10.2 - Cheerfulness
Following upon their conversation about the good in medicine with Dr. Chris Lisanti, John and Michael explore the challenges healthcare professionals face in maintaining cheerfulness amidst emotional turmoil. They highlight the importance of acknowledging emotions and the impact of patient interactions on the physician-patient relationship.
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Transcript
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Hi, and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic
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Society. In the podcast, we aim to reflect on deeper questions in medicine, all with
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the aim of rediscovering the ideals that brought us to medicine in the first place in order
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to better serve our patients and colleagues. Thank you for joining us, and we look forward
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to engaging with you through this podcast.
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Hi, and welcome back to the Hippocratic Society Podcast. Today, we want to talk about cheerfulness.
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And this episode is following up an episode we did with Dr. Chris Lissanti to talk about
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the good in work. And during that episode, we talked about how finding the good in work
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and finding meaning in medicine can return joy back to work. And so we want to talk about
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the virtue of cheerfulness, a little bit different than joy, but how that can contribute to our
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life. So, John, why don't we start off the usual way? So what is cheerfulness?
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Yeah, thanks, Michael. Maybe it would be helpful to start off with what cheerfulness is not,
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because sometimes the opposite can help us recognize like what something is. In the sense
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that it's a common misconception, I think, that we think about cheerfulness just as a
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feeling or a mood. And the reason why that's important is that if we're talking about cheerfulness
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it could be in conflict with the virtue of sincerity, right? I guess people might be like,
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well, if I'm not feeling happy, it would be lying to not be like how I feel, right? But there seems
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like there's something wrong with that as well, right? Like, okay, we're just in a bad mood. And
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so we're just going to go around being mean to people. It's obviously not seems like not the
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right thing either. But I think it's important to delineate that because that could be sometimes one
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of those things of like, okay, I'm not cheerful because that's like now how I feel and I justify
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it in some sense by saying that it's insincere to be otherwise. And so if we're talking about
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cheerfulness as a virtue, then I think we have to think about it in the classical virtue sense of
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recognizing what the good is and also activating the will towards that good, right? And so we have
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to see the good of cheerfulness. And I think in medicine, that's especially apparent because we
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are with patients where they're in the midst of some type of crisis, maybe smaller crises,
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as in not every visit to the hospital is something very grave. But it is still something that is
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affecting their daily lived experience or life that requires the patient to come into the hospital
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affecting their daily lived experience. And so we have to think about it in that setting where
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the person's coming in, where ranging from an annoyance in their life to something fairly grave
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that may be affecting also their own mood or their own ability to live life, or just like their
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patients being tested because of the fact that this particular pain or this particular tumor or
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this particular whatever it might be, may be affecting them, right? And so to see the good
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of cheerfulness, I think, also is part of this idea of the core of the physician-patient
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relationship, which is to be able to be in the place of the patient and to uplift the patient,
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recognizing what experiences that they are going through. So I think with cheerfulness, the most
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obvious or difficult part is acknowledging the emotions because, especially as a trainee,
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when we're in the hospital for hours and hours, it could be really hard to be cheerful because,
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well, sometimes we go through moments that are also hard in the hospital. Sometimes a patient
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affects us in a way that's pretty deep, both positively, but also sometimes really negatively.
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Like patients can sometimes make us feel really hurt too because we're there to help patients,
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either don't want our help or they get angry at us because of the emotions that they're feeling.
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And all of those can lead to various hurts that we sometimes have to carry. But then the question is,
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like, is it good then to carry the hurt that one experiences from one patient to the next patient,
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who also deserves a relationship with the physician where the physician can uplift them, right?
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Can engage them in a sense in which they imbue some of this joy and relatedly, I think, hope
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to the patient, that interaction.
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Yeah. Yeah. So that's very clear how important it is. And I like the three parts of virtue,
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where you're bringing in, as you said, seeing the good, acting with your will,
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acknowledging the emotions. Could you talk a little bit about, and you were touching on this,
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where does cheerfulness fit in parts of medicine where it is actually very grave? And obviously,
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there is a great good to be had in being cheerful to the patient and bringing them joy.
