Takeaway
Sometimes interactions with patients may feel challenging. Expressing gratitude to patients for positive encounters may help reduce stress and bring joy.
Passion in the Medical Profession | August 14, 2023 | 3 min read
By Megan Gerber, MD, MPH, Albany Medical College
The patient was sitting in the exam room unmasked, coughing, and sneezing when I entered. My second question, after asking him to put on a mask, was to ask him if he had tested for COVID before our visit. He looked at me with disgust and replied, “I didn’t test for COVID and I’m not going to!” He was certain he had allergies but told me he was really just there for a z-pack and needed to get to work so could we please move this process, whatever it was, along, adding, “I know myself; I get this every year.”
The morning seemed to continue in this vein with complaints about our phone center peppered in, “I was put on hold forever.” (I’m sorry, I’ll pass on your feedback.) “CVS says you didn’t send my prescription.” (I did, twice.) I felt disposable, impotent, the ever-crushing weight of the over-not-over pandemic and dysfunctional healthcare system causing me to drag. The nurses on my pod and staff at check-in were feeling it too. We were all trying our best. Did that matter anymore?
I braced myself, took several deep breaths, and knocked on the next door, apologizing for being a few minutes late in a way that I hoped sounded sincere and not bitter, “So very sorry, difficult morning.” Was I imagining this happy, open face? “Why doctor! It’s so good to see you, how are you?” I felt a wave of something. Relief? Dopamine? Certainly, in over thirty years as a primary care physician, I’d been greeted kindly many times before. What struck me after that visit was that the negative voices often resonate more powerfully than the positive ones.
Rising incivility everywhere hasn’t spared healthcare. Patients are frustrated and often direct negative emotions toward those who are trying their best to help. But are we hearing the negative voices too loudly and taking them to heart?
In fact, our brains have a negativity bias, a tendency to attend to, learn from, and use negative information far more than positive information. How can we focus more on the positive experiences we have throughout the day?
A silly, playful idea came to me. I remembered my children receiving colorful stickers at their pediatrician’s office and how excited they were to receive them. Could we recognize and acknowledge patients who make the day brighter? Could this go wrong? If we only give stickers to some patients would this be inequitable and based on misinterpretation of patient’s interactions related to their personal attributes, culture, communication barriers, and/or health conditions? Would we be more likely to give a sticker to patients who look and sound like we do?
Understanding and being aware of the potential for bias, we decided to try it. I found a roll of a thousand “kindness” stickers. Our first patient to get a sticker couldn’t wait to show her grandchildren and a Nepalese patient smiled broadly when the sticker’s meaning was translated. Patients love the stickers!
Giving out stickers became a gratitude practice, enabling us to recognize and dwell on positive encounters; it rejuvenates us and strengthens our resolve in the face of the negative encounters. Staff have put kindness stickers on their ID badges. Small acts of kindness matter but we also need to take a moment to see and experience them.
Giving stickers taught me that deliberately recognizing, even briefly, positivity and acts of kindness reduces the pain and exhaustion when negative things happen. Patients who are angry and frustrated still need care; understanding our negativity bias can help sustain us through difficult times. Here are three things to keep in mind:
1. Incivility is on the rise everywhere. Angry and/or frustrated patients still need our care.
2. Our brains have a negativity bias, and we take negative reinforcement to heart more than positive reinforcement.
3. A gratitude practice of recognizing positive experiences can help reduce the fatigue and distress challenging patient interactions cause.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.