Authentic gratitude 

By Carolyn Cumpsty Fowler, PhD, MPH, PCC & Lee Daugherty Biddison MD, MPH, Johns Hopkins Medicine

Last week in clinic, a patient offered an expression of gratitude that still resonates. He gave me a manila envelope containing a watercolor portrait that he painted of me—I was speechless. When I reflected on this experience with my colleague Carolyn, we realized that the impact of the gesture was because of his generously expressed gratitude—and the gift was just icing on the cake.

Expressing gratitude

Expressing gratitude is a simple yet powerful practice that can strengthen relationships, build trust, create meaningful connections, and support well-being. How gratitude is expressed matters just as much as the words themselves. Thoughtful approaches can elevate a basic or transactional “thank you” into a deeply impactful experience. Here are a few we’ve found helpful:

Authentic gratitude

The most meaningful expressions come from a genuine place, not from obligation or an attempt to create a certain impression. When gratitude feels natural and sincere, it resonates more strongly with the recipient.

Specific gratitude

General statements like “great job” are positive, but they lack depth. By clearly identifying what someone did and the impact it had, gratitude becomes more personal and credible. For example, recognizing someone’s calmness during a stressful situation highlights both their action and its value, making the appreciation more memorable.

The context and delivery

Public acknowledgment can be powerful, especially when it highlights behaviors that improve team dynamics, such as active listening or creating space for others’ ideas. However, not everyone enjoys public recognition. Tailoring appreciation to individual preferences ensures that it’s received positively rather than causing discomfort.

Unexpected gratitude

While politeness dictates thanking someone for a direct favor, acknowledging everyday efforts or unseen contributions can have a deeper impact. For instance, appreciating a colleague’s courage in admitting uncertainty is not only validating, it also promotes a culture of learning and openness.

Avoiding token gestures

Generic rewards like pizza or small perks can feel superficial if they fail to acknowledge the true effort behind someone’s work. Thoughtful recognition—especially when it reflects the depth of contribution—carries far greater weight than routine gestures.

“I appreciate you.”

There’s a subtle but impactful distinction between saying “I appreciate it” and “I appreciate you.” The former focuses on the outcome or task, while the latter acknowledges the person behind the contribution. Expressing appreciation for the individual fosters a deeper emotional connection and introduces an element of vulnerability that strengthens human relationships.

In summary, effective gratitude is authentic, specific, personalized, and thoughtful. When done well, it not only recognizes effort but also reinforces values, builds trust, and enhances both individual and team well-being.

We remember genuine expressions of gratitude, with or without a watercolor portrait to remind us of them. Their impact stays with us long after the words are spoken.

Authors’ note: For more on gratitude and well-being, check out our podcast here. 

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.