In a previous article we explored the evidence-base for gratitude improving a number of physician wellbeing measures. We also illustrated a number of approaches that may help us appreciate what we have more, reduce our stress by shifting perspectives, and even potentially reduce physician burnout. In this article, we illustrate 7 physician gratitude practice ideas that may help. We also note that no one intervention is a panacea for the core systemic issues causing the current epidemic of physician burnout and moral injury.
Yet, we still believe that until the systems change, we physicians can use the evidence base for what works to help each other get through this. And there is evidence that gratitude practice affects numerous measures of wellbeing.
Read more about this evidence base in our article Gratitude for Physicians.
So, what science-based gratitude practices do we use that help the Physicians Anonymous crew?
Many studies over the last two decades have found that people who express gratitude are happier and less depressed. A “Thank You” note can be given to the recipient, or just written and kept. It seems that the act of expressing, rather than the delivery, are the active ingredient.
While one thank-you note is not the kind of physician gratitude practice that leads to lasting, positive cognitive change, starting with that one note could be the beginning of a habit of counting our blessings in writing.
By following three good things or the three blessings practice, physicians can practice daily gratitude. This means:
Doing this regularly—even over the course of two weeks—once a day will allow you to begin to recalibrate your gratitude lens so that you will start looking out and seeing more gratitude. Like noticing more red cars after you’ve just bought a red car, your shift in attentional bias will start to reveal good things in life. This, in turn, may reduce stress, increase happiness, and start to tackle burnout.
Once a day, take five minutes to write down three good things or three blessings that happen in your day
This one is more of a commitment but has the potential to become a positive habit. Based on happiness research, writing a daily list of 5-6 things that we are grateful for seems to make a difference.
It could be anything. On good days, I note with gratitude the difference I made in a patient’s life; the beauty of a ray of sunlight through the clinic window; my salary. On hard days I can appreciate my knees, my eyesight, my lungs, that I didn’t get sued today.
My practice is to write down 6 items every day before I go to sleep. That way, I start my slumber in an attitude of gratitude. As soon as I can in the mornings, I review my gratitude journal so that I start my day reminded of the good things in my life from yesterday.
In my first month journaling, I wrote nearly 180 unique gratitudes. In a year, that added up to over 2,000 things in my life that I am so grateful for.
Physicians are in a privileged position. We get to help sick people using the art and science of medicine. Patient encounters are a unique opportunity for physicians to explore gratitude.
Leif Hass, MD, in his excellent article on cultivating gratitude, describes how physician gratitude practice can be present in their patient and family encounters:
In this way, we cultivate both gratitude and social connection, two powerful antidotes to misery.
Mark Greenawald, MD, a family physician, in a recent AMA webinar on physician wellbeing, described a letter he received from an upbeat cancer patient who remained incredibly upbeat in the face of terminal cancer.
The patient wrote:
‘Hey doc, you also won the lottery when you were born. Don't wait until you're dying to remember that and be sure to pass it forward.’
In contrast to those who have gone before us, our very existence is a constant benefit. However it is a benefit that we adapt to easily, so that it is taken for granted.
The last hour meditation is an opportunity to step back and remember that each moment might be our last. Would we rather have regret, shame, anger, guilt in this moment; or perhaps something more positive? We might ask ourselves: If this was the last time I was doing this, how would I be present differently than I am right now?
Dr. Greenawald described a second meditation in the same webinar: the life of your dream meditation. This, he explains, means that there are “billions of people on this planet living right now for whom your life, my life, is a life of their dreams… Just having that shift in perspective and realizing how incredibly fortunate we are, allows us the chance to step back and live in that perspective.”
It’s hard to imagine that there could be any blessings hidden within the slow-motion train crash that was and still is COVID-19. What, indeed, could be good about a global pandemic, millions of lives lost, millions more lives disrupted, economic downturns, and overwhelmed healthcare systems?
With some distance, people have indeed reported silver linings to the COVID cloud. This might include more time with family or learning new hobbies.
For physicians and other health professionals, this might also be seen in shifting perspectives about what is important in life and career; an increasing recognition by the general public that healthcare workers are human beings too; a global investment in health research; multiple innovations leading to the COVID vaccines with expected spin-offs into other areas of medicine.
On a personal level, I have completely reappraised my life priorities. I realize that my family, friends, and health are more important than killing myself in medicine.
Even the best gratitude practice for physicians (or yoga, corporate massage, team away days, or resilience building) or any other one intervention is a panacea. Writing this, I am acutely aware of the irony of trying to get burned out overworked and underappreciated colleagues to appreciate what they have when the systemic problems are the main cause – and are stubbornly resistant to change. After all, why would a CEO with shareholders and a board want to corporate reduce profits by hiring more staff to meet demand — just because a few unresilient HCPs are burning out/quitting/going off sick/getting addicted/killing themselves?
Dr. Greenawald notes that gratitude practice is a good thing, but cannot alone tackle the epidemic of physician burnout.
He says, “It’s important for people to be appreciated, but gratitude can ring hollow if we don’t follow through by hearing, preparing, protecting, supporting and caring for those people who are doing work in this challenging time”.
Medical leaders and health organization senior leadership teams need to ensure that that gratitude translates into listening and then action to tackle the root causes of physician burnout and moral injury.
For now, the bottom line is this: If you participate in a gratitude activity, don’t be too surprised if you don’t feel dramatically better immediately after the writing/meditating/patient encounter (but heck, you might!).
Be patient and remember that the benefits of gratitude practice, like starting exercise or studying a new subject at med school, might take time to kick in. But once they do – within a few weeks perhaps – you will notice a subtle improvement in your outlook.
In this article, we described 7 evidence-based gratitude practices for doctors. We hope that these may, at least in part, help doctors cope a little better with the unprecedented and inhumane demands that modern medicine brings upon its own healers.
Any physician wanting to access confidential and anonymous support is welcome to join the Physicians Anonymous private groups or support groups.
