A guest column by the American College of Physicians, exclusive to KevinMD.

By any measure, the past year has been difficult for everyone.

The ongoing pandemic with its widespread personal, social, and economic disruptions, as well as civil and political unrest throughout the country has clearly stretched the fabric of our society and had remarkably negative effects on the mental health and well-being of our patients and virtually all health care professionals.

Yet with the advent of coronavirus vaccines, dropping case and mortality rates, and at least some calming of recent societal tensions, it feels as though there may at last be a light at the end of a long and painful tunnel.

And this glimmer of better times ahead gives us a chance to reflect on our hope for the future.

Although the concept of hope and its meaning have been debated over millennia and there is no universally-accepted definition of hope, in practical terms it is commonly thought of as a desire for something, such as a specific goal or desired state, accompanied by an expectation or belief in its ultimate fulfillment.  But regardless of exactly how it is defined, it is an intrinsic and fundamental aspect of our human nature.

Hope is also deeply woven into the very fabric of medicine.  It is most commonly thought of as something that we as physicians are able to impart to our patients as caregivers, particularly in the context of severe illness, and throughout the long history of medicine prior to the scientific advances of the twentieth century, it was often the only thing that we could offer to those under our care.  And even today, the ability to foster hope in our patients has been likened to a powerful medicine that can shape their perceptions of the future and profoundly influence their attitudes and actions related to their health and personal lives.  We also know that this “medicine” can be used in both beneficial and negative ways, helping people set realistic expectations about their health or illness and providing a positive pathway forward with them, but with the risk of conveying unrealistic hopes for their future in the context of a difficult disease.   However, in its ideal form, hope is an essential element of a truly trust-based and healing relationship.

Yet little is discussed about the importance of hope to us as physicians and its key role in maintaining our own personal well-being.

As medical professionals, the events of the past year have challenged most of us in ways we hadn’t previously experienced.  The pandemic-related stresses and personal risks associated with confronting and seeking to manage a new and potentially deadly disease and the emotional toll exacted by the extensive suffering and loss of so many of our patients has been immense.  And this has been further compounded by the marked disruption of our personal, economic, and social worlds due to the coronavirus, not to mention the civil and political tensions that have been occurring at the same time.  This level of uncertainty, instability, and loss can easily negatively color our day-to-day existence, rob us of joy, and as with many of our patients, cause us to lose hope for the future.

A fracturing of hope can be devastating to us personally.  We know that one of the strongest predictors of depressive symptoms and suicidal behavior is despair, or lack of hope for the future.  We also know that attitudes of positivity and optimism, traits that are closely correlated with hope, are associated with better long-term health and well-being outcomes.  And it is our hope for the future that helps us navigate difficult times, keeps us looking forward, and drives us to do the things we need to do and in which we find reward.

But hope is complex, and when our sense of hope is diminished in the face of so many negative events, we unfortunately can’t simply will ourselves into restoring it.  We can only set the stage for hope to develop.  And because hope in many ways represents a constant inner struggle between our fears and those things that inspire and motivate us, fostering hope requires accepting and reconciling with the reality before us, but also imagining what the future can be like, drawing from the good we see in and around us.

The traumatic events of the past year therefore provide an opportunity for each of us to pause and reflect on our own hopes for the future.  For me, despite the many negative things that have occurred during this time, I’ve been touched by the tremendous resiliency of my patients and colleagues, witnessed first-hand the profound meaningfulness of the work we do as physicians, and had my belief in the often hidden goodness of people reaffirmed.  And I’ve found these to be very real reasons to be hopeful.   As we emerge from these troubled times, as physicians each of us will need to rediscover our own reasons to be hopeful for the future and tap into the intrinsic healing power we each possess inside.

But it is crucial to remember that having hope is just as important for us as physicians as it is for our patients.  The need for hope binds all of us together at a basic human level, and it is this shared aspect of our humanity that enables all of us to work together in a mutual healing process.  It therefore represents one of the strongest “medicines” we have to treat both our patients and ourselves.

Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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