Monday, 18 August 2014

Whatever Happened to Gratitude?

'Yes, it's so rare to receive thanks from people, that a bunch of flowers, one time, made our team cry.' I was sitting with some friends, sheltering from the rain during a good old British BBQ. I had started the conversation because I had been taken aback by a comment from an NHS Manager, who was asking me to tell him about my recent experiences in Mental Health Services. I mentioned one or two issues that had happened during my five years in the local area, but overall I expressed my profound gratitude to my Care Co-ordinator, my DBT Therapist and my GP practice. His response was such shock, that he stopped me in the middle of my story to tell me that such positive stories of treatment are unusual. It was then it occurred to me, it wasn't the first time I had come across this shock at gratitude when talking to healthcare professionals. My friend at the BBQ is an OT working in Palliative Care, she confirmed that thank you cards, etc are exceptionally rare.


As we discussed whether or not we give thank you cards or small gifts to people helping us, we came to the conclusion that as a profession, Teachers do really well from thank you gifts, compared with other public service professions. I know this from my own time in teaching. Teenagers, in particular, are very good at saying 'Thanks' (at least to anyone outside their immediate family who they feel helps them) and I still have so many cards and thank notes from my students. The chocolates and flowers are long gone. I was a Secondary Teacher for only five years.

When I completed my DBT skills group I gave the team a large box of chocolates to share and a thank you card. I did the same for my one to one therapist and for my Care Co-ordinator. I have always given Christmas chocolates or biscuits to my GP and continued this with my Care Co-ordinator and Therapists. When I was finally discharged from Services in July I gave my Care Co-ordinator a small gift and some chocolates. After a relationship both of us had committed to for over four years, not saying 'thanks', to me would have been unthinkable. Yet, once again, she told me it was so rare to even get a thank you card from Service Users.

To me it is not just polite and good manners, although it is. It actually acknowledges that we were all committed to helping me manage my condition. I wouldn't have learned my skills, or managed the ups and downs of the last four years without these people. I give gifts to my friends. The relationships we have with those who care for us are equally as important, for the time we need services. That is why discharge is such a painful process. Especially if it is effective, both sides have invested emotionally as well as in terms of time and effort. I expect to be praised for the progress I make in managing my condition, why shouldn't my Care Co-ordinator expect to be praised and thanked for her part in that process? We absolutely know when things go wrong, we are willing to let anyone who will listen know about it. However, when things are going well with our treatment, I think sometimes it is easy to slip into the 'They're only doing what they're paid to do' view of good practice.


I think there is a wider principle that affects us in our therapeutic relationships. Gratitude generally has fallen out of favour in our society. In the US customers are better at complaining directly for bad service. In the UK, we think we are less forthright, but any time spent on any social media, or bus, will tell you that we are no slouches in the complaining department. Another of my friends told me she recently felt she should phone customer services at TESCO to tell them that she really felt their online service was a godsend. She spoke to a call centre worker, who did a double take, then thanked her for her comments. Later on that day, she received a phone call from the Supervisor who was checking she had made the call. Again, she was told that gratitude was so rare.

Don't get me wrong, I think pointing out when things are wrong in the service we receive, is important so that others don't suffer from poor service. We need to be able to know when things are going wrong in order to fix them. How often, though, do we feedback when we have received good or excellent service? It is all very well for services to speak to one another about 'best practice' but in operation, what does best practice look like?

When I read on social media the many stories of those who experience lack of people skills, lack of compassion and lack of professionalism in the care they have received, it makes me more grateful for the good experiences I have had.

I was brought up to show gratitude. We never went visiting, or for a meal without bringing something for our hosts. I witnessed my parents buy gifts for staff in hospitals that were thoughtful, hand creams, chocolates, things to be shared among teams. We gave Christmas bonuses (or boxes) to the milkman, paper boy etc. And we always gave soap or chocolates to our teachers.

I wonder if it is a practice that is dying out. I do know that when I was at the beginning of my battles with BPD and Depression I was not emotionally equipped to think about the people around me, I was too busy just struggling to get by. But today, I have made such progress that when I am able to look back and recognise how far I have come, I am also able to acknowledge the part that the healthcare professionals involved have played in my recovery. Why wouldn't I say 'Thank you'? My whole life has changed, with their help.

The NHS is under attack from all sides. When I look at the alternatives I realise that, whilst there are problems and services that are performing below par, overall I am grateful that I have been able to access five years of intensive treatment without a huge debt burden to worry about. The NHS means that I can access physical health services that enable me to manage my emotional health more effectively, again, without having to worry about finding the money to access this help. I want to be able to highlight the good practice and positive relationships I have experienced in my relationships with healthcare professionals. If you haven't done so in a while, look at your therapeutic relationships and try saying 'thanks' when things are going right. It may just reinforce best practice.