Hope

Definitions

Hope is the virtue by which we desire and expect good things, even in the face of difficulty
Confident expectation that perseveres through challenges
The theological virtue that orients us toward the ultimate good

What is Hope?

Hope in medicine means maintaining confidence in the possibility of healing, growth, and meaning even when facing serious illness or death. Hope is not naive optimism, but rather a grounded trust that good can emerge from difficulty.

Why should we practice the virtue of Hope?

Patient encouragement: Hope sustains patients through difficult treatments and uncertain outcomes
Physician resilience: Hope prevents cynicism and burnout in the face of medical setbacks
Realistic optimism: Hope allows us to acknowledge difficulty while remaining open to possibility
Meaning-making: Hope helps us find purpose even in suffering and loss

How do we foster Hope?

Acknowledge difficulty while affirming possibility: Be honest about challenges without foreclosing hope
Celebrate small victories: Recognize incremental progress to sustain long-term hope
Connect to larger purposes: Remember why medicine matters beyond individual outcomes
Cultivate gratitude: Regular gratitude practice strengthens hopeful disposition
Support colleagues: Create communities of mutual encouragement

Clinical Case 1: For the Practice of Medicine

It’s 7:20 PM and you are the admitting resident just minutes from the end of your shift. You happen to have a high school student shadowing with you who has expressed interest in medicine. It’s been a taxing day, your sixth in a row, but the 7:30 PM cutoff is coming soon, and you’ve managed to come up with sufficient plans to ensure the safety of the patients you’ve admitted so far. Your eyes blur as you scroll down the computer screen, praying you’ll be spared a final admission, which will easily add an extra hour to your shift. All you want is to go home to your apartment (currently in disarray), eat a small meal, shower, and see how much you can catch up on your sleep debt before returning for another shift.

But then it happens. The gnawing alarm of your pager at your side causes your stomach to drop. You curse silently under your breath—an admission at 7:25. There’s no use in fighting it, you’ve tried that before; it will only delay the inevitable. Hopefully, this is an easy one. You pull up the chart and slump back in your chair. It’s Mr. Jones, a patient well known to you. He is a sixty-five-year-old with heart failure, obesity, chronic obstructive pulmonary disease, narcotic dependence—the problem list is long. Under your breath you declare that this patient is “hopeless,” knowing that this will easily add an extra hour to your shift.

A fellow resident laughs, looking at the shadowing student and commenting cynically, “You think Mr. Jones is hopeless, medicine is what’s really hopeless.” The student laughs politely but looks crestfallen. She accompanies you as you admit the final patient. A few hours later, walking out of the hospital, she asks you, “Should I really do this? Is medicine really hopeless?”

Adapted directly from: Benjamin Frush, Brewer Eberly, “The Virtue of Hope in Medical Training,” The Linacre Quarterly 2022;89(3):319–26.

Clinical Case 2: In the Care of the Patient

You are a fourth-year medical resident on your internal medicine rotation. You’ve been assigned to see Mrs. Silver, a 48-year-old woman recently admitted for a pulmonary bronchoscopy and biopsy. Her primary care physician discovered a firm, supraclavicular lymph node just last week and sent her for a CT scan of her chest which revealed a large mass suspicious for lung cancer. The pathology results are pending. You enter the room and introduce yourself, explaining your role as a student and gathering the history and physical data specific to your role on the clinical team. Suddenly, the patient asks you, “Is there any hope this isn’t cancer?”

The pathology results come back confirming large cell lung cancer. The patient has already discussed her prognosis with the pulmonologist and the rest of her clinical team by the time you see her. From your understanding, the prognosis is rather grim, even as the patient is pursuing aggressive treatment. As you talk with the patient, she says offhand, “I have to hope that I can better. Is that crazy? Do you think there is hope for me?”