RAB 2025-2026
Theme A: Learning Primary Care in East LondonTheme B: Kindness in Primary Care Through Thin Attention
by Dalila Marra
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I sat in consultations in primary care where nothing appeared to happen, yet everything important shifted in the space of attention between two people. What stayed with me was not what was said, but how it changed depending on whether it was held or interrupted.
Before starting my placement, I imagined general practice would be defined by clear answers and structured decision-making. I expected consultations to move efficiently from symptom to diagnosis to plan. What I encountered instead was something far less linear. Consultations often began in uncertainty and stayed there longer than I expected. Tiredness, dizziness, poor sleep, “not feeling right”. Symptoms that did not immediately resolve into categories, but instead required time, repetition, and interpretation in real time.
A chair. A desk. A computer between two people. The sound of typing. The consultation room felt defined as much by infrastructure as by interaction.
The drawing shows a consultation in primary care between a doctor and a patient, seated across a desk with a computer positioned between them. A window sits further back in the space, framing what lies beyond the room. It suggests a world outside the consultation that is always present but cannot be fully accessed within it.
The work is in black and white charcoal because these encounters do not remain in memory as fixed scenes. They persist as fragments: partial sentences, pauses, interruptions, and returns. Charcoal holds instability better than line. It smudges, it erases itself slightly, it refuses clean edges. That felt closer to how consultations actually stay with me.
The figures are indistinct. Not to anonymise, but because attention itself does not stay fixed long enough for the scene to feel fully defined. There are moments where I remember the patient clearly, and moments where I remember only the rhythm of the interaction, how it moved between us, how it stalled, how it restarted.
The composition is structured around three elements: desk, screen, and window.
The desk marks the formal boundary of the consultation space. The screen introduces a second site of work, where documentation runs alongside listening. I became aware early on that my attention would split in ways I did not fully control: listening, typing, thinking ahead, returning. The window sits further back, suggesting a wider life that enters every consultation but cannot be fully contained within it. People arrive carrying context that is not immediately visible: housing, fatigue, caregiving, uncertainty accumulated over time.
During my placement in primary care, I began to notice something very specific. When I turned to type, even briefly, the patient’s speech often changed. Sometimes it shortened mid-sentence. Sometimes it paused entirely. Sometimes they restarted in a different direction, as if the thought had been placed down temporarily. When I looked back up, there was often a subtle re-entry into the conversation, as if permission to continue had been restored without it ever being taken away.
Nothing about this was spoken about directly in the room. But it was present in how conversations unfolded.
I started to understand attention not as something passive or internal, but as something that has visible consequences for how patients construct what they say.
Weight of the Heart by Lynda Khun
It Remembers- Exploring the Quiet Power of Kindness in General Practice
by Dalila Marra
“If you ask years later what helped—
they may not recall the diagnosis,
but they will remember
the way someone looked at them
as if they were whole still,
the way the room held them
when they were finally allowed
to be human.”
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The body keeps what language can’t hold—
secret stories pressed beneath the skin,
where words fall short and silence speaks.
Kindness keeps the room where silence is not rushed,
where the clock slows to the heartbeat of presence,
and a name is spoken softly, like a lifeline.
Not every healing begins with medicine—
sometimes it begins in the gentle stillness
of a chair you were allowed to fall apart in.
A GP turns away from the glowing screen,
turns toward the person—
asks again, gently,
when the first answer didn’t come.
Waits.
Not because there is time,
but because there is care.
And in that waiting, something shifts—
a guarded face unfolds,
a voice trembles then finds strength,
trust quietly blooms in the cracks.
A woman describes a pain no scan will ever show—
the nurse does not flinch,
does not fill the silence,
she simply stays—
and in staying, she becomes a balm
in a world rushing past itself.
The child with bruised silence is not just weighed and measured—
someone kneels,
someone says his name,
not as a question, but as a truth that matters.
Kindness is no grand gesture—
it is presence,
the whispered revolution
to hold space where there is none,
to see the person, not just the problem.
And this is what the body, the person, remembers—
long after the words fade,
long after the clinical charts are closed,
long after the healing seems complete—
It remembers where it was listened to—
the sacred quiet that cradled pain,
the pause that gave breath to brokenness.
It remembers who stayed—
the steadfast witness to unraveling,
the keeper of shattered fragments.
It remembers what it felt like—
to be seen, to be held,
to be given a chair
where falling apart was allowed,
where fragility was met with grace.
It remembers the kindness,
not just the care—
the difference between being treated
and being truly met,
between hearing words
and hearing the soul beneath.
Long after prescriptions end,
long after wounds are closed,
long after notes are archived, t
he kindness remains—
quiet, enduring, unbroken.
If you ask years later what helped—
they may not recall the diagnosis,
but they will remember
the way someone looked at them
as if they were whole still,
the way the room held them
when they were finally allowed
to be human.
And that—
more than anything—
is what heals.
