Writing for Harvard Medicine Magazine, Sachin Jain, an adjunct professor at Stanford University School of Medicine, explores the profound ways thank-you notes from patients and their family members impact physicians.

Your data-driven road map for physician engagement

'Thank you for giving us what we need'

Jain writes that when he was first starting out at Brigham and Women's Hospital in internal medicine, he began receiving notes from patients.

"It is so hard to find words or ways to thank you for what you have done for us," one note read. "You have a family in Boston to turn to whenever you need it!"

And, according to Jain, he's far from the only physician who cherishes these notes. "Most of us have a folder. Or a shoebox. Perhaps a desk drawer. Or a special, yet aging, briefcase," he writes.

Nancy Oriol, a Harvard Medical School associate professor of anesthesia, describes her collection of thank you notes as "a gift." While Oriol keeps all of her patients' thank you notes, there's one in particular that stands out.

The note is from a patient Oriol treated at a mobile clinic in Boston. "Thank you for giving us what we need," the note said.

"Just seeing that made me think about the role we played in that women's life," Oriol said. "It filled me with awe."

Some physicians, like Joel Katz, a Harvard Medical School associate professor of medicine and director of the internal medicine residency program at Brigham and Women's,  reply when they receive a thank you note. "When I get a thank-you note, I appreciate it. And I try to respond to it," Katz said. He also forwards the notes to the residents who treated them. "Uniformly they say, 'I'm glad I was able to help this person and glad I was able to learn from this patient,'" Katz said.

Michael La Quaglia, a pediatric surgeon and chair of pediatrics at Memorial Sloan Kettering Cancer Center, said many of his thank you notes are from his patients' families, since most of his patients are children. "I think it's good, positive feedback," he said. "But the be-all and end-all is, in your mind, knowing you've done the best you could."

But not all thank you notes are generated by positive outcomes, Jain writes. Many of La Quaglia's letters come from families whose children died in his care. "The fact that I've done something good for somebody is what keeps me going even if the outcome isn't positive," La Quaglia said.

How gratitude can help fight burnout

Andrew Morris-Singer is a primary care physician and founder of Primary Care Progress, an organization that works to improve the primary care experience for patients, doctors, and other care team members.

Much of Morris-Singer's work focuses on physician burnout, and he said patient letters can play a role in alleviating that problem.

"The silver lining in the epidemic of physician burnout is that it's forcing us as a community to have a conversation about the psychological, sociological, and behavioral needs of health professionals," Morris-Singer said. "Doctors are not machines or robots who wear suits of armor. They're people. And they have needs."

Further, Morris-Singer said that he wished more doctors would admit they like receiving gratitude. "You're not supposed to say that you need someone to thank you because that's 'emotionally needy,'" he said. "But deep down we all have the need for others to appreciate us and our work." He added that gratitude from both patients and colleagues "are going to be required to help pull health professionals out of the accelerating burnout spiral that we're in" (Jain, Harvard Medicine Magazine, Autumn 2019).