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Psychiatrist Sarah Hollander, clinical psychologist Kelly D. Holder, and physician advocate and physical therapist Kim Downey discuss their article “Joy in medicine: a new culture.” Sarah, Kelly, and Kim explore how the culture of medicine must evolve from a system of endurance to one of meaningful well-being. They examine the critical role of medical education in shaping the next generation, arguing that joy is not just an emotion but an alignment of purpose that can be taught and modeled. The conversation highlights the power of shared vulnerability and how caring for each other through heartbreak fosters a deeper, more resilient professional community. Discover how integrating humanity into the curriculum can help physicians avoid burnout and rediscover the soul of their practice.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome psychiatrist Sarah Hollander, clinical psychologist Kelly D. Holder, and physician advocate and physical therapist Kim Downey.

Today’s KevinMD article is “Is joy in medicine a new culture?” Everybody, welcome to the show.

Kelly Holder: Thank you, Kevin.

Kevin Pho: All right, thank you. So Kim, obviously we have you on. So first off, how did you find Sarah and Kelly?

Kim Downey: So Kelly, I was privileged to meet last year at the Dr. Lorna Breen Heroes’ Foundation Healthcare Worker Well-Being Day in DC in March. She was a presenter. She was so positive and dynamic and I loved her message. So after the presentation, I approached her and thanked her and told her so, and we exchanged contact information.

Then Sarah and I connected more recently on LinkedIn. I thought that they would enjoy getting to know each other, so I had them on my podcast together speaking to this topic. It was such a great conversation. I wanted to continue it further and I asked if they would like to collaborate again, and they enthusiastically responded. And that is how we brought this message to you today.

Sarah, when we collaborate, one person writes a letter and another person writes a letter and I try to tie it all together. Sarah had written first and this sentence just got me in the gut. She says: “Yet, every July something remarkable still happens. A new wave of residents walks through the hospital doors, white coats still stiff, with hearts still open and carrying hope.”

Kevin Pho: Excellent. Today we are going to talk about joy in medicine, a new culture. Kelly, you are a clinical psychologist. Just briefly tell us a little bit about yourself. Then jump right into the article for those who did not get a chance to read it and summarize it.

Kelly Holder: Sure. So I am Kelly Holder. I am a clinical psychologist and I have spent the last nine or ten years of my career working in academic medicine, supporting the well-being of medical students, residents, faculty, and staff. I am currently in a new role supporting health care providers in oncology and cancer care, and I have gotten to get back into my clinical work as a health psychologist supporting the emotional well-being of the cancer patients where I work.

This article was a privilege to write with this team, this idea of joy in medicine and exploring what that might mean. In the article, we talk about joy as being something that can be taught and transmitted. That quote that Kim just explained, Sarah lovely wrote in this idea that in spite of all the challenges that we talk about that happen in medical education, folks still want to continue. They still enter residency with that bright hope and wanting to move forward.

As we move forward into my portion of the article, we really talk about what does it mean to bring joy into the work that we do. This is the idea of joy not just being an emotion, but joy being a value, and how it shows up. When it intersects with the challenges that we face and then the ways that we support each other moving forward, we could think about that as an anchor point for us moving forward in the work that we do in health care and medical education.

Kevin Pho: And before I move on to Sarah, Kelly, just tell us, what does joy in medicine look like? Because I think that whenever we talk, especially on this podcast, we talk about things like physician burnout and really all the negative aspects that really obstruct medical students, residents, and physicians from giving the best care that they possibly could to patients. So what is your definition of joy in medicine in concrete terms?

Kelly Holder: Yeah. My definition of joy in medicine is that joy moves beyond happiness. Thinking about joy in terms of a value that aids us in building community and holding onto hope in the face of obstacles is key. So when we think about joy in medicine, we can think about the hope and support we offer to patients as we are caring for them, but also the hope and courage that we present dealing with the culture of medicine and the work that we do and how we do it together. So that is what I think about when I think about joy in medicine.