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But I'm thinking of cheerfulness as a virtue and virtues as good in themselves.
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But perhaps maybe I could say, and maybe I'm wrong here, but would there be instances where
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cheerfulness would not be appropriate? Or what would cheerfulness look like in difficult
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conversations?
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Yeah. So I think one example is something that we were just actually talking about where you
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have a patient interaction. And it was really hard, let's say that the patient had just got
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a diagnosis that they didn't want to hear. And they replied to you in a way that was
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kind of hurtful. Like they say, you don't know what you're talking about, or you're a bad doctor,
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I don't want to listen to you, and you're lying to me, and I want you to get out of my room.
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Things that could happen. I think I would say they're very rare that somebody is so upset.
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I think that there's ways, communication wise, to not get to that stage. But sometimes even with
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the best communication, people can act out in ways that can be pretty hard sometimes to take.
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And so part of that is one has to be almost an expert in cognitive behavioral therapy, I think,
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in order to not just be repressing the feelings, but acknowledging the feeling of feeling hurt,
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or feeling sad about the interaction, or maybe even feeling angry, welcoming the feeling and
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recognizing that it's there. But then with the intellect, recognizing and identifying that for
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the next patient, they have nothing in relationship to this patient, they too are also having a
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difficult time. Also recognizing where sometimes these things are coming from in that current
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patient relationship or interaction. Recognizing that sometimes things that are said emotionally
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are not actually things that the patient also means intellectually. And so I think there's
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a lot of mindfulness that is important in these interactions, and making sure that one, we give
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that particular interaction the benefit of the doubt, we recognize and feel those emotions.
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And we know that this is not something that we should carry into that interaction. And so how
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can we still be patient, kind and also joyful for that patient? Because I think that the other very
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basic human thing is when you're with your friend, and the friend is sad, and responding to you in
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like one word answers, it's hard to have a conversation with that person. Whereas if somebody's
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happy, cheerful, responding to you, the conversation feels very easily flowing. And I think that that's
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the same thing with patients, right? With all human beings, that for approaching it in a way in which
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we approach this interaction with a sense of cheerfulness, that it also allows the patient to
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open up more to you, to tell you what's actually going on. Because people sense when somebody is
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guarded or upset, or not wanting to talk, or whatever it might be. And I think that those
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things happen in the relationship between the physician and patient as well.
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Yeah, so that makes it sound that last point that cheerfulness is very interrelated with
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the virtue of self-effacement for a physician, where it's not even if you are feeling these
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things. And maybe even maybe you could talk to this as well, maybe even if you have difficult
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things going on in your life, there's a certain amount of detachment that you have to have to
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approaching a patient and still maintaining that cheer, even in the face of your own difficulties.
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Yeah, there's an aspect, of course, as we talk about with the virtues, a lot of
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adjacent virtues. And even though we might not think about it as such, that cheerfulness,
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I think is very closely related to self-effacement, self-sacrifice. There's a quote that I don't
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remember the exact quote that I really like about cheerfulness, especially when it's the hardest.
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It may actually be the biggest sacrifice that one can give to those around them, that it could be
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the greatest sacrifice, especially when you're in the moment of really not feeling cheerful.
