Being thankful for less thanks

A few weeks ago, I found myself in a discussion with a handful of other psychiatry trainees about the earliest stage of our careers – the first few years after medical school that we all spent in general hospitals, mastering the very basics of doctoring. Taking blood, listening to chests, scurrying to write in the notes during the ward round as the consultant whisked from bed to bed. Though the work was relentless and unforgiving, we remembered it fondly.

The discussion turned to the differences we’d noticed between working as psychiatrists, and working back then, as general medical doctors. One difference, we realised, is that we don’t tend to get thanked as much. Now don’t get me wrong – we certainly weren’t complaining, nor were we incinuating that our patients are thoughtless or unappreciative – they are anything but. In addition, though I find thanks as heartening as anyone, it’s never been one of my reasons for being a doctor. All we were doing was musing on an observation.

The thing is, in general medicine, doctors sometimes find themselves drowning in praise from patients. Stereotypically from little old ladies who can remember healthcare before the days of the NHS, the hefty thanks can be quite disproportionate to the amount of genuine effort the doctor has put in, or the effect he has had. We got thank you cards, chocolates, and presents at Christmas. I once knew a GP who had three cupboards rammed full of whisky from patients.

In psychiatry, this level of adulation is entirely less common. We seem to lack the aura of assumed benvolence, omniscience and trustworthiness that doctors from other specialities possess.

I pondered why it is that psychiatrists don’t tend to get thanked a tremendous amount in comparison to doctors in others specialities. I could think of a few reasons – and here’s the crux – each of these reasons served as a reminder to me of my real motivations for being a doctor – of things far more important to me than getting the occasional thank you.

Firstly and most obviously, many of our patients are often far too unwell to even consider showing us gratitude. Torn by sadness or engulfed by suspicion and perplexity, the last thing they want to do is thank the mental health professional who is asking them a lot of strange questions and admitting them to an often imposing, unfamiliar hospital. This serves as a constant reminder to me that what my patients go through is not easy; that the suffering of the people I treat is as profound as any I will ever see and is as worthy of as much help.

Secondly, the families and friends of our patients, who in other medical specialities are so frequently the ones giving thanks in lieu of the incapacitated patient, are often nowhere to be found – long since harried away by illnesses that are hard enough to understand, let alone cope with in a loved one. After two straight weeks of psychiatric night shifts in A+E last year, I could count on the fingers of one hand the amount of people I saw who had brought someone to accompany them on their trip to the hospital. Though many amazing families weather the storm, many more aren’t be able to get through it. This reminds me that our patients have been shorn of the social support that most people would take for granted when they fall ill – and that helping rebuild those bridges is an important tool for recovery.

Thirdly – and for me, most powerfully – I think patients are reticent to thank psychiatrists because some of them have suffered badly in the hands of mental health services in the past. Some of our more coercive and invasive practices feel violating even when performed by caring, thoughtful professionals who have the best interests of the patient at heart – but I’d be naïve to believe that there aren’t impersonal, malignant doctors and nurses out there who make being mentally unwell a nightmare. Having had their illnesses for decades, many of the patients I see will no doubt have been exposed at some point to practice so shameful that to even trust another doctor again would be hard – let alone to feel like thanking one. Recognising that fact, and building that trust back by listening to our patients and facilitating the choice of care they want as far as possible, is a far more worthwhile goal than appreciation.

So, although being thanked for what I do has never been a guiding focus, thinking about why it doesn’t happen so much now I’m a psychiatrist can help me appreciate far more meaningful motivations for doing my job – and hopefully, to do it better.

About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

3 Responses to Being thankful for less thanks

  1. I wrote my psychiatrist a thank you note when he left the CMHT a couple of months ago. I did feel a little bit embarrassed doing this and worried that it might seem disproportionate from his perspective: I only saw him for half an hour every 4 to 12 weeks (depending on my level of wellness) and I imagine I was one of his least labour-intensive patients. But from my perspective, his manner and approach to my care/treatment had made a massive difference to my life during a difficult year. It was partly because my past experience with psychiatrists had been nowhere near as positive, that I felt compelled to write to tell him this.

    It’s interesting to read your take on this. I’m still a bit wary of psychiatrists but I know there are many good ones out there and I’ve sometimes felt a bit sorry for them as I imagine being a psychiatrist must be a very thankless task at times for the reasons you’ve mentioned. It’s great that you’ve reflected on this in such a considered and positive way and that you show such empathy for your patients.

    Reading your blog and Tweets makes me a bit less wary of psychiatrists too – thank you! 😉

  2. Patient1 says:

    I am somewhat conflicted with regard to thanking Psychiatrists. I will thank someone who I feel has been respectful towards me or who has given me time to speak but often the needs of my psychiatrist have not coincided with how I define my own needs.

    And lets be real here – this is NOT a relationship of equals – a psychiatrist can and does lock people up in an environment that can be as cruel as it gets.

    My previous consultant was paid approx £100k p/a and as a very senior Dr in a totally paternalistic environment was simply never challenged by anyone in the MDT as far as I could tell. In this Trust when savage cuts came in the Psychiatrist decided to negotiate their own packages as they see themselves as somewhat different to everyone else ( being Drs and all that). Psychiatrists are responsible for accepting and promoting the most dubious aspects of the DSM and clustering that has led to the system of payment by results and turned patients in to currencies there to fund the services.

    I did genuinely trust him for the first few years because I needed to. But when there is a closed culture and one person gets to decide how the world sees you by virtue of a diagnosis then this affects how you see them.

    So I would not thank a Psychiatrist beyond how I would thank anyone else in the world and significantly less if I felt his/her actions had caused harm. And on a ward I am certainly not going to thank someone who helps perpetuate inhumane and unsafe surroundings whether junior or senior.

  3. Anon says:

    Really good points raised. I would like to mention some other things that might contribute to a lack of thank yous. I would think twice about sending a thank you card to a psychiatrist because, unlike with any other medical speciality, I would be afraid that it would be misinterpreted. Would I be seen as trying to ‘manipulate’ the psychiatrist? Dare I send a thank you to one psychiatrist when I didn’t send one to his predecessor…and run the risk of being labelled as someone who ‘plays staff off against each other’? If I send a thank you card now, but at some point have reason to complain, am I laying myself open to accusations of idealisation and devaluation? Will a thank you card result not in a ‘pleased to be appreciated’ doctor, but rather an increased level of suspicion towards me as a patient? And those fears aside, while I’m waiting 6 months for a delayed benefit appeal to go through, can I afford a card? And even if I can, while my main symptoms may have been treated, will I yet be well enough to overcome difficulties with paperwork to take thank you cards to post boxes?

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