Recently a few of my colleagues were sitting together and one asked if any of us had ever given money to a patient. There was an awkward pause, and then the stories starting coming out — a few dollars for a co-pay, or to help a frail patient take a cab instead of a bus; a bag of food or an extra meal. “How could I not,” one doctor said, “when my patient’s immediate need could be solved by the small change in my coat pocket?”

A physician recently wrote in JAMA about giving a patient $30 to help pay for a medication after a two-hour phone battle with the insurance company came to naught. He was cited by his institution for unprofessional behavior, but was also deluged with letters from doctors and nurses who have been in the same position and done the same thing.

We hear daily about “health care costs,” a lumbering behemoth that dominates the news and the economy. But it is the smaller amounts, literally the pocket money, that often has the most profound and palpable effect on the concrete currency of health.