Joy to the world

By Jason Liebowitz, MD, Columbia University

It was 9 p.m. on a Thursday night in late July. I was sitting in the workroom with Julie and Chunhui, two first-year fellows in our rheumatology program. It had been a long day. The consult service was overflowing, and the diagnostic complexity of our patients left my mind feeling like molasses slowly moving through differential diagnoses and treatment plans. As I looked at Julie and Chunhui, I worried that these demanding days might burn them out before they’d settled into fellowship. What I found, however, wasn’t exhaustion—it was exhilaration.

“Do you think Mr. Smith might have an autoinflammatory disease?” Julie asked.

Chunhui nodded. “Maybe. Let me look through the literature and see if there’s a case that fits his presentation.”

Despite the late hour, the room buzzed with curiosity and intellectual energy. Ideas bounced back and forth. Questions led to more questions. This wasn’t a scene of burnout. It was a scene of joy.

Happiness

We often talk about “finding happiness” in medicine, but I think the phrase can be misleading. Happiness is a fleeting emotion. It’s what my children feel when they receive a lollipop from our rabbi after Friday night Shabbat services. It comes and goes with moments of pleasure, excitement, or relief.

Medicine, even at its best, shouldn’t be measured in moments of happiness alone. A clinician who expects to feel happy throughout the day will often be disappointed. Electronic documentation, insurance authorizations, administrative tasks, and bureaucratic hurdles rarely produce happiness.

Joy

Joy, however, is different. Joy emerges when we invest ourselves in meaningful work. It’s found in spending extra time untangling a complex patient’s story and arriving at an insight that improves their care. It’s found in teaching a trainee a new clinical skill, modeling thoughtful patient care, and watching their confidence grow. It’s found in extending compassion to families during their hardest moments and in writing a letter after a patient’s death expressing what an honor it was to be their physician. These experiences are often difficult. They require effort, patience, and emotional investment. But they also provide something deeper than happiness—meaning.

I caught a glimpse of that meaning during those first weeks of fellowship with Julie and Chunhui. By a fortunate twist of scheduling, I also worked with them during the final weeks of their first year. If there was ever a time to feel weary or disengaged, that was it. Instead, our conversations remained just as thoughtful and animated as they had been in July. The same curiosity persisted. The same commitment to learning endured. The same excitement for solving difficult clinical problems remained.

Watching that growth—and sharing in it—left me with a feeling that can really only be described by a single word—joy.

Five things I took away from this experience:

1. Joy is more sustainable than happiness.

Happiness often depends on circumstances and short-term rewards. Joy comes from meaning, purpose, and connection, making it more durable in a demanding profession.

2. Intellectual curiosity protects against burnout.

Challenging clinical work can be energizing rather than draining when learners feel engaged in discovery and problem-solving.

3. Teaching is a source of professional fulfillment.

Educating trainees can be one of the most rewarding aspects of medical practice and a powerful reminder of why we entered the profession.

4. Meaning often arises from effort, not ease.

The moments that bring the greatest satisfaction—working through a difficult diagnosis, supporting a family, mentoring a learner—are rarely the easiest moments.

5. Culture matters.

A team environment that values curiosity, collaboration, and shared learning can transform long, difficult days into experiences that foster growth, resilience, and joy.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.