Why Hope is The Only Strategy

Hope is Hard, But Necessary

In my last post, I argued that what many doctors describe as moral injury is better understood as the loss of our leadership voice. The shift from practice owners to employees has left us with less agency and more frustration.

Once we get that, the question becomes: what do we do with our frustration?

One option is cynicism. And it is a tempting one.

Cynicism feels smart. It is both armor and shield. Roll our eyes and say, “The system will never change,” and we seem savvy, tough, and realistic.

Psychologist Jamil Zaki, author of Hope for Cynics, calls this the myth of the “smart cynic.” Research shows the opposite of how cynics see themselves. Cynicism weakens trust. It makes people less happy and even reduces success. In other words, cynicism is not realism. It is surrender.

Instead, Zaki urges us to be “hopeful skeptics.” Admit that the world has problems and recognize that the world is mostly good.

Cancer Tales

A few years ago, a doctor told a member of my extended family that what they saw on a test could be prostate cancer. The words, “rule out malignancy,” caused such despair that he took his own life before the diagnosis was even confirmed. This, even though the common forms of prostate cancer tend to grow so slowly that 5-year survival rates approach 100%.

At the other end of the spectrum, I saw my wife Uzma. When her breast cancer returned, it had already spread to the liver. A doctor herself, she looked up all the medical literature about her condition. Half of all patients whose breast cancer spreads to the liver die within 3 years. The 5-year survival rate is 25% or less. She knew her death would most likely come from a failed liver. And that much suffering would accompany her death.

She sped up doing things she always wanted to do.
She increased her support for others through informal help and formal advocacy.
She spent more time with our kids.
She modeled in Ulta Beauty’s commercial for cancer awareness.
She wrote a book.

And through all this, despite knowing that her time was winding down, she took every treatment her oncologist recommended till it would stop working. She never stopped therapy due to side effects. In the end, cancer took her just days shy of the third anniversary of its return.

She was not unique. Many patients with terminal cancer live this way to some degree. How do they do it?

I believe that they practice what Zaki would call hopeful skepticism. They know their journey will likely end soon with pain and suffering, and there is joy to be felt and shared in this world.

Hope Is Not Naive

Hope isn’t just the belief that things will get better. Those who study it see it as disciplined and practical.

Psychologist Shane Lopez, author of Making Hope Happen, defined hope as: “The belief that the future will be better than the present, coupled with the belief that you have the power to make it so.”

Psychologist Charles “Rick” Snyder, who wrote a textbook on Positive Psychology, said it better when he broke hope down into two parts:

Willpower — the drive to move forward, even in uncertainty.

Waypower — the ability to see a path and take the next step.

Hopeful people don’t just feel better. They perform better. Studies show hope predicts academic success in students, creativity in executives, and resilience in patients. For physicians, hope isn’t a luxury. It’s a leadership strategy.

How to Use Hope as a Strategy

Here are three habits that make hope practical:

Imagine a plausible, positive Future. If we can’t imagine a better future, we can’t work toward it.

Identify the next best action. Hope turns vision into movement by asking, “What’s one thing we can do right now?” Doctors are used to this kind of thinking. We are asked this question about clinical cases in the numerous exams we must take to get and keep our licenses and certifications. All aspiring leaders, whether doctors or not, must bring that thinking to everyday life.

See setbacks as inflection points. Hope sees every challenge as a chance to adjust course and grow.

From Frustration to Agency

If the real problem is loss of voice, the solution is not silence or withdrawal. It’s reclaiming leadership.

Identify shared goals. As we discussed here and here, clinicians and non-clinical leaders may not understand each other completely. And they may not value everything equally. But pay attention, and we will find things that we all care about, e.g., quality and patient safety.  Finding that common ground is essential. Greater things can be built on that foundation.

Empower ourselves and others. Even small wins restore agency: mentoring a colleague, starting a pilot project, taking the lead in team meetings.

Celebrate progress. Negativity snowballs, but so does hope. Marking small wins builds confidence that larger changes are possible.

Former Michigan governor Rick Snyder would call this approach “relentless positive action.”

Why This Matters

Calling everything “moral injury” risks painting doctors as victims. It puts the responsibility of our relief in the hands of others.

Within the moral injury framework, the only choice left in our hands is to check out of the system — leave medicine altogether, or practice in a niche that effectively checks us out of mainstream medicine.

This way of framing our dilemma paralyzes us.  And it makes it hard for us to find our leadership voice and for others to see us as leaders.

But if we frame the problem as a lost leadership voice, then the path forward is clear: Reclaim agency, practice hope, and learn to lead in the new world of healthcare.

Because Medicine is an art, a science, and a business, it will always be impossible to do something that is equally right for all of its facets. But imperfection doesn’t mean doctors, nurses, and other clinicians are powerless.

Without us finding a way to lead or influence more effectively in the new world, the soul and art of medicine have no hope.

Despair won’t build the future of healthcare. Hopeful leaders who choose agency over cynicism will.