Enhancing relational care through expressions of gratitude: insights from a historical case study of almoner–patient correspondence release_duqut6265rapxjucb4bhoawvhe

by Giskin Day

Published in Medical Humanities by BMJ.

2019   Volume 46, Issue 3, medhum-2019-011679

Abstract

This paper considers insights for contemporary medical practice from an archival study of gratitude in letters exchanged between almoners at London's Brompton Hospital and patients treated at the Hospital's tuberculosis sanatorium in Frimley. In the era before the National Health Service, almoners were responsible for assessing the entitlement of patients to charitable treatment, but they also took on responsibility for aftercare and advising patients on all aspects of welfare. In addition, a major part of the work of almoners at the Brompton was to record the health and employment status of former sanatorium patients for medical research. Of over 6000 patients treated between 1905 and 1963 that were tracked for the purposes of Medical Research Council cohort studies, fewer than 6% were recorded as 'lost to follow-up'—a remarkable testimony to the success of the almoners' strategies for maintaining long-term patient engagement. A longitudinal narrative case study is presented with illustrative examples of types of gratitude extracted from a corpus of over 1500 correspondents' letters. Patients sent money, gifts and stamps in gratitude for treatment received and for the almoners' ongoing interest in their welfare. Textual analysis of letters from the almoner shows the semantic strategies that position gratitude as central to the personalisation of an institutional relationship. The Brompton letters are conceptualised as a Maussian gift-exchange ritual, in which communal ties are created, consolidated and extended through the performance of gratitude. This study implicates gratitude as central to the willingness of former patients to continue to engage with the Hospital, sometimes for decades after treatment. Suggestions are offered for how contemporary relational healthcare might be informed by this unique collection of patients' and almoners' voices.
In application/xml+jats format

Archived Files and Locations

application/pdf  595.0 kB
file_unnzrhkp5ng2bcwq47uveka3ea
mh.bmj.com (publisher)
web.archive.org (webarchive)
application/pdf  594.5 kB
file_3xt75l7pmjdlpn46frl747mrxq
mh.bmj.com (web)
web.archive.org (webarchive)
application/pdf  601.1 kB
file_4ois3xv2rfcpxevoyiibm3mxwa
spiral.imperial.ac.uk:8443 (web)
web.archive.org (webarchive)
Read Archived PDF
Preserved and Accessible
Type  article-journal
Stage   published
Date   2019-10-04
Language   en ?
Container Metadata
Open Access Publication
Not in DOAJ
In Keepers Registry
ISSN-L:  1468-215X
Work Entity
access all versions, variants, and formats of this works (eg, pre-prints)
Catalog Record
Revision: 2be4a187-90ea-4ae8-b066-9ff2583ed80e
API URL: JSON