When I ask clinicians about joy in medicine, why do they tell me about burnout?
Brene’s theory is that we lack the language to describe positive experiences or emotions. (As a lifelong resident of puritanical Boston this rings true – weather, the Red Sox, family, and other major factors in our daily existence are broadly described as not entirely hideous on any given day.) She explains that, as a species, we’re wired to identify and respond to negative emotions or stressors, but that the positive is often intangible and hard to grasp because our survival doesn’t depend on it.
She says of her research “when I asked people about love, they told me about heartbreak; when I asked people about trust, they told me about betrayal, when I asked people about connection, they told me about disconnection…[We have] the inability to articulate in a meaningful, galvanizing way what is possible.”
In healthcare, when we talk about joy in medicine, we talk about burnout. We talk about EHRs, and “pajama time” as clinicians hunch over laptops charting late into the night, and billing requirements, and decreasing reimbursements. Sometimes we talk about what we perceive to be the antithesis of all this, in sanitized terms: an organization’s mission, vision, and values, and the concept of professional fulfillment.
Brene goes on to explain that we can develop the language to articulate positive experiences and emotion, but that this requires mindfulness, critical thinking and (in my interpretation) old-fashioned hard work. She says “I can’t scare you into joining me; I have to engage with you cognitively…to inspire you to join me.”
How then, to align both the concept and language of professional fulfillment more closely with true joy in medicine?
David Brooks writes that “Happiness usually involves a victory for the self. Joy tends to involve the transcendence of self.” Many thought leaders also tie joy to the state of “flow”, in which a person is challenged at the perfect level of their ability, and as a result, is fully immersed and engaged in the activity at hand.
Daniel Pink (in his book, Drive) explains “…that balance produced a degree of focus and satisfaction that easily surpassed other, more quotidian, experiences. In flow, people lived so deeply in the moment, and felt so utterly in control, that their sense of time, place, and even self melted away. They were autonomous, of course. But more than that, they were engaged.” Needless to say, most clinicians aren’t exactly in flow state while charting and billing. (Nor, one imagines, are they transcending their sense of self, unless it’s an escapist survival mechanism.)
But let’s talk more about these moments when joy and flow (and fine, professional fulfillment) do exist.
Then what is joy in medicine? Is it the mere absence of charting or billing patient clinic visits? Maybe, but I suspect not.
Let’s find out. Let’s do the hard work to talk about these moments and understand what they mean, and allow them to serve as our north star as we construct our mission and vision, and define our values and metrics. After all, Einstein’s saying is as true when applied to the joy in medicine as in the rest of life: “if you cannot explain it simply, then you don’t understand it well enough.”