Patienthood is complicated, which is why only some of the many people who feel grateful for your care show it. When it comes to gift giving, some patients are motivated purely by a need to express their gratitude. Others hope to receive preferential treatment, lessen the power difference, or assuage guilt for being a needy patient.
Let's focus on one specific scenario: patients thanking you for your care with a small gift. Your response matters because research suggests that gratitude can play a role in patients' physical and emotional well-being. Here are a few thoughts from a physician-survivor about optimizing the healing potential of this social interaction in clinical settings.
Before I opened my medical practice, nobody had taught me etiquette for dealing with patients' thanks, other than refusing gifts of value greater than, say, a nice book or tray of fancy treats. If patients insisted on thanking me with an expensive gift, a proper response was to direct them toward philanthropic giving. When presented with a small gift, I accepted it with surprise and smiles. My words stated both expectation of enjoying the gift-This looks great!-and insistence that they shouldn't have. It's an honor to care for you. I was just doing my job.
I'd be lying if I said the gifts didn't make me feel appreciated in a nice way. They did. They also made me uncomfortable because I was just doing my job. The warm feeling and confidence boost were offset by concerns about gift-born bias clouding clinical judgment, and fear of taking praise too much to heart and becoming overconfident. To guard against any of that, I'd quickly put gifts aside as soon as givers left my office and click back into professional mode. My response, while not wrong, missed opportunities for healing, something I discovered after becoming a patient.
Since my first cancer treatment, which I received just days before Thanksgiving 1990, I have felt an uneasiness in my chest that crescendoes as the leaves change color each fall. I've learned to relieve the discomfort by savoring the mundane pleasures of being alive-from the love of family to my blue-glass salt and pepper shakers. Paying it forward through survivorship work helps, too. Daily prayers of thanks play a vital role by enabling me to let go of both survivor's guilt and efforts to answer Why me?
In contrast to my inability to answer the metaphysical "why"-the ultimate reason-for my good fortune, I know the practical "who" behind my extraordinary survival: researchers and the doctors, nurses, and allied health professionals who guide, treat, and support me. As a physician, I believe they are just doing their job, one that doesn't call for gifts. As a patient, though, I feel a need to thank them in tangible ways.
Why the disconnect? I found an answer in the writings of Adam Smith, an 18th-century philosopher. Smith argues in his The Theory of Moral Sentiments, (and I'm paraphrasing) that when people become aware of an act of kindness toward them, they are hardwired to experience gratitude. This complex human emotion creates a sense of debt. The receiver's burden is relieved by returning kindness in some form or fashion to the person who was kind to them. Smith helped me understand that my chest discomfort was more than just bursting gratitude. I was also feeling an unsettling burden of debt.
For 33 years, I've been the beneficiary of a kajillion acts of kindness by the members of my healthcare team. With compassion during my visits, they've acted as if they had all the time in the world. They've answered every question (in-person or via the portal; practical or theoretical) with kind reassurance that they hear my concerns and will answer as quickly as possible. They've helped me save face when I've misunderstood or lapsed in following their instructions. They've noticed shivers and provided a warm blanket. They've offered tissues. They've waited a beat before heading for the door when it looks like a visit is done, just to be sure. And more.
Over the course of each year, the debt of my gratitude steadily builds. Finding appropriate small gifts and then delivering them helps relieve the sense of burden, especially when the receivers look happy about them.
I hesitated to write this column. The last thing I want to do is ruin the easy joy of receiving a gift by turning it into more work. Don't worry. I am not asking you to remember which patients gave you what gifts. Nor am I suggesting you add "thank-you notes" to your to-do list or find diplomatic ways to thank patients for gifts that miss the mark, such as foods you don't eat or knick-knacks you have no room for. So, then, what?
If Smith is correct, all you need to do is to put aside your professionalism long enough to see and hear their appreciation for your efforts...and for you. Let yourself experience that moment as an emotional human being, touched by what your patients perceive as reciprocating kindness. Enjoy the validation that you've developed a meaningful connection threaded together with compassion.
For each grateful patient who brings you a gift, I suspect others also feel grateful but, for a variety of reasons, never offer words of thanks, let alone gifts. Certainly, patients are not obligated to give gifts. If anything, you save time staying in professional mode without the social detour. Forbidding gift giving, though, would be a loss.
Good things come in small packages. For patients wanting to do something special for you, accepting their gifts helps relieve their sense of debt. For everyone in the room, patients' expressions of gratitude confirm a truth easily lost in today's technology: The heart of medicine lies deep within clinician-patient bonds, connections defined by people helping people.
WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Healing Hope-Through and Beyond Cancer, as well as Diagnosis Cancer, After Cancer, When a Parent Has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on "Healthy Survivorship" and "Healing Hope." As she notes on her website (http://wendyharpham.com) and her blog (http://wendyharpham.com/blog/), her mission is to help others through the synergy of science and caring.