There Is More to "Thank You" Than Meets the Eye.

Abstract

Sometimes I blush when a patient says, “Thank you.” As a medical student, I constantly feel thankful to patients for the opportunity to be part of their care, so I feel a little embarrassed if a patient thanks me first. I also worry that patients may feel obligated to be thankful when the opposite is true—it is my privilege to be involved in their care. Recently, I had a short foray as a patient. After several appointments and mounting pain, I accepted that I had to go to the emergency department for an urgent (but not serious) medical procedure. I was exhausted, worried about setting foot in the emergency room in the midst of a COVID-19 surge, and plagued with stress about how I should have been studying for the United States Medical Licensing Examination Step 1 all day instead. In the emergency department, I was swiftly assigned a bed. I laid on my side wondering if I could squeeze in a nap, but to my surprise, a resident came over quickly. I could have sat up, but before I could manage the painful maneuver, he crouched down to my eye level. I thought about the number of times I had been in his position, squatting precariously in a narrow space, wondering if the patient noticed my awkward positioning. I will never worry about that again; speaking to him directly, as I lay curled up on my side, felt natural and comforting. The procedure was painful. I cried and felt embarrassed. Through puffy eyes I sobbed, “I’m sorry!”—a phrase I had heard so many patients say when they did not need to. The attending physician replied that it was okay, I could cry as loud as I needed, and invited me to scream. When the procedure was over, we discussed follow-up instructions, and I admitted to feeling distressed about managing my recovery while studying for Step 1. She looked at me with soft eyes and said, “I’m so sorry … that is so hard.” The words were simple, but her voice communicated her true sympathy. As we wrapped up, my tears were still flowing. I felt overwhelmed with gratitude and blurted out, “Thank you so much!” The warm words bubbled up spontaneously from deep inside. I felt grateful for how the team listened, did not dismiss my outside stressors, and spent precious moments helping me heal. My gratitude was magnified by vulnerability. Usually, I feel control over my body. But then suddenly, I depended on these physicians for care. Saying thank you was a tiny action that I could contribute, and it helped me grasp a sliver of agency. Giving thanks was emotionally soothing because it helped our interaction feel more reciprocal; the exchange of gratitude was an unconscious recognition of partnership. For the first time, I truly empathized with patients in their moments of thanks. As a patient myself, I did not think about the surface-level embarrassment that I had worried about as a student. I did not feel obliged to be thankful, and it certainly did not matter whether the people I thanked were learners or not. My gratitude was not motivated by acknowledgment; it was driven by the profound emotion I felt after caring interactions and my desire for reciprocity. Next time a patient thanks me, I will not let self-conscious worries diminish their words. True thankfulness reflects deep humanistic connection and is unburdened by the hierarchies of medicine. Gracefully appreciating gratitude from others is an important lesson in the art of building a patient relationship. In the future, I will look patients in the eye and fully appreciate that solidification of partnership in the departing moments of a connection. Acknowledgments: The author wishes to thank Dr. Kunal Bailoor, Jean Torres, and Elena Lorenzana.