Foreword

“When I was 5 years old, my mother always told me that happiness was the key to life. When I went to school, they asked me what I wanted to be when I grew up. I wrote down ‘happy.’ They told me I didn’t understand the assignment, and I told them they didn’t understand life.”
– John Lennon

When you were growing up, you probably got asked the same question John Lennon’s teachers posed to him: What do you want to be when you grow up? If being a doctor was where you set your sights, you were in good company. Forbes magazine poses this very question to children periodically, and one of the most frequently reported aspirations of these youngsters—right alongside astronaut, professional athlete, and rock star—is physician. When children dream of their futures, treating patients and curing disease hold the same status as the work of John Glenn, Simone Biles, and Taylor Swift.

As children grow up, however, their priorities shift, and they realize there is something of even greater importance than their specific profession. One study interviewed thousands of young adults from all over the world and found that rather than love, money, health, or even getting into heaven, what they valued above all else was happiness.

And both of those aspirations—becoming a doctor and finding happiness—seem to be getting more and more difficult. Admission to medical school continues to be among the most competitive and highly selective endeavors that exist, and a mental health crisis has taken hold of our society, with depression and anxiety rising at staggering rates.

What about becoming a happy doctor? No doubt anyone fortunate enough to be accepted to and make their way through medical school will receive a solid foundation for becoming a physician. But even the best professors, labs, and simulations aren’t guaranteed to provide a foundation for becoming a happy physician.

Count John Lennon out.

The Pursuit of Happiness

In order for us to become happy in our profession—be that as an astronaut, athlete, rock star, or physician—we first have to understand a few things about the nature of happiness and its pursuit. For most of the 20th century, the field of psychology was largely reactive, focused primarily on treating depression, anxiety, and other disorders of the mind. It wasn’t until the 1990s that a network of scholars dedicated to understanding behaviors and mindsets that proactively contribute to well-being emerged. Soon there was a proliferation of research illuminating the benefits of such an approach: People who are happier are healthier, more successful, and have stronger relationships both personally and professionally.

This research also uncovered the very promising news that a large part of our happiness is within our own control. It previously had been assumed that happiness was something that just “happened” to people. Even the root of the word happiness, “hap” (the same root of words like happenstance or haphazard), is derived from the Latin word meaning “by chance.” More recent scientific discoveries have identified very simple strategies for attaining happiness, showing that not only can it be pursued at all, it can be pursued even without extraordinary means or resources. Just as organic chemistry or human physiology can be learned through intentional effort, so too can the strategies for increasing everyday well-being.

Barriers to Happiness

Most happiness-boosting strategies boil down to one of three elements:

• hard work that leads to tangible, worthwhile outcomes (competence);
• pursuits that are freely chosen in alignment with our personal values (autonomy); and
• activities that build relationships with others and leave us feeling connected to something bigger than ourselves (relatedness).

Unfortunately, many aspects of medical training make these three elements difficult to achieve. Let’s put them under the microscope one at a time.

Competence. Although a doctor who has successfully traversed the challenges of medical school and residency is well-equipped with an extraordinary set of skills, putting those skills into practice may be fraught with challenge and frustration, often on account of the ineptitude or carelessness of others. Administrative challenges, the bureaucracy of insurance companies, and noncompliant patients make it more difficult for a doctor to accomplish what they know they are capable of, therefore potentially threatening their sense of competence and, in turn, their well-being.

Autonomy. Although much of a student’s premedical and medical school training is prescribed for them, eventually they must choose a specialty that will set the stage for their entire career. The way that specialty is chosen may come from any number of factors, ranging from external (compensation, prestige, or familial expectations) to internal (a sense of a “calling” or a personal connection to a given specialty). Making such a decision for reasons that are more external than internal may limit a student’s feelings of autonomy and, consequently, their satisfaction with their career. Even the sheer number of specialties to choose from may present a burden for many young trainees. The tyranny of choice, studied by behavioral economists, shows that an abundance of options is cognitively taxing and can lead to decision regret (a form of “buyer’s remorse”) in which one constantly wonders “what if” they had gone with the other options that once were available to them.

Relatedness. Feelings of loneliness and isolation characterize many aspects of medical training as well. Electronic medical records, though necessary for efficient documentation, have replaced systems that encouraged more casual interactions in the profession in previous “lower-tech” generations. Even something as simple as seeing others who happened to be accessing a filing cabinet at the same time fostered an environment with more human contact and stronger relationships among colleagues. Long hours of many specialties (especially during residency and fellowship) also limit opportunities for socialization outside of work, further dampening any sense of connectedness to others.

Becoming a Happy Doctor

Although the path to becoming a doctor can pose challenges to the pursuit of happiness, if there’s one thing we know about doctors, it’s that they are resilient. The same work ethic that leads an aspiring physician to develop an understanding of the science and intellectual side of seeing patients and making diagnoses can also be applied to incorporating satisfaction, purpose, and yes, even happiness into their life’s work as well.

Although there is not a clear-cut curriculum for the pursuit of happiness and well-being during life, one thing that is clear is the importance of mentors. Hearing stories from others who have traversed the path you are about to embark on (or upon which you are finding yourself at a crossroads) is one of the most effective ways not only to get a sense of what is ahead, but also to optimize your personal and professional success as you make your way.

One of the ways that psychologists conceptualize happiness is with a simple formula:

Happiness = (What We Have)/(What We Want)

The pages that follow offer a glimpse into the medical profession from a seasoned anesthesiologist revered not only for his scholarly contributions to the field, but also for the kindness and compassion he extended throughout his career to his colleagues, trainees, and even his own neighbors (I can personally attest to the last one). As you read each chapter, consider how you would have handled the situations that are described, and how they may relate to future decisions you will have to make.

These stories and vignettes can help prepare you for what is realistically in store for your own career (calibrating the “What We Want” component of the formula above) and also direct your attention to the joys that await you (emphasizing the “What We Have” component). Understanding the inevitable challenges ahead can minimize their negative impact and arm you with the appropriate strategies to address them productively. And maintaining attention on the good parts of our careers, which can so easily fade into the background of life’s challenges, engages us in the practice of gratitude, one of the most effective ways to increase our happiness. After all, a large numerator equates to a large overall quotient.

Ultimately, this resource will allow you to remain true to the childhood dreams you may have set for yourself long ago while simultaneously incorporating the one thing that nearly all of us are pining for above all else: happiness.

John Lennon would be proud.