Little Joys of Medicine
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The little joys of medicine ” has become a topic of considerable interest in the past several years . This can largely be traced to the increasing awareness of burnout among health care personnel , fueled by the stresses and strains imposed by the pandemic . The launch of the “ Joy in Medicine Health System Recognition Program ” by the American Medical Association and the recent publications on the topic 1 , 2 are signs of increasing momentum to reverse the trend of physician dissatisfaction and burnout .
While scales of pain severity are well accepted and commonly used , similar measures of joy / happiness are yet to become reliable . Thus , there is no good definition for “ little joy ” or “ big joy ” and hence I plan to be more generic and look at joys in medicine based largely on my own experience . The instances of joy have become less in frequency and size in the past few years , but they are still there to relish .
Now that I am an octogenarian physician , not a day passes without someone asking me , “ Why are you still practicing medicine ? It must be tough with the ever-changing rules and regulations , increasing overhead and dwindling payments .” My answer has always been the same : “ You are quite right ; I should be fully retired , but unfortunately I am badly addicted to the practice of medicine !” When I pondered over the topic for this year ’ s essay , I asked myself the same question and sought to find some answers . If I believe that I am addicted to the practice of medicine , that means I also experience some form of joyous reward . The brain substrate that is concerned with the irresistible pursuit of joy , is believed to include the dopamine pathways and the nucleus accumbens ( NAc ) among other sites . I wondered which components of my medical practice have had the potential to substantially increase dopamine release and activate the NAc . I “ Googled ” my hippocampal reservoir with the key words “ joy ” and “ medical practice ” and came up
22 LOUISVILLE MEDICINE by VASUDEVA IYER , MD
with numerous results . I categorized them into three groups : the joy of making the correct diagnosis , the joy of effective treatment / cure and the joy of bettering the life of a patient and enjoying the expression of genuine gratitude .
When I started residency in medicine several decades ago , I realized that I felt joyful when I made a correct diagnosis and more so when a patient is cured of his / her disease at least in part by my effort / input . I also noticed a dichotomy in the process ; the joy / excitement of arriving at the correct diagnosis in a difficult case by clinical examination was akin to what Sherlock Holmes may have experienced after deciphering a complex mystery . However , the happiness one feels with curing a patient is more multifaceted and often includes a feeling of both accomplishment and joy , as well as the satisfaction of a good deed . Initially the diagnostic part was more appealing to me as it involved use of “ Holmesian tactics ” ( this was further kindled during my training in neurology ). I conceptualized ( simplistically ) that my left brain which was adept at “ Holmesian tactics ” had much stronger rapport with the joy centers than my right brain which modulated multiple emotions such as empathy , care and compassion involved in patient care ( I call it the “ Oslian ” brain out of respect to the great physician , William Osler ). As I completed my training and started practice as a young neurologist , I continued to relish in the joy of making an accurate diagnosis ( I should tell you it was the pre-CT / MRI era ). However , many neurologic conditions that I saw at that time lacked specific treatment and hence the joy was often limited to making a speedy and correct diagnosis .
The first decade of my practice ( the 70s ) witnessed remarkable breakthroughs in the treatment of two disorders : carbamazepine for treatment of trigeminal neuralgia and levodopa for Parkinson ’ s disease . Seeing the dramatic improvement in the horrible neuralgic pain after use of carbamazepine triggered joy and a sense of achievement . The remarkable phenomenon of seeing a wheelchair bound akinetic Parkinsonian patient taking a brisk walk a few hours after intake of levodopa ranks as one of the most joyful experiences ever .
I can ’ t resist recalling several patients whose diagnosis and treat-