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. This sits uncomfortably with some of the literature (e.g. Simmons, 1979, Moral Principles and Political Obligations) in which it is argued that there are difficulties with expressing gratitude to an institution, especially if the individuals that form it are merely carrying out their duties. Most of those joining in the discussion thought that gratitude was owing to the NHS because patients got a lot more out of it than they put in. Some invoked comparisons with other parts of the world, making the case that access to the NHS is a privilege and definitely something for which to be grateful.
When it came to receiving gratitude, the most memorable gifts or cards came from patients from whom it was unexpected. An example was given of a man that had to be sectioned and was incredibly angry at the time, so a card saying ‘thank you’ a few weeks later was particularly touching. Homemade food as a currency of gratitude was also prominent, especially amongst the Asian community. Receiving gifts was confirmed as a particularly tricky issue for doctors with high potential to cause offence by refusing gifts, but sometimes it’s tricky to tell whether gifts do indeed come with strings attached.