Kevin Pho: All right, so Sarah, you are a psychiatrist. So briefly tell us a little bit about yourself and then tell us what joy in medicine means specifically to you from your perspective.

Sarah Hollander: Thank you so much for having me today. Yes, Dr. Sarah Hollander. I am a holistic and existential psychiatrist. I did follow the traditional path of residency and medical school, but throughout my life and through training, I always had much larger questions about meaning of life and purpose. A lot of existential questions were always just a part of my own being.

Joy was a big part of my upbringing. Particularly when Kelly and I met, I know she works particularly a lot in joy. As a psychiatrist and a holistic psychiatrist at that, we look at the biopsychosocial model, which is an older model, but now we are really starting to move into the spiritual dimension and what that even means. Much larger questions to ask include purpose fulfillment, and sometimes it is going to be about religion or spirituality, depending on the patient.

Why do I bring that up? Even in terms of not just patients, but even how we are as people and clinicians and what we bring to the table, joy is also often a very nervous system-oriented thing. In order to be and have joy, it means that your nervous system is in a certain place and it carries a certain vibe. You hold yourself in a specific way. That is something that you give off and other people can feel and relate to. They can feel safe in your presence if someone carries joy. And so when we created this article, a lot of that was about joy not just as a value, but also what you transmit.

Kevin Pho: Sarah, in the article you mentioned that the current medical system sometimes mistakes endurance for excellence. Talk more about that and how that can affect joy in our physicians or not.

Sarah Hollander: Sure. So endurance, when you think about it, you think of grit, you think of tenacity. While fantastic and needed for the longevity of a marathon, which is what medicine and the career in medicine is, when I think of endurance and when it is not in balance, what happens in the body is it is more of a pushing sensation. It is a lot of resistance and pressure while constricting yourself.

So it feels like a lot of shame. It feels like playing small. It does not feel like you can take up the space that you are allowed to take up. But when you have joy, when you feel that, that is much more about a pulling sensation, a calling, an expansion, a brightness. When you work from that place, everybody around you feels that and gets joy from you, and so do your patients and so do everyone else around you, and it is a beautiful thing.

Kevin Pho: So the next part I want to ask both of you, of course, how can we implement techniques to gain some of this joy that both of you are talking about? But before I do that, Kim, as you hear Kelly and Sarah’s perspectives about what joy in medicine is, tell me what you learn most from listening to them, working with them, and reading about their perspectives.

Kim Downey: Well, one thing that is interesting is our article showed up immediately after an article you shared where the question was: “Is medical school culture replacing academic rigor?” We were actually going to write a follow-up article and we will have to see. We will regroup after this. And this physician, and again I would be, I would love to have a conversation with him because I always come from a place of curiosity.

He puts culture in quotation marks several times throughout the article and welcome as if to ask, is that really important? Like one of the sentences he says is: “In the end, patients are concerned with how welcome a surgeon felt in medical school. They care whether the scalpel is ready.” And I beg to differ. I have seen 42 doctors over the past few years and I have had all kinds of experiences and I left a few doctors. I feel like belonging is such a critical word and related, and that is the sense I get from them. The joy in medicine and how it is related to the word belonging is key.

What just struck me right before we came on is I do not know if you know, but we have a new book coming out, White Coats, Human Hearts. And Dr. Simon Craig, who you know, writes his chapter titled “Finding my place in medicine: the journey from isolation to belonging in health care.” Even the section headings are “Belonging as a practice,” “Fostering a culture of belonging,” and “Culture is the catalyst for change.” So to me, those words culture and belonging really are so important in everything.

Kevin Pho: So Kim, you were mentioning that previous article. How much do you think that is a generational difference? Because meeting Kelly and Sarah for the first time, they look relatively young to me. But how much of it is a generational perspective from those physicians who are always practicing our health care system saying: “This is always the way we have done it. There is no room for joy in medicine.” So, Kim, tell me what you think.

