Optimism or Hope
Optimism and hope are commonly used interchangeably, but there is a considerable body of evidence suggesting they are not the same thing. As we approach the crisis of the pandemic now seems a good time to examine the difference and why it matters. Optimism is defined as the core belief future events will be positive and is often described as a personality trait. Hope, on the other hand, “is a positive motivational state that is based on an interactively derived sense of successful (a) agency or goal-directed energy, and (b) pathways planning to meet the goal.” A more succinct definition of hope may be “Hope: optimism with a plan.”
Not surprisingly, religious thinkers have also written about the difference. Rachel Mikva quotes Rabbi Jonathan Sacks. “Optimism and hope are not the same. Optimism is the belief that the world is changing for the better; hope is the belief that, together, we can make the world better.” She notes hope requires more courage than optimism and notes that Sacks describes the Hebrew Bible as not particularly optimistic but a literature of great hope. Roland DeVries writing from a Christian perspective describes the differences as a Venn diagram in which the large circle of hope contains all of the smaller circle of optimism, but a circle of pessimism is also included. Thus it is logical to say I am pessimistic about the death toll from the pandemic over the next four months, but hopeful over the next year as vaccinations are adopted.
Will dealing with the pandemic prove an opportunity to reshape our healthcare system? The pessimist notes most of the people trying to lead the healthcare system are so consumed with the problems of today there is little energy, and probably little incentive, to think and plan longer term. On the other hand, as people reflect on their experience during times of great crisis, they sometimes decide it is time to make things better.
I had the opportunity to interview the people who created the current system in my town after they had become old men. Each was affected by their experiences in World War II, and each was dissatisfied by the status quo after the War. Dr. John R. Thompson was a member of the Tennessee National Guard and was called to active duty when that unit was federalized in 1940. He ended up in the Surgeon General’s office, responsible for equipping the Army’s field hospital system. After the war, he returned home and started working with local leaders to obtain Hill-Burton funding for a state-of-the-art hospital to replace the private doctors’ hospitals in town. Dr. Leland Johnston was board certified in Internal Medicine when he moved to town in 1941, but had chronic tuberculosis, so spent the war as a civilian. However, he became convinced a multispecialty medical clinic was the best way to improve the quality of medical care locally. He recruited a general surgeon, Dr. G. Baker Hubbard, who had also been in the National Guard, and ended up as the orthopedic consultant to the surgeon general for U. S. Forces Europe. (It was a different world.) The three worked together, although they decided it would be best if the hospital was separate from the doctors, given their previous experience with private hospitals, so Dr. Thompson remained independent of the medical group.
It is important to remember building a public hospital to compete with the private hospitals produced negative feelings as did formation of a multispecialty medical group, which was judged “communist” at a time when that was a pejorative as “terrorist” is today. One of the questions I pursued with them was why they did it. To a man, these three and the others who were pioneers all said “Because it was the right thing to do.” I interviewed these men some 30 years ago and the system they started has grown, but is essentially unchanged some 70 years after they began. So, I am hopeful men and women of good intentions can come together and start a new movement designed to serve the community for another 70 years, even though I am not optimistic that it will be quick or easy.
Of course, one may argue times are different, because hospitals have become big business. But the conflicts over money and mission were present then, too. It is worth noting Dr Hubbard made $100,000 as an independent surgeon in 1949 and took a salary in 1951 of $10,000. Collectively, the leaders persuaded the owners of the private hospitals to close and shift their practices to the new public hospital, which was also a financial sacrifice. The sums may be larger, but “doing the right thing” includes a willingness to forego income, at least for a while. It is also worth pointing out the project took more than four years and involved community support combined with Federal money for hospital construction and support of indigent care. These men were not saints. They had their disagreements, dislikes, arguments, and hurt feelings, but they also had pride that they had, in the main, done what was best not just for themselves, but for their community.
For the past dozen years, I have been convinced the balance between the clinical and the business aspects of health care had been skewed toward the business. I was also concerned that “bigness” had become the solution to all problems, when small and flexible seemed more important. The pandemic has wrenched the balance toward the clinical with perhaps hopeful results. First, the weakness of the current business model, based on volume, is more apparent to lay people and some clinicians. Second, dealing with the virus has required clinical and operational flexibility in ways not seen since World War II. Maybe once the pandemic subsides and the players have time to recover, the importance of organizational structures that balance the clinical and business demands may seem central to success. Finally, the pandemic has reminded us that medical care is not just the medical center, it includes public health and what are now termed social determinants of health. A new system will have to rebalance the efforts between the center and the local communities.
So, optimism and hope are not quite the same thing. But as Winston Churchill reportedly said: “Never let a good crisis go to waste.” As we enter the New Year with the pandemic at a deadly pitch, we should be cautious and likely pessimistic over the short term, but we should also hope that not only is their “light at the end of the tunnel,” there may also be a chance for the once in a generation reform of our healthcare institutions. Let’s hope selfless leaders emerge to seize the moment.
28 December 2020
 Dholakia U. What’s the Difference Between Optimism and Hope? Psychology Today, 26 February 2017. Accessed 21 December 2020 at https://www.psychologytoday.com/us/blog/the-science-behind-behavior/201702/whats-the-difference-between-optimism-and-hope.
 Brazeale R. Hope: Optimism With a Plan. Psychology Today, 9 February 2017. Accessed 21 December 2020 at https://www.psychologytoday.com/us/blog/in-the-face-adversity/201702/hope-optimism-plan.
 Mikva RS. Optimism vs. Hope—And Other Differences That Matter. 6 February 2019. Accessed 21 December 2020 at https://vocationmatters.org/2019/02/06/optimism-vs-hope/.
 DeVries R. The Difference Between Optimism and Hope. Christian Courier, 8 June 2020. Accessed 21 December 2020 at https://www.christiancourier.ca/the-difference-between-optimism-and-hope/.
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