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Editorial: What Do You Say When a Patient Says Thank You?

Leopold, Seth S. MD

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Clinical Orthopaedics and Related Research: August 2019 - Volume 477 - Issue 8 - p 1763-1764
doi: 10.1097/CORR.0000000000000855
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Pop quiz.

What do you do when a grateful patient says, “Thank you”?

  1. Look down, shuffle nervously, offer a small nod of the head, and inch slowly towards the door.
  2. Respond with some earnest version of, “No need to thank me, just doing my job, ma’am.”
  3. Offer a response that minimizes the impact of your surgical intervention, like “No problem,” “De nada,” or “Aww, c’mon.”
  4. Meet the grateful patient’s gaze, give the gratitude a moment to sink in, and—while maintaining eye contact—say, “You’re welcome.”

The operations orthopaedic surgeons perform can become ho-hum to those who perform them, but they are anything but routine in the lives of those who receive them [10]. When an intervention works well, it can be life-changing for the patient. That being so, gratitude from the person whose life has been changed is normal, and expressing that sentiment is important. Surgeons who want to help heal patients (and not merely cure them) might consider that accepting a patient’s gratitude, and embracing that moment of connection fully, is a key part of the grateful patient’s healing process.

I’d suggest that doing so also is good for the surgeon.

Speaking personally, I spent decades with my postoperation patients bouncing from choice (A) to (C) to (B) and back again. As an occasional patient myself, I noticed that my doctors tended to do likewise.

Life changed for me when a physician caring for me gave me a real-life demonstration of option (D).

This physician had improved my health in a fairly dramatic way, and as it became evident that our time together would no longer be necessary—a happy thing—I felt grateful to him, and I said so. I suspect that most of us help our patients in comparably large ways all the time: We help people who can't walk to do so, we get athletes back into the sports they love, and we make it possible for people to use their bodies to earn their livings. While this was not the first time I’d felt gratitude towards a physician who had treated me, it was perhaps the first time a physician had really turned things around in my life in an important way.

Likewise, it was not the first time I’d thanked a doctor, but he was the first one whose response suggested that he understood the importance of accepting someone’s gratitude—in this case, my gratitude—as a part of that patient’s healing.

His response? He looked me in the eye, took a breath, and said nothing for a long moment. Then, while continuing to maintain eye contact, he said “You’re welcome.”

His bearing radiated deep kindness and caring. The way he let the moment unfold allowed expression of the deepest sense of his words. I’d never heard or seen someone do that before, certainly not a physician. His treatment helped me in a big way, and his response made it clear that this truth made him feel good: I was welcome to his care. He’d gladly do it again, should the opportunity or need arise. I was why he came to work, he knew it, and he showed it. It was clear that both the connection we’d made during the course of my treatment, and my gratitude for it, had nourished him.

The feeling in my heart—and the lump in my throat—when I received his “You’re welcome” made me realize what I’d been missing as a surgeon, and the intimacy I’d been withholding from my own patients up to that point. As an important aside, this physician was the first person I heard use the term “intimacy” in a professional and nonsexual way. Though I’d earlier thought I understood his usage of that word (which, unsurprisingly, made me uncomfortable at first, despite his using the term in its plain-sense meaning), it really wasn’t until that moment that I fully grasped what he meant by it: An authentic, deep, and meaningful personal connection.

I began trying out “You’re welcome.” Not just the words, but also what comes before them: Purposefully slowing myself down as the patient shares his or her thanks, trying to feel for a moment a bit of what (s)he may be feeling, and working hard to accept in as deep a way as possible the sentiments offered. What a difference. Clinic days since—which still are not always fun or easy—at the very least are punctuated with moments of deep satisfaction and joy. Allowing those moments of intimacy and connection to happen or, rather, facilitating them with a gaze, a breath, and two heartfelt words, unquestionably lets the last bit of healing happen.

By being more mindful in these ways, I’ve also found that these moments happen as often when the surgical journey did not go as the patient or I had hoped. Some patients are grateful (and express gratitude) even when things have gone badly, as long as the physician walks alongside with a spirit of openness and caring. Perhaps I knew this before, but I did not really “get it,” or at least not fully: Healing sometimes is possible even when curing doesn’t work out.

When surgeons don’t connect to the deeper sacredness of what we do [10], things bite back. Burnout, substance abuse, and physician suicide are much in the news these days, and researchers have offered many solutions [8]. Many of us “give at the office” in more ways than one; I know that I have, and I’ve told some of those stories here before [7]. Good work suggests that connecting to something important outside ourselves mitigates burnout [3]; cultivating intimacy with patients by slowing down and accepting that we have helped them in meaningful ways is one way to make that connection.

I am not the first person to suggest that gratitude—a key part of resilience [4]—may be an antidote to burnout. I believe, though, that what I am suggesting is different. In this setting, what I’ve seen described as gratitude seems mainly to be a one-way street: To prevent burnout, we’re told we need to be more grateful [1, 2, 5, 6, 10]. I’m sure this is true.

What I’m proposing here might be called “gratitude’s other direction”: Don’t just send gratitude out, let some come back in as well. I wonder whether accepting another person’s gratitude may be just as important as feeling it ourselves. By allowing more moments of genuine, deep, intimate connection with those whose lives we touch, I believe we would gain immeasurably in terms of job (and life) satisfaction. Our patients seeking this connection will also appreciate being afforded this last measure of healing.

I know that when a physician changed my life—and accepted my gratitude—I did.


I would like to thank Albert Sheldon III MD, who both improved my health and taught me about healing others. I also am indebted to David Ring MD, PhD, Terence J. Gioe MD, and Mark C. Gebhardt MD, whose thoughtful suggestions improved this essay.


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    © 2019 by the Association of Bone and Joint Surgeons