Abstract
Amazingly, there was a time when many people looked forward to seeing their doctor and vice versa. There weren’t as many pressures in the system, and the doctor–patient relationship was revered. Today, however, many patients and health care clinicians would agree that interacting and working in the medical field can be very stressful. Burnout rates are at an all-time high, and many clinicians feel significantly frustrated with their work schedule. Too much charting, paper work and technology, along with less time with the patient, can hinder clinicians from forming deep connections with patients and colleagues. Both patients and clinicians can feel defeated rather than healed after a visit. More joy in medicine is needed, and there is a call to reclaim the feelings of optimism that were high when clinicians entered the field. How can we accomplish this? By naming the problem and finding solutions.
The Need for Joy
In an article by Arnett, he comments that joy, in fact, can be defined in varying ways depending on the context and perspective. 1 One of the ways that may be appropriate in medicine is the feeling of “right relation between ourselves and the world, a sense that there is an ideal fit between ourselves and the world around us at that moment. The right relation that characterizes joy is ‘right’ in the sense of being ideal, as we mean when we say something is ‘just right.’” 1 He adds, “In the state of joy there is a match between our identity and what we are experiencing.” 1 It is important to note that joy can last for varying amounts of time and comes and goes. But the presence of joy can be enhanced and fostered, and there is a great need for this in medicine.
Gilmartin and colleagues commented that repeated surges of COVID-19 increased the pressure on health care workers even beyond what existed before, resulting in “excessive workloads, disorganized staffing, administrative burdens, and a lack of organizational support for the physical, emotional, and psychological well-being of health care workers.” 2 They stated, “As burnout spreads throughout the health care system, it’s time to consider innovative approaches that empower health care workers to stem the tide.” 2 The authors pointed out that creating more joy in medicine does not need to be complex, technological, or multifaceted.
Serwing and Stewart commented, “Physician burnout is at epidemic levels. In our role as healers, the concepts of humanism and relief of suffering are central themes in our work, yet burnout and depersonalization can threaten these values. While working to mitigate burnout, we need to move toward a focus on health and well-being and develop preventive strategies to cultivate resilience.” 3
Strategies for Increasing Joy in Medicine
The bottom line is that many health care professionals and students are suffering today from exhaustion, a lack of motivation and a lack of recognition of deep emotions that the field brings and few outlets to find relief. We need to create the opportunity for people to experience more joy in medicine. Below are some of the strategies that are being used to help health care workers in that way.
Focusing on Joy-promoting Strategies
Interestingly, in a review by Rashida and colleagues, the authors found that focusing on joy-promoting strategies was more important than focusing on the problem.
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They stated, “As academic medical leaders, we aimed to improve the workplace by promoting joy at work. Unlike deficit-based approaches that focus on burnout or disengagement, joy is a strength-based approach. Nurturing joy increases productivity, creativity, and happiness. To achieve our aim, we performed a scoping review on how leaders can better support joy at work for individuals in the academic medical setting.”
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In this review, the authors included 25 publications and reported, “Themes included shifting to a strengths-based focus on joy at work, implementing programs to prioritize it, and the key role of leaders in championing joy.”
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Specifically, results showed:
“Making system-level changes and adopting evidence-based programs that promote joy at work for academic physicians is effective,” according to the authors.
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Leaders should be competent in using evidence-based approaches to improve joy in the workplace and can promote joy through suggestions from their colleagues regarding changes that could lead to a more positive workplace, according to the authors. They added that feedback and involving others in decision making enhances positivity and autonomy and may contribute to well-being. The PERMA model can be effective and includes Positive emotion, Engagement, Relationships, Meaning, and Achievement. The authors said, “These five aspects contribute to an individual’s wellness in varying degrees, but overall, they have all been identified as major contributors to joy, according to reports by physicians and workshop participants.”
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One reviewed study created small groups to discuss what “a good day looks like” and participants identified the workplace obstacles that can hinder joy and suggested leaders act on suggestions for improvement, according to the authors.
Framing, Gratitude, and Kindness
Gilmartin and colleagues present the simple practices of “framing, gratitude, and kindness to remedy the effects of burnout and to help health care workers experience some joy in the practice of medicine.” 2 Evans quoted these authors, further describing how these aspects can lead to more joy. 5 For example, framing or reframing can mean “putting a problem in a different light or context or finding another path to approach it and one may feel positive about achieving a task that might be too daunting if it is perceived negatively.” 5 Gratitude journaling can enhance joy, as a given example, and kindness may lower stress hormones and help people feel less depressed, less lonely, and happier.
Creating a Joyful Workplace
The stance that a joyful workplace must be created seems essential. If the lack of joy in medicine is not acknowledged and acted upon, nothing will change. Jalilianhasanpour and colleagues emphasized that “Creating a joyful workplace is not the same as dealing with issues of stress, fatigue, burnout, and resilience. It requires a proactive approach to augment feelings of worth, appreciation, and well-being in the members of the team. The sense that one is pursuing worthwhile, valuable activities requires a wholesale commitment to the mission, vision and values of the organization.” 6 They stated that “Well-being is addressed through the creation of a bright and cheerful physical and psychosocial workplace that offers programs that encourage mindfulness, humor, playfulness, and fitful lifestyle choices. The sense that one’s work is appreciated and valued stems from an attitude of gratitude on behalf of all levels of the organization including management and peers where such encouragement flourishes. Those expressions of appreciation may be in the form of celebrations in the workplace and/or compensation and benefits that appropriately value the contributions of the employee. The organization’s executive team should be dedicated to crafting an environment that leads to delighted, healthy employees.” 6
One can see that the potential for a much-improved work setting for health care workers is possible when leaders accept the deficit of joy and act on suggestions such as those offered in this article. This holds true for many types of medical settings, small or large, private practice, or academic settings. This article is a glimpse into the problem and solutions, and there are many more excellent articles on the topic with creative suggestions for increasing joy in the workplace.
Conclusion
As an internal medicine resident, I, the author, remember feeling so tired at one point that I couldn’t take in what the attending physician in front of me was saying. The nature of the work and working 80-plus-hour work weeks had led to burnout. During that time, a conference focusing on “the heart of medicine” was offered by the American Holistic Medical Association. The conference was full of joy, loving people, and wonderful plenary speakers talking about reclaiming the joy and heart of medicine. There was so much sharing, play, and laughter. There were mentors who gave me a lift. It was just what I needed for renewal. Most of us left feeling happy and connected.
Rashid and colleagues conclude, “Academic physicians should recognize and amplify things that bring energy and meaning to their colleagues and shift toward a joy-focused culture. Academic medical leaders should be encouraged to design and incorporate programs that prioritize joy. These may include increasing flexibility and autonomy, decreasing administrative burden, investing in relationships at work, supporting connections, and measuring wellness.” 6
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.▪