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Kindness in primary care is more than a courtesy or a feel-good gesture; it is the foundation of meaningful healing. Yet, despite its undeniable importance, kindness often remains overlooked, undervalued, or mistaken as secondary to medical expertise and efficiency (Zohny, 2023). In an environment frequently pressured by time constraints, bureaucratic demands, and clinical targets, the simple act of being present — truly present — can seem revolutionary. Yet it is precisely this presence that often unlocks pathways to healing that medicine alone cannot reach.
The poem accompanying this reflection captures this essence with poignant clarity: “The body keeps what language can’t hold.” It reminds us that patients’ bodies are repositories of stories, traumas, and emotions that transcend words or clinical measurements. The body remembers the atmosphere in which care was delivered — whether hurried or patient, dismissive or attentive — and these memories shape not only physical outcomes but emotional and psychological wellbeing as well (Greenhalgh et al., 2014).
In primary care, where clinicians meet patients at their most vulnerable and everyday, kindness becomes a radical act of acknowledgment. It demands the clinician’s attention beyond the digital screen, beyond lab results, to the lived experience of the person sitting in front of them. This is no small feat in a system increasingly dominated by rapid consultations and checklist-driven care. Yet the poem’s image of the GP asking again, gently, when the first answer didn’t come, resonates deeply with what kindness entails: patience, curiosity, and a refusal to settle for superficial understanding.
Such moments of pause and listening are where healing begins. They create a relational space in which trust can grow — trust that is crucial for effective healthcare. Without it, patients may withhold information, disengage from treatment, or feel isolated in their suffering. Research reinforces this: Hojat et al. (2011) found that physicians' empathy is associated with positive clinical outcomes for diabetic patients, including better control of haemoglobin A1c and LDL cholesterol levels. Similarly, a systematic review by Derksen, Bensing and Lagro-Janssen (2013) concluded that empathy in general practice improves patient satisfaction and adherence, decreases anxiety and distress, and leads to better diagnostic and clinical outcomes.
Yet kindness in primary care is not simply about making patients feel comfortable. It carries complexities and sometimes costs. The emotional labour involved is immense. Clinicians routinely witness pain, grief, and hardship — not only of patients but of communities burdened by social inequities. In diverse, economically challenged areas like East London, these layers are acute. Here, kindness intersects with cultural humility, social justice, and advocacy. To be kind is to recognise systemic barriers and to act in ways that affirm dignity amid disparity.
This intersection adds depth to the poem’s depiction of kindness as a “whispered revolution.” It is not passive warmth but active presence — a conscious choice to see the person, not just their symptoms. It challenges the fragmentation of care and the invisibility that marginalised patients often endure. The simple act of remembering a patient’s name, or noting “Lives alone. Seems tired,” in a margin becomes profound gestures of humanisation.
Moreover, kindness embodies paradox (Fine, Takla and Rajput, 2024). It requires both closeness and boundaries. Clinicians must offer empathy without becoming overwhelmed. Without support, kindness risks compassion fatigue — a real and documented phenomenon threatening healthcare workers’ wellbeing. Figley (2002) described compassion fatigue as the cost of caring for others in emotional pain, highlighting the need for systemic support to sustain kindness in healthcare settings. Sustainable kindness requires systemic change: protected time for reflection, supportive teams, and cultures valuing emotional as well as clinical competence. Macklin (2025) emphasises that kindness can be proactively decided and trained for, making it a feasible and sustainable practice even in high-pressure healthcare environments.
In reflecting on the poem’s image of “a chair you were allowed to fall apart in,” I am reminded how rare and precious such spaces are. Healthcare settings can sometimes feel transactional or hurried. Providing a literal or metaphorical chair — a safe space to be vulnerable — is kindness in action. It requires bravery from clinicians to remain present with discomfort, uncertainty, and sometimes silence.
This presence — staying even when there is no easy answer — disrupts dominant narratives of medicine as solely problem-solving. It acknowledges that healing is a process often slow, nonlinear, and deeply relational. Sometimes, it begins with the act of being seen, held, and believed. The child whose bruised silence is met with kneeling and naming is not merely a patient; they become a human being restored to wholeness through recognition.
The poem’s assertion that “not every healing begins with medicine” speaks volumes. It situates kindness as an essential dimension of care that transcends diagnostics and prescriptions. This aligns with qualitative research in primary care showing that patients often value being listened to and understood more than specific treatments (Greenhalgh et al., 2014).
Kindness also ripples beyond individual encounters. It shapes the culture of general practice teams and communities. Studies show that kindness improves team cohesion and reduces burnout. West et al. (2017) demonstrated that compassionate leadership and a culture of kindness within healthcare organisations are associated with improved staff wellbeing and patient outcomes.
