Imperial College London


Faculty of MedicineFaculty of Medicine Centre

Principal Teaching Fellow





Ms Carly Line +44 (0)20 7594 5178




281Sir Alexander Fleming BuildingSouth Kensington Campus




Expression and Reception of Gratitude in Healthcare

The National Health Service (NHS) in the UK has come in for increasing criticism over the past few years, both from within and without the system. Newspaper reports tell of neglected patients and money-grubbing GPs, and concerns about a target-driven culture, privitisation and staffing levels create an impression of a system at breaking point. Yet, the NHS is a cherished institution about which many feel passionately defensive. One of the drivers of morale in a beleaguered NHS is the gratitude that patients express in a myriad of ways, almost all of which are informal. Whereas there are numerous systems in place for making a complaint, the ways in which people say 'thank you' are often 'under the wire' and rarely receive formal recognition. 

My research investigates the ethnography of gratitude within healthcare. How is gratitude expressed? How do expectations of gratitude square with a system based on entitlement to treatment? Do the informality of expressions of gratitude give them a sincerity that would be lacking if gratitude was encoded in the same procedural rhetoric that applies to 'making a complaint'? How can we recognise that complaining does not imply a lack of gratitude, and that gratitude is often codified in ways that highlight deficiencies in a system as well strengths?

This research involves a historical dimension. I am investigating an archive of letters between former TB patients and the almoner of the Royal Brompton Hospital, a fascinating correspondence that spanned much of the twentieth century. The almoner solicited follow-up information from patients about their health, expressing gratitude for their continued cooperation in important work about the effects of treatments for TB. Patients in turn expressed gratitude for the hospital's continuing interest in their health and circumstances, and often enclosed postage stamps or donations to help the hospital, especially in times of war. The reciprocity of gratitude is evident in the correspondence, and it is possible to explore changes in this relationship with the introduction of the NHS and more formal, and impersonal, follow-up arrangements. The letters are of interest, not only for their content, but also because they constitute a social and health history written by those whose voices have rarely been preserved in the historical record of healthcare in which almost all communication by patients is reinscribed in medical records written by health professionals.