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Tuesday Dec 20, 2016

Can a Sense of Gratitude Make You Happier?

With Thanksgiving over and the end of the year fast approaching, these weeks can feel hurried and rushed. However, it also can be a wonderful time to pause and reflect. We can take stock of our lives, reminiscing on the ups and the downs, and be grateful for our blessings.

When I was in medical school, a patient taught me a valuable lesson. In the exam room, she told me a heart-wrenching story about struggling to care for and obtain custody of her granddaughter after she'd lost both her husband and her daughter in a car crash. Despite the enormous stress in her life, she said she was getting by. In addition to seeing her care team, exercising and eating well, she kept a journal where she wrote her prayers and recorded things that made her happy.

Keeping thank you notes from patients and words of encouragement from colleagues helps me keep things in the proper perspective.

Not a diarist, I was intrigued when she told me that she found her journal to be the most helpful part of her self-care plan. She said her little book helped her get through the hard days and cherish the good days. I hadn't yet heard the term "gratitude journal," and I didn't think to apply this practice to my own life at the time.

Years later, the idea returned to me. Working full time, I found myself feeling ever more stressed as my practice ramped up. It became harder to bounce back from the challenges of being a new physician caring for underserved patients. On the other hand, it became easier to gripe to colleagues about a hard day. I often felt drained when I left work. I felt even worse if people asked me about my day because I often couldn't remember many positive things. I knew there had to have been some, but I couldn't put my finger on them because I wasn't taking note.

To avoid getting worn down by the daily grind, I started looking for happy moments. I found myself saving every drawing my pediatric patients gave me, and posting them on my wall. I saved sticky notes with "thank you" and "good job" on them. As I grew to know my panel better, I took special note when a patient shared a success story or a deeply personal moment with me. I started to save nice emails from my boss and positive feedback in a "happy" inbox folder.

I realized I was keeping my own gratitude journal.

So I formalized the process. I started writing three happy memories from each work day before I packed up to leave. It allowed me to record positive moments and reframe my day. Instead of labeling each day "stressful," I started counting the happy moments and positive impacts I had. The journal became a ritual, a way of reviewing the day, shedding stress and leaving work at work.

I found this ritual uplifting, and it's no surprise. There has been increasing public interest in the ideas of positive thinking and gratitude. People have dedicated entire websites and books to the theory that we can be happier if we express gratitude. There was even a social media phenomenon, the #100happydays challenge, which is essentially a photographic gratitude journal. (Yes, I did it.)

Gratitude is being studied, and there is increasing evidence that a daily gratitude practice is good for us. Martin Seligman, Ph.D., of the University of Pennsylvania found that writing a gratitude letter helped study participants feel happier for a month at a time.

Other research suggests gratitude may help people be healthier, too. Studies conducted by Robert Emmons, Ph.D., of the University of California, Davis, and Michael E. McCullough, Ph.D., of the University of Miami showed that people who kept weekly gratitude journals experienced more happiness and complained of fewer health problems. Specifically, Emmons proposed that practicing gratitude can improve immune system function, blood pressure, pain scores and sleep, in addition to subjective happiness and compassion.

Gratitude can help people function better at work, too. In a more positive environment, people tend to work harder and derive more satisfaction from their jobs. Adam Grant, Ph.D., of the University of Pennsylvania showed that employees performed better after their manager gave them a pep talk that included gratitude.

I posit that a gratitude journal can be an excellent tool for the practicing physician. I challenge you to start a gratitude journal specifically centered on work. To create a ritual, write down three happy memories from the day before you leave work. You could start by writing just a few times a week. The memories could be positive patient outcomes, when someone thanked you, or a hug from a patient. It could even be a prior authorization that went more smoothly than expected -- anything that brought you a moment of joy.

As for me, I will keep writing work-related gratitude entries, especially on hard days at clinic. Recently a patient arrived 40 minutes late on a day that I was already overbooked. I ran behind schedule, and then one of my most challenging patients needed to be admitted to the hospital but refused to go. By the end of the day, I was exhausted and had many charts left to complete. Before I left, I took a moment to remember some good moments. I had a good discussion about health goals with one patient, I found out another had quit smoking and I got to see a precious 2-week old (the patient who arrived late). Writing down these moments helped me reframe my day and cherish the good moments.  

Melissa Hemphill, M.D., is faculty at Providence Oregon Family Medicine Residency and practices in an urban underserved clinic in Portland, Ore. You can follow her on Twitter at @MhemphillMD.

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