Kim Downey: Right. So I haven’t looked this physician up yet, but I would be interested to know how long he has been practicing. Now, of course, I am almost 60, so I would say I am old, but in physical therapy we had that culture of joy and belonging and all that. But I do believe in medical training it was different. And to your point, I believe there is a lot of that. They are like: “I put up with it, you should.” Or they mistakenly think that is what made them a good doctor. But it could be that they are a good doctor in spite of that. And I think that is a critical distinction.

Kevin Pho: So Kelly and Sarah, I am going to ask each of you in terms of next steps, how can we implement more joy in medicine? It could be within the medical education context or even for those attending physicians who may be listening to us today. So Kelly, why don’t you go first? What are some practical ways that we could implement some of the framework that both you and Sarah are describing today?

Kelly Holder: Yeah, I think starting in medical education, undergraduate medical education, some of the simple ways that it could be implemented practically is if those who are teaching our students are able to disseminate the joy that they do have. So being able to share what the work is about from an emotional standpoint, but also in little ways helping students understand the pieces that make that happen is important.

So beyond the studying and the work and the hard work, which everyone kind of understands, ask: “Who did you need to ask for help from? Who supported you with the things that are happening at home? How are you caring for your body and mind?” The necessity of doing that is crucial. Ask: “What kinds of things do you shift so you make sure your care for your body supports the work that you do showing up?”

Really sharing that in very practical ways is important. Also around some of the challenges that come up. When I hear physicians talk about burnout and moral injury and some of the changes and strains within the health care system, aiding students in understanding what they do to navigate those things as they persist in health care and how they share and work at micro levels to make changes even within their small teams and groups that make the work sustainable in the face of the things that are happening in health care that make things difficult is key.

I have often heard from students once they get onto clerkships or get more exposure to the health care system, like: “I didn’t hear about any of these things. These are none of the things that came up.” Right. And so being able to aid them in knowing that we can find joy here, even though there are things that need to be improved, and even though every day does not feel happy or joyous, we are working as a team communally to support each other moving forward. So I think those things could really help.

Kevin Pho: OK, Sarah, so tell us from your perspective in terms of practical things that we can do to implement some of this joy that you are describing for both our medical students and physicians.

Sarah Hollander: I think that joy is something I have always seen from a preventive and developmental perspective. That is why I particularly talked about implementing this through the educational system very early on. What most people do not discuss is all of the identity changes that actually happen during a career and the educational process during particularly formative years. A lot of them come in mid-twenties, early thirties. These are formative years around identity. They are starting to understand patterns in their behaviors or not, which medicine will often push them into recognizing, and this is part of that issue.

So I think talking about it early on openly is the first place to begin. You know, talk about things like burnout does happen sometimes. Ask: “What does that look like? What are the warning signs? What can you do about it?” And then if you keep adding to that every year more and more, implementing a little sprinkle here, a little sprinkle there, a lot of that goes a long way and it normalizes it. It doesn’t mean that burnout is normal necessarily. It just normalizes the debate of being able to talk about it because it is an important discussion to have. It is sort of like teens and sex education is an important discussion to have. It is better to talk about it than not.

Kevin Pho: Now Sarah, I am going to ask Kelly this question too. Give us an example or share a story of maybe a little bit of a before and after of either a medical student or physician where before you may have talked about them, they may not have felt that joy in medicine and maybe an after picture where they would better appreciate the joy in medicine. Sarah, what would be a story or a case study of what that would look like?

Sarah Hollander: I actually loved working with medical students as a resident, and I loved asking them questions about what fields did they want to go into and why. And when we really went into it, a lot of the reason they picked a particular field was because of old patterns and old conditioning, believe it or not.

When we discussed that, they had thought about it and they said: “I wonder if that might not be the direction for me when I really look into it and what place is it coming from.” So when you ask them from before, “Oh, I want to do this because of X, Y, and Z,” it was often because they wanted to prove something. But when you really get to the heart of who they are and what lights them up and what brings them joy, they start to recognize: “Well, this is what I really wanted to go into this for. This is what this is really about. This is what lights me up,” and their whole body changes.

