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Gratitude

I recently became aware of how often I minimize the impact we clinicians have on patients and their family members’ lives.

As a family physician, I have the great privilege of caring for multiple generations of people within a single family. A few years ago, a woman in the sandwich generation – she was both a mother and daughter – of one of those families came in for a small amount of rectal bleeding. As a self-described “health nut” who practiced yoga daily, ate a plant-based diet, exercised, meditated, and enjoyed fulfilling personal relationships, she was not particularly concerned about this one-time symptom and assumed it was hemorrhoids as a result of two pregnancies. Her mother encouraged her to have it evaluated.

On my exam I could not detect a source of bleeding, so I recommended a colonoscopy to determine the source. She was reluctant to take this step because she couldn’t believe that she would have a disease. However, she did proceed with the colonoscopy and the results surprised us all: she had rectal cancer.  Fortunately, it was at a fairly early stage and she proceeded through treatment, including surgery and chemotherapy. She is now happily in remission.

About 6 months after she completed chemotherapy, her mother had a follow-up appointment with me for hypertension and arthritis. Early in that visit she paused, became tearful and said: “You know, you saved my daughter’s life. I will be forever grateful.” And, just to emphasize she added: “I mean it!”

The practice of gratitude – the intentional regular expression of appreciation for what one has – has increasingly come to the forefront in popular culture. Oprah shared her practice of keeping a daily gratitude journal on the air and Brene’ Brown has written: “people who have the capacity to lean fully into joy have one variable in common: they practice gratitude.” Further, several studies have demonstrated that the practice reduces anxiety and depression, improves physical well-being and self-esteem, promotes resilience, and enhances empathy.

Though the literature is replete with the benefits of cultivating gratitude, I could find nothing about how to accept it when someone shares their gratitude for you.

How would you respond to the heartfelt words of gratitude that my patient expressed? Here was my response: “Well, thank you, but I was just doing my job.” Her nonverbal response was a both a bit bewildered and a bit disturbed to which she said: “No, I really mean it! You saved my daughter’s life and we are ever grateful.”

As I thought about this exchange later, I became aware of how often I minimize the impact we clinicians have on patients and their family members’ lives. Perhaps because we are so embroiled in the actual skills that go into the practice of our craft, we create some distance from the actual meaning of our work. We may be “just doing our jobs,” but our actions can create deeply significant life changes for those we serve.

I realize now that saying: “it was nothing, it’s my job” disregards the feelings of gratitude that one has for whatever happened in our physician-patient exchange. And, by discounting these, I may be contributing to a reversal of the benefits of gratitude – the opposite of my intention for patients.

This was a powerful lesson for me. Now when patients express their gratitude, I humbly and simply accept it with an authentic and heartfelt “Thank you.”

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