Giving Thanks Where It Counts

Like most holidays, I'll be working this Thanksgiving. I don't have kids, so years ago I started volunteering for these shifts. It seemed like the right thing to do—give my colleagues with young children a chance to be home making memories with their family. It's become something of a tradition for me now, whether I'm in the ED, urgent care, or seeing palliative care patients.

But here's something I've noticed over the years, something that's both heartening and revealing: patients act differently on Thanksgiving–in a good way. Not dramatically so, but meaningfully so. They're a bit more likely to pause before we part ways and say "thank you" in a way that sounds different. Under normal circumstances, a reflexive "thanks" is not uncommon. I'm talking about a sincere "thank you for being here." From the heart, maintaining eye contact. A genuine recognition that acknowledges appreciation for being there on the holiday. Sometimes it comes with a slight catch in their voice, or an unexpected moment of connection that transcends the usual transactional nature of a healthcare visit. It never gets old.

Civility Campaigns and Missing Conversations

Last week, Transportation Secretary (and former reality TV star) Sean Duffy launched what he's calling a "civility campaign" for air travel. He's asking passengers to dress better, say 'please' and 'thank you' to pilots and flight attendants, and help each other with overhead bins. The campaign cites concerning statistics: since 2019, the FAA has seen a 400% increase in in-flight outbursts, with 13,800 incidents involving unruly passengers since 2021.

I can appreciate the sentiment (albeit missing the mark on other factors which are larger contributors to air safety, namely working conditions for air traffic controllers). He's right about one thing though: civility and kindness matter. And yes, airline workers deserve our gratitude and respect. And I couldn't help thinking: where's the similar conversation about healthcare workers?

We face our own epidemic of workplace violence—one that makes airline disruptions look tame by comparison. According to a January 2024 poll of ACEP members, 91% of emergency physicians said that they, or a colleague, were a victim of violence in the prior year alone. Let that sink in. Nine out of ten emergency physicians either experienced violence themselves or witnessed it happen to a colleague in just one year.

More than one-third of emergency physicians have been assaulted multiple times in the past year (myself included). Many have experienced assaults even more frequently. And it's not just physicians. The rate of serious injuries related to workplace violence is six times higher for hospital workers compared to all other private sector employees in the United States. Between 2015 and 2017, approximately 1.14 million injuries to workers in the healthcare industry were treated in U.S. hospital emergency departments, with intentional injuries by another person accounting for 15% of these healthcare-related injuries. No one's asking us to dress better. We'd just like to not be assaulted while we work tirelessly to care for others.

The Gratitude Gap

I've talked to other physicians about the Thanksgiving phenomenon, and most recognize it immediately. There's something about the holiday that briefly lifts the fog of frustration that often clouds the patient-clinician relationship these days. For one day, people seem to remember that we're here by choice, that we could be somewhere else, and they genuinely appreciate that we're not.

What strikes me most, though, are the patients who express surprise at the paucity of expressions of gratitude we receive. "You must hear thank you all the time," they say, as if I've just revealed something unexpected by mentioning that true gratitude isn't necessarily a daily occurrence. Unfortunately, that's not the case these days.

There was a brief window in 2020 when things were different. Remember the early COVID lockdowns? Healthcare workers were suddenly "heroes." Strangers thanked us at grocery stores. There were yard signs, free meals, effusive gratitude everywhere we turned. Some of my colleagues found it embarrassing, but I never did.

It felt good to be seen, to have our work acknowledged in that visceral, public way. And as the reality of the pandemic faded, the financial and illness-related stresses–which are inseparable from the experience of attempting to navigate our deeply convoluted healthcare system—displaced these sentiments of gratitude. I understand why. When you're drowning in medical debt, or watching a loved one deteriorate while fighting with insurance companies over coverage, or waiting months for an appointment to have an urgent concern evaluated, it's hard to feel grateful toward "the system" or the workers who can easily be seen as an extension of that dysfunctional system. For my patients, I am the face of that system and a natural scapegoat in the same way a flight attendant is the face of a flight delayed for mechanical issues. The gratitude recession has also coincided with something else: escalating workplace violence in healthcare settings.

