What do you do when someone says thank you? Do you struggle, as many do, between “you’re welcome” and “no big deal”? Do you find that it’s hard to understand why someone would appreciate something that, quite frankly, you would do for almost anyone?

It’s hard to know exactly what to say when someone says thank you. While we might readily express gratitude to others, we may struggle to respond when that gratitude is directed toward us. This is a natural human reaction and has a rich background, some of which is influenced by our own worldview.

To discover why gratitude is so hard to accept, it may be useful to consider the less meaningful side of appreciation. Many of us are prone to simple expressions of appreciation on a daily basis. This perfunctory appreciation reflects politeness, but not sincere thanks. We frequently express appreciation for the simple things done right – the right change at checkout, the holding open of a door, the passing of a dish at the dinner table, or even the signature line of virtually any correspondence. In essence, we are following etiquette and expressing simple appreciation for a simple action.

When someone offers heartfelt gratitude, they are, in a sense, offering something much more substantial. Heartfelt gratitude comes from a place of having experienced or received something more than expected. The grateful person’s own personal perspective entirely determines their evaluation of “more.” When the giver of gratitude has determined that he or she has benefitted in some way beyond what was anticipated, the person reciprocates by the most available means possible – an expression of gratitude and a gift of his or her feelings.

For the receiver of gratitude, it may be hard to distinguish between the offhand “thank you” and the deeply meaningful expression of gratitude. This is especially true for those of us who work within the healthcare environment. Typically, the perspective of the patient experiencing healthcare is significantly different than that of the caregiver. During a recent engagement at Georgetown University, a medical professional shared with us the incredible gratitude of a patient who had a very simple mole removal procedure. Not something complicated, the procedure lasted less than 25 minutes. This was something that was completely routine. Yet, in the patient’s mind, this was “life-changing.”

During a recent research interview, a physician shared from his own experience:

If you’ve ever tried to thank someone and they sort of refused to accept your gratitude, it makes you feel weird. They say, “Yeah, yeah, you’re welcome,” or they’re not as gracious as they could be. If someone has really done something for you and you really feel a heartfelt gratitude, you want to look him or her in the eye and say thank you. When they demure, or don’t want to look you in the eye or engage you in that way…well, that hurts.

This happens a lot in the healthcare setting. The goodness in most people when they’re faced with challenging health issues is immense. They want to give back. Part of giving back means expressing gratitude to physicians. I think for many patients, there is some desire to directly thank the physician, an element of gratitude that goes beyond the handshake.

When responding to a heartfelt expression of gratitude, it is not appropriate to demure, change the subject, or respond with, “It was no big deal.” Doing so would unintentionally communicate that this was not as important of an event as the giver of gratitude believes.

Compassionate responses to heartfelt gratitude must acknowledge the giver’s intention by recognizing her or his perspective. Even something simple for us, something we would do for anyone, could in fact be significant to someone else. By acknowledging that the experience was important, we can recognize the authenticity of the gratitude expressed. One especially powerful phrase is, “Thank you. That means the world to me.

The beauty of responding to gratitude in a meaningful way is that it doesn’t shut down a conversation, but rather opens it up for a more meaningful exchange.


Ask and Act

  • How do you respond when someone expresses gratitude to you?

  • How might that make the other person feel?

  • What might be a better response?



Contact us to learn more about engaging healthcare professionals in referral-based medical philanthropy.

The Art and Science of Healthcare Philanthropy