When I was a medical student, I believed that the work of being a doctor meant that I would develop strong relationships with my patients and that their gratitude for my work would be my reward.
Fast-forward six years to clinical training. I was in a busy Boston-area teaching hospital. Sometimes I’d see a patient just once. Other times I’d visit their bedside several times a day. But rarely did we develop strong relationships. And rarely did my patients express appreciation for my work. It’s not that I think my patients weren’t grateful. Ultimately, I think that in the hospital setting my patients were focused, quite understandably, on a thousand other matters besides rewarding my sense of self-worth with expressions of gratitude.
But when they did express gratitude, it meant the world to me. The other day I pulled out a yellowed card with bent edges. “It is so hard to find words or ways to thank you for what you have done for us,” wrote one patient. “You have a family in Boston to turn to whenever you need it!!” she added. After a long day or a disappointing setback, I often go back and read this note. Invariably, it makes me feel better. I also think it makes me a better doctor.
There’s a lot of talk these days about physician burnout. A well-known Mayo Clinic study found that, in 2014, 54.5% of physicians reported at least one symptom of burnout. That number was up from 45.5% in 2011. It’s important to remember that physician burnout isn’t just bad for doctors. It’s bad for patients too. Increasingly, research shows a harmful relationship between physician burnout and patient safety. The same studies indicate that these outcomes are linked to patient interactions.
While the causes of physician burnout are many and varied–poorly-designed electronic health records, the treadmill of modern medical practice, the growing load of student debt–I believe strongly that a significant solution to the physician burnout problem will lie in more gratitude and a greater appreciation the people delivering care. Too many people who deliver care feel like they are a number. Genuine, heartfelt expressions of appreciation can do the opposite–and acknowledge the humanity healthcare professionals bring to their work every day.
At the clinical organization I lead, we have begun a program of nominating “Unsung Heroes”–encouraging employees at all levels of the organization to call out people who perform small heroic acts on a daily basis. We use the nomination to publicly recognize these individuals. Within an hour of requesting nominations, I received over 300 nominations, many of which we have shared with all employees. I received countless acknowledgements like this one:
David is the heart and soul of our clinic. He goes above and beyond for every patient every time!!! He drops off bus tokens, gets gloves, coats or a blanket for the homeless or transient, gives up his lunch for patients who are hungry. He checks on his teammates and makes sure they are doing ok.
I’ve now begun to address all our teammates as “Heroes” instead of “employees” or “associates.” It fits.
We have also begun encouraging our patients to share when they have had positive interactions with our staff. The other day a patient wrote, “I call all my caretakers and nurses my Blue Angels (a reference to the uniform colors of our staff) because they are angels sent from heaven to take care of the sick.” After I read these words, I held the note in my hands and read it again. Several times. Then I took a picture of it and tweeted it. A nurse expressed my feelings perfectly when she wrote that receiving notes like mine, “Makes my day regardless how hectic the day was. Love what I do.”
In a recent New York Times article, Dr. Mikkael A. Sekeres admitted that he saves every letter he receives from patients in a file – even letters that question whether he’s done all he can for a patient who has passed away. “It’s almost like a part of the person I cared for, and it seems callous to discard it,” wrote Sekeres.
I have the same file. An informal survey of my colleagues indicates that we all do.
The holiday season is a time to give back, say thanks and show gratitude for the people in our lives. So I’d like to ask patients and doctors alike to take a few minutes to focus on their relationships with each other. Take a moment to talk, to learn about one another, to acknowledge each other’s struggles and hard work.
And then say thanks.