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Being the random thoughts of a middle aged overeducated physician, father, and citizen. James M. Small MD PhD. Send me a reply to jmsmall @ mycap.org.

Wednesday, December 31, 2008

The Expectation of Gratitude 

The Expectation of Gratitude

Luke 17:11, NIV.
Now on his way to Jerusalem, Jesus traveled along the border between Samaria and Galilee. 12As he was going into a village, ten men who had leprosy[a]met him. They stood at a distance 13and called out in a loud voice, "Jesus, Master, have pity on us!"
14When he saw them, he said, "Go, show yourselves to the priests." And as they went, they were cleansed.
15One of them, when he saw he was healed, came back, praising God in a loud voice. 16He threw himself at Jesus' feet and thanked him—and he was a Samaritan.
17Jesus asked, "Were not all ten cleansed? Where are the other nine? 18Was no one found to return and give praise to God except this foreigner?" 19Then he said to him, "Rise and go; your faith has made you well."

A 49 year old woman came in for biopsy of an ovarian cyst. The gynecologist sent me a portion for frozen section. I overcalled it as a malignancy, and she had a hysterectomy. The next day I realized my mistake and called the doc, who said that he would go tell the patient the good news. “She will be thrilled—she doesn’t have cancer!”

The way she showed me how thrilled she was, was to file suit for excessive surgery due to my error.


Most of us came to medicine to help others. We work long hours, gave much of our youth to studies rather than parties, sacrifice time with our own families. Of course we mostly do get paid well, but on the other hand we are on call and get called at all hours.

Is it too much to expect gratitude in return? Can’t we expect that people will understand how hard we work, how hard we try, how much we sacrifice, how much we worry over their conditions? Isn’t it wrong and unjust of people to not at least thank us?

And what do we often get? Complaints about bills. Complaints about waiting too long in the office. Complaints that recovery is taking too long. And of course complaints filed in court.

As I’ve matured, the realization has dawned that it is unwise to rely on expectations of undying gratitude and thanks from our patients. While gratitude and generosity are the absolute requirements for a happy and joyful life, for some reason many people choose ingratitude, thoughtlessness, or greed. Their choice is beyond my control, and should not dictate my satisfaction with my chosen calling as a pathologist. The scripture for the day reminds me that gratitude is a gift, not an obligation.

Luke 17 is a great story for young doctors and medical students. It teaches that even Jesus himself, performing miraculous cures that nobody else could have done, received only 10% gratitude. In fact, as I look back, I’ll bet my record is better than 10%. Our reward is doing a good job, taking the best care of people who have trusted their lives and health to our care and skills. The few times they come back to thank us are not their obligation, but a grand, generous, and unexpected gift from them to us, to be savored, enjoyed, and appreciated.

Lord, you of all of us most understand ingratitude from those you love. Your people constantly turn from your open arms and defy your loving instruction. We know you want to make us like you, like your Son. Teach us to serve without expectation, to excel in our work with your sons and daughters, to help them in their sufferings, and to rest content whether they think to thank us or not. Amen.
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