An Ode to Joy

Keith Stewart, MBChB, MBA
Carlson and Nelson Endowed Director, Center for Individualized Medicine, and Vasek and Anna Maria Polak Professor of Cancer Research, Mayo Clinic in Scottsdale, Arizona

We have new leadership at my institution, who, in an act of inspiration (or accidental greatness), have declared that bringing joy back to the practice of medicine is a worthy administrative goal. Now, in this respect, I am a generally happy person, despite a youth inflicted by daily rain in my native Scotland, a worrisome expansion of waist, and a lack of any omens predictive of oodles of cash in my future. I also am totally rubbish – really awful – at remembering names, which brings me circuitously to ward rounds this past month.

We rotate in-patient attending weekly and I am usually at sea for 24 hours, trying to remember which patient is which.

I have learned to compensate by identifying an alternate memory primer for each patient, like a picture in the room, a visiting relative, or something the patient is reading that captures my attention. However, on this day, I entered a patient’s room to introduce myself and encountered a gentleman contorted in a pose somewhere between the lotus position and a cage-fighting maneuver. On seeing my perturbed look, and much to the amusement of the staff on rounds, he patiently explained to me, as if educating a poorly informed medical student, that everyone on the planet except me, knew that the position encourages “kidney flow.” I had no trouble remembering him from then on.

As I continued rounds, various patients – as if sensing my ineptitude – felt obliged to give me much to remember, variously educating me about the value of checking candida levels in the stool, the dubious joys of supporting the Dallas Cowboys, and the unique taste of the Brazilian soft drink Guaraná (and my equally unique inability to pronounce it).

Sensing weakness, the staff joined in. With much joy at my discomfort, they began reciting tales exploiting both my propensity for calling them the wrong name for months on end and regularly blurting out completely unfiltered thoughts that should have never seen the light of day. The bottom line: We laughed a lot and the week flew by.

Contrast this with the general sense – frequently examined in these Editor’s Corners – that a malaise has fallen over the practice of medicine, brought on by a noxious brew of time-devouring clerical tasks, increasingly complex care competing with declining reimbursement, ignominious supplication to payers, and stacks of Orwellian regulations. These ingredients, in aggregate, concoct a work environment where an increasing number of practitioners may feel at times unappreciated. It is easy to see how some might feel banished to the pit of misery.

Reconciling the purposeful week I had just enjoyed with the insidious decline in satisfaction in the profession, it struck me that some of the fondest memories from my work life date to rotations in stressful environments, like intensive care and the emergency room. These times were filled with merriment, dark humor, and stories not appropriate to commit to paper but of a nature that I am certain we could all compete in retelling.

The concept may be trivial, but the point is important: Injecting a dash of irreverence and good nature can help bring some fun back into the practice of medicine. In that light, one of my friends recently told me that she was gently advised not to laugh so loud at work; in my world, she could laugh as loud and as often as she wants.

We read that the road to happiness is founded in family, friends, and community – with fulfillment, purpose, and self-determination contributing. Notably absent is a calendar invite to meet with the surgeons at 6:30 a.m., an invitation to speak in Cleveland, a peer-to-peer review call about a PET scan, or a late-night page to order potassium replacement.

My interest in the subject of joy in the workplace was piqued further after reading about the country of Bhutan, which had adopted a Gross National Happiness index metric for how the government is performing.

A recent United Nations survey of the happiness of nations found that top-ranked countries tended to demonstrate high values, not just in income and population health, but also for social support, freedom, trust, and generosity. You may well note, that the latter four metrics could easily resonate with health-care institutions. Perhaps adopting a medical happiness index could stem the tide of discontent. A focus on building supportive communities of peers, actively encouraging physician autonomy, and removing the burdens of excessive regulation, melded with a culture of trust, generosity of spirit, and an embrace of diversity, may go a long way toward reinserting the joy into medical practice.

So, here is my idea: If you are involved in health-care administration, take the happiness challenge. At the risk of being dismissed as nuts and being asked if you were dropped on the head in childhood, try advocating at your institution for a measurable staff happiness index. Develop strategies that emphasize fulfillment derived from patient care (not from a computer screen) and actively embrace efforts to bring back the joy of practicing medicine.

I hypothesize that you will be establishing a more motivated workforce who experience daily purpose in their work – and who will thank you with discretionary effort in return. Who knows? It may even contribute to the bottom line. A dash of humor, a sprinkle of irreverence, a soft glove when it comes to enforcement and an Irish pub within walking distance might not be such bad ideas, either.

Sadly, if you live in Cleveland, work at Harvard, never forget a name or enjoy allogeneic hematopoietic transplantation, then I am sorry, there is no point. It’s off to the pit of misery for you.