However, the ideal of kindness must be tempered by realism (Silvester, 2011). Systems may not always reward or even allow kindness to flourish. Performance metrics, appointment quotas, and resource limitations impose constraints. These realities provoke necessary questions: How can kindness be preserved amid such pressures? What structural reforms are needed to embed kindness as a core value rather than a luxury?
One answer lies in recognising kindness as integral to quality care, not optional. The BMJ’s recent focus on kindness in healthcare emphasises that kindness leads to better outcomes and must be supported institutionally (Zohny, 2023). Training curricula can foster emotional intelligence and reflective practice. Workflows can be designed to allow time for meaningful engagement. Leadership can model and reward kindness as part of professionalism.
And yet, kindness also calls us to redefine success within healthcare. It asks us to move beyond purely quantitative outcomes and make space for qualitative dimensions of care — safety, dignity, connection, and presence. These are not easily measured, but they are deeply felt. Patient narratives, reflective practice, and peer learning forums can help capture and honour these invisible threads of practice that too often go unnoticed.
Moreover, kindness is not just a matter of individual willpower; it is sustained by collective ethos. A culture of kindness requires communities of care where clinicians support one another, where vulnerability is not stigmatised, and where compassion is seen not as a personal risk, but a shared value. Kindness, in this sense, becomes a communal resilience — a buffer against the moral injury that can arise from working in systems misaligned with core human values.
Kindness is a quiet revolution that asks us to slow down, listen deeply, and hold space for others’ suffering. It is not sentimental but grounded in respect, curiosity, and courage. It challenges us to resist the dehumanising forces of modern healthcare and reclaim care as a relational, transformative practice — one encounter, one conversation, one small act at a time.
And perhaps this is the most radical element of kindness: its everydayness. It does not require grand gestures or extraordinary effort. Rather, it is found in the way we enter a room, in a pause before speaking, in the willingness to hear what is not said. It thrives in the margin notes, in remembering a detail about a patient’s life, in a follow-up phone call that acknowledges worry lingers after the appointment ends. In these small acts, we affirm that each patient matters — not just as a case, but as a person.
Kindness, then, becomes a form of resistance. It pushes back against the erosion of empathy that can occur when time is short, resources stretched, and systems strained. It resists the notion that healthcare must be transactional, instead asserting that healing is fundamentally relational. By protecting and prioritising kindness, we protect the soul of medicine itself.
As future challenges emerge — from workforce shortages to widening health inequalities — kindness will not be a luxury we can no longer afford, but a necessity we cannot do without. It is both balm and backbone. And it reminds us why many of us came into healthcare in the first place: not only to treat illness, but to witness, accompany, and care. In a world where so much feels broken, the choice to be kind — and remain kind — is an act of moral courage (Fine, Takla and Rajput, 2024).
Ultimately, kindness asks a radical question — what if the true measure of healing is not just cured bodies, but healed humanity? What if our legacy is not the number of prescriptions written, but the number of lives held gently in moments of presence? In answering this, kindness is not optional—it is essential.
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Derksen, F., Bensing, J. and Lagro-Janssen, A. (2013) Effectiveness of empathy in general practice: a systematic review, The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 63(606), pp. e76–84.
Available at: https://doi.org/10.3399/bjgp13X660814Figley, C.R. (2002) Compassion fatigue: psychotherapists’ chronic lack of self care, Journal of Clinical Psychology, 58(11), pp. 1433–1441.
Available at: https://doi.org/10.1002/jclp.10090Fine, L., Takla, T. and Rajput, V. (2024) Role modeling kindness at the bedside, Cureus, 16(3), p. e57078.
Available at: https://doi.org/10.7759/cureus.57078Greenhalgh, T. et al. (2014) Evidence based medicine: a movement in crisis?, BMJ (Clinical Research Ed.), 348(jun13 4), p. g3725.
Available at: https://doi.org/10.1136/bmj.g3725Hojat, M. et al. (2011) Physicians’ empathy and clinical outcomes for diabetic patients, Academic Medicine: Journal of the Association of American Medical Colleges, 86(3), pp. 359–364.
Available at: https://doi.org/10.1097/ACM.0b013e3182086fe1Macklin, N. (2025) In Conversation with Nicki Macklin. BMJ Leader.
Available at: https://blogs.bmj.com/bmjleader/2025/02/03/879/Silvester, H.S.S.P. (2011) Empathy in healthcare settings. Gold.ac.uk.
Available at: https://eprints-gro.gold.ac.uk/id/eprint/6704/1/PSY_thesis_Scott_2011.pdfWest, M., Eckert, R., Collins, B. and Rachna, C. (2017) Caring to Change: How Compassionate Leadership Can Stimulate Innovation in Health Care.
The King’s Fund.
Available at: https://www.scirp.org/reference/referencespapers?referenceid=2474220Zohny, H. (2023) What place does kindness have in medicine? Journal of Medical Ethics blog.
Available at: https://blogs.bmj.com/medical-ethics/2023/08/25/what-place-does-kindness-have-in-medicine/