Being able to tell them: “Look at how you just talked about that. Look at how you just lit up. Do you want to talk about that for 10 hours a day, or do you want to talk about the other one?” And just even having multiple conversations with multiple medical students was so fulfilling and so rewarding. And then hearing back from them years later: “I am so glad I pivoted, so glad I changed. This was such a good fit for me.” And when you remind them what they do this all for, sometimes we miss it. That sounded like a horse with blinders on. You know? Because you have to do the day in, the day out. The everyday you get lost and you forget. What is this all for? It is not just a career. It is such a calling and it is such sacred work.

Kevin Pho: And Kelly, tell us a case study or a story that you want to share with us.

Kelly Holder: Yeah. The story I can’t shake from my mind is about a physician towards the end of their career. They were working in a subspecialty that is known to be particularly difficult and had a wonderful career doing it. However, sometime during their later part of their career had something happen that was especially challenging. And it challenged their identity in the work. It challenged their ability to show up and this was something that they concealed. They did not share this with others.

And upon retirement, I had the privilege of having multiple conversations with this individual as they were making that transition and talking about how they wanted to share this information so others did not have to struggle in that same way silently. Although the word joy never came up in our discussion, thinking back on those conversations makes me think about how this person wanted to hold onto their joy of doing this work and continue to do this work, but didn’t have the spaces to talk about the particular challenges that they were experiencing. They were trying to figure out ways to keep that from happening to others who might have those similar experiences.

So I can see how, because Sarah shared at the beginning of careers, as we move towards the end of our careers in the middle of our careers, there is that need for that community. That is very supportive in us holding onto the joy of doing the work that we do.

Kevin Pho: We are talking to Sarah Hollander, psychiatrist, Kelly Holder, clinical psychologist, and of course Kim Downey who brought us all together. She is a physician advocate. The KevinMD article is “Is joy in medicine a new culture?” Now, I am going to ask each of you just to end with take-home messages that you want to leave with the KevinMD audience. I will start with Kelly and then Sarah, and then we will always end with Kim. Kelly, why don’t you start first.

Kelly Holder: Yeah, a take-home message is I really want those who listen to this to think about the ways they think about joy. We can easily throw it into the bucket of happiness. And as I have been doing research, joy has been understudied. We know that joy has elements of both value. It can be motivating. And it definitely moves beyond emotion. So don’t let this conversation about joy trip you up because you are not strong on the happiness part of your life. We are talking about something far beyond that, something that is integrative, something that holds people together, gives us hope, and anchors us in being able to live the lives we want to live. So consider how you think about joy and think about the ways it can be incorporated into your life beyond feeling happy.

Kevin Pho: Sarah, your takeaway messages.

Sarah Hollander: If any one of you is struggling out there, it is important to recognize that you have community and that you are not alone first and foremost, and what you are going through is something that is OK. Something that we can handle. But don’t be afraid to speak out to someone that you trust because there are ways to mitigate that and still move forward and still find joy again. So this is my reminder. Don’t lose hope in yourself. Don’t lose hope in our profession. We are here to make positive changes for you, for everyone, for our patients, and more to come.

Kevin Pho: And Kim, we will end with you. Your take-home messages.

Kim Downey: Sure. I would say the more I am involved in these spaces, individuals and teams and systems are all inextricably connected. So when we are talking about joy, it is not just individual joy, it is teams and systems. And Simon also in his chapter shares stories about chocolate cake and curry puffs. That changed everything. So it was those moments, but it was with teams and then that changed the culture of whole systems. It affected him an individual level and team and system.

And I will just share a quote from Paul Westfield. He shared this on one of my posts yesterday: “Communication skills combined with emotional intelligence are the foundations for leadership and team effectiveness.” And he is a former fighter pilot who helps hospitals and physicians minimize error risk and improve patient safety. They aren’t just soft skills; like soft skills aren’t optional. They are really foundational.

Kevin Pho: Everybody. Thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Kelly Holder: Thanks for having us. Thank you.