This week I gave a research seminar in my department, the Centre for Language, Culture & Communication at Imperial College London, in which I synthesised some of the ‘lessons learned’ in the course of my research and how this has informed my teaching. It was streamed live, and Julian Lecoeur from ProlificTV has kindly made a recording available here.
I am a great admirer of Paul Fussell’s ‘The Great War in Modern Memory’. Fussell writes eloquently and persuasively about the relationship between language, literature, action and cognition. Interviewees, he found, often recalled incidents from the war precisely because they were ironic: the irony of a man being ‘comforted’ by a friend, oblivious to the terrible injuries sustained by the friend; the stumbling across of a corpse of a family member; and so on, and so on.
This resonates with ironies about how gratitude is received and remembered. Many of the anecdotes told to me by doctors involve irony. The irony of a mental health patient railing against being sectioned by a doctor who feels dreadful about the situation, only to be profusely thanked for ‘saving my life’ by the patient some months later.
In an interview for the Oldie magazine, oncologist Prof. Karol Sikora has recommended being as nice as possible to those that treat your health conditions. “If someone is particularly helpful be appreciative – everybody likes positive feedback,” he told John Sutherland. Sikora is promoting his new book The Street-wise Patient’s Guide to Surviving Cancer in which he advises patients to charm their doctors if they hope to persuade them that they are worth ruinously expensive cancer drugs. NHS staff are “dedicated and remarkably caring”, he said, “and they naturally respond well to pleasant patients.” His advice,though to “tell someone they have a lovely smile,” might come across as a bit obsequious though, not to mention downright creepy in some situations.
Happiness is an A3 page and a sharpie. I have made a start on mapping various theorists I’m reading against disciplinary areas. Two distinct camps are emerging: those that look at gratitude as a form of capital (the Maussian ‘gift’ literature, Bourdieu) and those that see moral generosity as a refusal of reciprocity (Levinas, and to some extent Bakhtin). The first camp sees gratitude as a form of accrual and the second a form of sacrifice. The ‘accrual’ camp as being quite cynical about gratitude: it is characterised as self-interested (although not always consciously). In contrast, those that view generosity as a form of moral perfectionism for which the recipient need not enact gratitude are very idealistic.
I recently paid a visit to the University College London Hospital (UCLH) archives in Euston to discuss gratitude and see some of the archive’s holdings. Annie Lindsay and Penny McMahon have charge of a vast amount of material. Some fascinating highlights are on public display in UCLH’s highly recommended heritage trail. Annie and Penny gave me an insight into the kinds of documents that are preserved. Patronage, of course, is well documented, and this has an enduring legacy in a number of wards in hospitals being named for their donors. Complaints are also kept on record although, interestingly, Annie pointed out that in the past this largely depended on the diligence of the superintendent in charge.
A few weeks ago I had the opportunity to present some of my work on the gratitude expressed in the Frimley correspondence to GP trainers and trainees from West Middlesex Hospital, whose two days away were delightfully themed around ‘happiness’. It was a nice way to hear some stories of gratitude from the frontline.
We had a lively discussion about whether patients are morally obliged to feel grateful. Lots of the delegates were uncomfortable about the word ‘moral’, although most agreed that patients had lots to be grateful for. The overwhelming majority felt that patients should be grateful for the NHS in general, rather than specific practitioners.
Cards displayed on the ward, chocolates in the common room… but there is an increasing trend to use Facebook as a collective noticeboard to proclaim gratitude. Showing Thanks is a recently established webpage for conveying gratitude to healthcare professionals involved in maternity care and childbirth. Mothers have been posting their stories on this Facebook site and then Rachel Ellie Gardner has taken it upon herself to let healthcare trusts know when a member of their staff has been thanked.
Anecdotally, we know that staff involved in obstetrics get a lot of gratitude. Even if a birth has been dramatic (and, let’s face it, most births have elements of trauma), the outcome is usually happy.
Jonathan Tomlinson is one of the most eloquent, sensible defenders of the NHS today. Writing on his blog, A Better NHS, he recently tackled the embarrassment doctors feel about accepting gifts. Entitled Giving and Receiving, the post takes the form of a reconstructed dialogue between Jonathon and an erstwhile colleague who says, “Accept the presents graciously, it means a lot to them and it should mean a lot to you too. Your patients care about you, and caring for others is one of the things that makes a hard life a bit more bearable. For some of course, you’ll have gone the extra-mile or diagnosed them with something really important, and for others there’s precious little kindness in their lives and you’ve been a part of that.
These amazingly creative cupcakes were made by the aunt of a young tonsillectomy patient for the surgical ward and theatre team. It meant a great deal to the staff. Dr Ruj Roplekar, who was one of the recipients, said, ‘I was delighted that someone had shown that degree of appreciation for all those involved in the care of someone she loved.’ When Ruj posted this image on Facebook, it was interesting to see that one of her fellow medics urged her to save the photo as evidence for the ARCP of the ISCP (that’s Annual Review of Competence Progression for the Intercollegiate Surgical Curricular Programme).
… and concludes that it is not a good idea. The article, which cites this blog, is here. It looks like sensible research on gifts from patients has not been done since the 1980s. The ethics of accepting gifts are well rehearsed and there are clear guidelines. An understanding of why gifts are offered, however, is lacking. There is much speculation about cultural reasons, or potential bribery, but getting the heart of the supererogatory actions that inspire acts of gratitude would help to inform policies on these issues, and also give us an insight into what patients think about the issue.