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But I think we all have had this experience too, where, and also if positive psychology research
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shows this too, that even if we're not cheerful, it's not insincere to smile if, again, the virtue
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is the intellect and activation with the will, right? But if we smile, it actually activates
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different neurohormones that make you happier. And then, of course, there's also the positive
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psychology research around mirror neurons, where when you're smiling, other people tend to also
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smile too, because we're social beings and we respond to each other in that way, which is why
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people who, or one theory behind an elderly couple who have been together for like 40 years,
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why they look more and more similar, it's not actually that they look more and more similar,
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but that the way that their smiles have responded to one another, like create similar patterns of
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wrinkling that actually make them look more alike. And I think that that's like a beautiful analogy
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to virtue, because it shows us one that, again, virtue being a habitual disposition towards the
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good. And so if we are disposed towards the good and trying to practice those, and if we identify
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it as good with our intellect, and then we act on it with our will, that over time, being cheerful
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becomes less and less hard. It continues to be a sacrifice if there are times of difficulties for
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us, but that it becomes something that in some sense becomes habituated, it becomes embodied
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in our body, and it becomes something that is easier to do. And also just this idea that if we
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virtues being communal, that we could in some sense, like this one, especially like almost directly
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share it with those around us, you know, whether we're talking about it in the scientific way of
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mirror neurons, or whether we're talking about it in terms of just positive psychology, that
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cheerfulness is contagious. And that way, I mean, we've all also had this experience where like,
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somebody starts laughing, and then it kind of just like catches on, and everybody starts laughing,
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right, in the sense that it is something that can be spread. And in that way, can actually make
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something a little bit lighter for a patient. I've definitely had interactions where,
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and if we've had serious conversations, but then also in moments in the conversation where we
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laughed together, smiled together, kind of causes, in some sense, like a medicine for the patient,
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like a healing of sorts, where there's a lightning of the burden. And so it's not just medications
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that we give, or even advice that we give, but it's like our whole self that we give when we
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encounter the patient. And cheerfulness is in some sense, like a very embodied way in which we give
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of ourselves to patients, and a very embodied way in which we give ourself in sacrifice.
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Yeah, that's very beautiful to think about in terms of a shared virtue. And I definitely have
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had the experience of someone else laughing, and it's just catching on and being contagious.
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I think it would be great to hear in your experience, especially in the clinic, those long
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hours and days of residency, how can we grow in this virtue of cheerfulness?
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Yeah, part of it is a practice that I think we just talked about, which is mindfulness,
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that sometimes when I'm feeling in a little bit of an inpatient mood, I have to take a pause and
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be like, okay, what's happening inside? And what's going on there? And what was it that maybe is
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making me do this? And sometimes it's something as simple as I can't really identify it, but it was
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very cloudy and rainy this morning, and I was tired. And so it's sometimes just something as
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physiologic. But identifying that in a mindful way is helpful, because then it's like, okay,
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that was a physiological thing, but I could still use my will to then overcome that and be happy
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with those around me, be cheerful with those around me, right? And spread that. I think that
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that's one is this, like, again, mindful awareness that when we recognize this, like, these annoyances,
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the way that we're acting, how aware are we of our emotions, how aware are we of our actions to
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back on like what we are doing. But I think there's also another type of mindfulness, which
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is not just the reflection of the mindfulness of our inner state. But the times like, you know,
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when I've had a difficult patient interaction that I do need to take like a few minutes,
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sometimes in a medication closet or something, where I have to take a little bit of stock,
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calm, also my emotions, seek for the higher ideals. And then also pause before going into
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the next patient's room to really like center myself and say like, I want to be cheerful,
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because this patient also deserves it. And I want to be it for this patient. And so to gather that
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strength, and then going to that room with the same like, Hi, I'm Dr. E, like, it's really great
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to see you. Like, it's really great to meet you. You know, how are you doing today, right? In the
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sense of this, again, is a part of the, I think, sacrifice that we live in medicine and how we can
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also see in which you could even approach it from like, how can I make someone else smile today? How
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can I spread the cheer? How can I lighten the situation for patients too? And how can I intertwine
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like even though some things sometimes are difficult conversations, but also to lighten things
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recognize that as I practice that, that I also become habitually cheerfully disposed.
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Yeah, so it's a tiny back to the beginning, it sounds like the more cheerful you become,
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it almost does become an emotion as well, where you are just emotionally cheerful as well as being
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begrudgingly cheerful sometimes.
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Yeah, that's right. Yeah, part of the embodiment idea is that we are like body and soul. And so
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the more we become habituated to it, in some sense, our body like remembers it, and it becomes
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easier for us to practice that and in some sense more natural.
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Thank you, John. We will see you all next time on the Hippocratic Society podcast.
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Thanks, Michael.
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Thank you very much for joining and reflecting with us today. Keep up with new episodes by
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