Please Wait a Moment

Innovation Blog

Blog posts are written by Russell Kohl, MD, FAAFP. Dr. Kohl is the Chief Medical Officer and Chief Operating Officer at TMF Health Quality Institute. He works across the company to support quality improvement efforts, leads the Innovation Team and has served as lead physician for the Comprehensive Primary Care initiative.


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Delayed Gratification

Dec 7 2020 - Russell Kohl, MD, FAAFP

When I was a medical student, I was greatly amused by a famous experiment involving children and marshmallows: evaluating the impact of delayed gratification. Children were given a marshmallow and told that they could eat the one now, or, if they waited some specified amount of time before eating it, they could have two to eat at that time. In the past 10 months, I’ve thought of that experiment many times.

Seeing a maskless face on a grocery trip is replaced with the image of a child popping a marshmallow into their mouth. Watching colleagues struggle with an ever-rising tide of hypoxic COVID-19 admissions and delaying the events that they had planned has been replaced with a child longingly looking at a marshmallow, but waiting for the right time to eat it — and to be rewarded for the wait. I sometimes wonder about how the experiment would’ve proceeded if all the subjects were in the same room and visible to each other, instead of individually tested. Would they still be able to delay gratification if they could see other happy children immediately eating their marshmallows?

In health care we have long seen the impact of impulsive decisions and denial, probably more so than most professions. However, delayed gratification is only possible to the extent that someone believes there actually IS a potential for future gratification. If you don’t see a future where you can achieve that gratification, it’s virtually impossible to deny the compulsion for instant gratification, regardless of the results.

The most heartening thing I’ve seen in our hospitals, physician offices and nursing homes is individuals continuing to defer that instant gratification, which means they still believe that we can get through this pandemic. All our preventive measures (e.g., masks, social distancing, quarantines) are sometimes described as “surrendering to fear” by those who wish to detract from our combined prevention/response efforts. They couldn’t be more wrong. It isn’t fear; it is hope. It’s a belief that we can make a difference in getting through this pandemic. Detractors ascribe a “superhuman sense of duty” in an attempt to understand the health care workers who struggle to care for our most vulnerable and those already infected. It may be superhuman, but it’s not an abstract sense of duty. It’s a deep-seated optimism that lives in every health care worker.

I started my health care career in the fire service and EMS, where gallows humor and sarcastic coping mechanisms sometimes hide the optimism from outsiders. In nursing homes, I worked alongside underpaid and underappreciated health care workers who “dutifully” showed up every day and provided for the activities of daily living that many take for granted. Underneath all of these veneers is a burning optimism that we CAN, and through our actions we WILL, make a difference. We miss holidays and risk our own safety because of delayed gratification. We are building the world that we want to live in, and know that world will be our gratification.

In our colleagues, we know the same flame burns deeply, even if well hidden from the outside world. We believe in this better future, not because of blind faith, but because we are going to create it. We know that treatments are improving. We know that a vaccine is coming. We know that vacations and “social proximity” will return. Just because they aren’t here now, doesn’t mean they aren’t coming.

At our bleakest moments, we know that our health care colleagues are working to make that future. We are patiently saving our marshmallow, knowing that the people around us are also saving theirs. We see others gobbling down their marshmallows and citing, “Eat, drink, and be merry; for tomorrow we die.” We realize that they don’t see that future where their delayed gratification makes a better world for all of us. What they don’t realize, though, is that the hope in those of us saving our marshmallows may be the only reason they don’t die tomorrow — not on our watch.

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