase the hospitality felt by patients in her clinic.  What if we replaced all the little signs requesting payment at the time of service, with brightly colored signs welcoming our patients like honored guests?

What if we anticipated the need for kindness at every step through the maze of our health care systems?  I suspect we might stumble over all manner of ways to offer kindness, creating increased ease among our patients, staff and visitors.  I imagine we would see positive changes in job satisfaction, patient satisfaction, and patient-doctor communication if everyone’s heart were just a little more open.



  1. I'm visiting your blog for the first time, traveling via Donna Thomson's caregiver one. Wow. I can't believe I'm only now reading your beautiful, wise words. As a caregiver to a now 23-year old developmentally disabled daughter, I could have used even a small measure of kindness more consistently over the years. I imagine it's a good exercise to even remember those acts that WERE kind -- we so often make tracks, grooves with the bad stuff. I look forward to reading more of your work.

  2. Inspiring! Thank you, Jim!