A Crisis of Violence and Burnout: Why This Matters for Everyone

Studies show emergency nurses and other members of the emergency care team experience a violent event once every two months on average. But these statistics don't capture what it feels like to work in this environment. Healthcare workers routinely underreport violence to supervisors because they perceive it as the norm—an expected part of the job—and fear the response they may receive when reporting. Think about that. We've normalized violence against healthcare workers to the point where many don't even report it anymore. It's just part of the landscape, like long shifts or challenging diagnoses.

The violence takes many forms. Verbal abuse. Threats. Physical assault. In one recent survey, 85% of emergency physicians reported that a patient had threatened to return and harm them or other emergency department staff. Sexual harassment is not uncommon, especially for many of my female colleagues. The psychological toll is immense, contributing to burnout, PTSD, and the growing exodus from clinical medicine.

And yes, burnout continues unabated. Recent data shows physician burnout rates at 43% in 2024. Emergency medicine is the specialty leading the pack at 63%. I'm personally witnessing a record number of colleagues actively seeking to leave clinical medicine entirely—not retire early, but fundamentally walk away from patient care because they find it unsustainable.

The reasons behind this decision are complex: administrative burden, EMR demands, fighting with insurance companies over denials, malpractice lawsuits, stagnant pay, and overall moral injury from being unable to get our patients the care we know they need in an efficient manner. But workplace violence and the normative experience of basic respect and appreciation being absent compound everything else. When you add physical danger to professional frustration, the combination becomes overwhelmingly demoralizing. Economic pressures worsen the situation. Research tracking physician compensation from 2017 to 2022 found that average real compensation fell by $18,468 when adjusted for inflation. We're working harder, dealing with more complexity and danger, and earning less in real terms.

Here's the uncomfortable truth: a healthcare system staffed by burned-out, demoralized, and physically endangered workers cannot deliver the care that patients deserve and that we yearn to provide. Violence doesn't just harm us—it harms everyone. More than one in four nurses are currently feeling "likely to leave their positions" as a result of violence. Each departure strains an already fragile system. The physician burnout crisis costs the U.S. healthcare system an estimated $4.6 billion annually, primarily due to turnover and reduction in clinical hours. But the real cost isn't measured in dollars—it's measured in delayed care, in missed diagnoses, in the slow erosion of the patient-physician relationship–the relationship that's supposed to be at the heart of healing.

A Simple Ask

So if you'll allow me a simple PSA–and I ask this more on behalf of my colleagues than myself, as I've diversified my professional life to protect my physical and mental health by scaling back my clinical shifts–say "thank you" if you appreciate anything that a healthcare worker is doing for you. Or even if you're just happy they're there, especially if you show up on a major holiday.

It's understandable why it's overlooked in these overwhelming and emotional moments of sickness and sadness, but when you or your loved one find yourselves in the patient role, try to remember how much it can mean. It just takes an extra five seconds to thank them for being there on a holiday (or any day). Thank them for showing up, despite everything and remember, they share most of your frustrations with the system (and feel them on a much more consistent basis). I'm not asking for the effusive gratitude of 2020. I'm not asking you to pretend the system isn't broken or that your frustrations aren't valid. A simple, sincere acknowledgment is enough.

For all the flaws of the American healthcare system—and they are legion—it still limps along and offers a safety net that's easy to take for granted. But it all depends on healthcare workers showing up, shift after shift, day after day, holiday or not. Many of us are hanging on by a thread. Your gratitude won't fix the systemic problems, won't reduce the violence, won't close the wage gaps or solve the insurance nightmares.

It is, however, a simple way to remind us healthcare workers why we chose this career in the first place. It reconnects us to the human beings at the center of everything we do. And in those moments—especially on Thanksgiving, but really any day—it makes a difference.

If the Transportation Secretary can ask airline passengers to bring back civility at 30,000 feet, surely we can ask the same for healthcare workers at ground level, in emergency departments and clinics and hospital rooms across the country. Certainly we rely on air travel for much of our modern world's normal function, but we need a functional healthcare system more. And it truthfully takes very little to make a big difference. It can feel, at times, uncertain why we chose this path when it's not clear that those we are trying to serve appreciate our sacrifices. Simply offering your sincere thanks might just make the difference between a healthcare worker–someone who spent often a decade or more training for their role–sticking it out or choosing an alternate and more sustainable way to pay their bills. I'll start. To all my fellow healthcare workers, thank you for showing up and caring–today and everyday.

© Josh Russell, MD, FACEP – November 27, 2025