Editor’s Corner
An Ode to Joy
W
The content of the Editor’s Corner is
the opinion of the author and does
not represent the official position of
the American Society of Hematology
unless so stated.
E 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, one day, I entered a patient’s
room to introduce myself and encountered a gentleman con-
torted 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 remem-
bering 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 pro-
pensity 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. No-
tably absent is a calendar invite
to meet with the surgeons at 6:30
a.m., an invitation to speak in
Keith Stewart, MBChB, MBA,
is the Carlson and Nelson
Cleveland, a peer-to-peer review
Endowed Director of the Center
call about a PET scan, or a late-
for Individualized Medicine and
night page to order potassium
the Vasek and Anna Maria Polak
replacement.
Professor of Cancer Research
at Mayo Clinic in Scottsdale,
My interest in the subject of
Arizona.
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 physi-
cian autonomy, and removing the burdens of excessive regula-
tion, 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 enforce-
ment 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.
Keith Stewart, MBChB, MBA
Have a comment about this editorial?
Let us know what you think; we
welcome your feedback. Email the
editor at [email protected].
6
ASH Clinical News
March 2019