The meaning of joy

Emilie Couchman is an NIHR Clinical Lecturer in general practice with the Division of Primary Care, Palliative Care and Preventive Medicine at the University of Leeds, and a salaried GP in Wiltshire.

‘Happiness can be found, even in the darkest of times, if one only remembers to turn on the light.’¹

This line prompted me to pause ‘Harry Potter and the Prisoner of Azkaban’ mid‑film and make an ill-timed attempt at conversation; an act my family regarded as cinematic treason. As penance, I relinquished my place on the sofa and dutifully refilled the popcorn.

Joy can be found in the most unexpected of places: in an under-resourced general practice in the UK’s National Health Service (NHS) perhaps? Within the hearts and souls of this workforce, meaning can translate into joy. The Institute for Healthcare Improvement recently published their ‘Framework for Improving Joy in Work’.² Joy is apparently not simply the passive absence of burnout, but a proactive presence of purpose, autonomy, safety, belonging, equity and camaraderie. For an individual general practitioner (GP) to achieve meaning from their professional role, their work must: be congruent with their own moral compass; be adequately resourced; provide opportunities for intellectual stimulation; and permit mutual recognition within professional relationships with patients and colleagues.^2,3

If it was a stretch to align the word ‘joy’ with NHS general practice, then please, bear with me, as we now consider the context of terminal illness. The undeniable meaning of the work undertaken by clinicians in palliative and end of life care was eloquently and succinctly stated by the 14th century scholar and poet Francesco Petrarch: ‘a good death does honour to a whole life’.⁴ In her book entitled ‘Come What May’, the aptly named Lucy Easthope – a professor of disaster management – speaks of ‘hopium’ as the dark side of hope, which prevails when blind optimism errs on the side of denial. As the end of life approaches, perspectives may shift, and the subsequent change in priorities and altered preferences must be acknowledged. The motivation to live well can supersede the realisation that life is limited: ‘The real hope no longer comes from the thought of a long life but the potential of a good death with ends tied up.’⁵ Of course, supporting people to die well is a key aim of palliative and end of life care provision, but so too is enabling people to live well until they die. The presence of joy does not require picture-perfection, and its intensity may be amplified in times of tragedy, in a cruel but beautiful juxtaposition. In dramatisations that portray characters faced with the stark realisation of their impending death, they often reflect on the meaning of their life; their raison d’etre. Perhaps the nature or constitution of this meaning does not necessarily matter; more important is that meaning exists.

Given the strain within the NHS, and in other healthcare systems worldwide, moral distress is rife within the NHS primary care workforce: ‘when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’.⁶ For example, existing evidence and policy suggests that prioritising certain patients may be a manageable strategy for implementing certain interventions given resource limitations. However, the unseen impact on clinicians who experience moral distress from such decision-making requires further exploration.⁷ Proposed solutions to moral distress involve the clinicians themselves attending sessions or engaging with practices that may improve their wellness and resilience, but in fact the institutional and organisational origins of their moral distress need attention.⁸ The utopian antidote to moral distress is endless resource and manageable demand. In reality though, if healthcare professionals are able to find meaning and recognise the values upheld within morally distressing situations, the emotional toll may be counterbalanced.⁹

Joy within this workplace can also originate from a strong sense of professional identity. The dynamic process by which professional identity is formed must be considered in tandem with contemporary societal norms and expectations.¹⁰ As a healthcare system adapts to meet the changing needs of its population, so too do the roles and responsibilities of the individual professionals working within the organisation. Circling back to NHS general practice, GPs are seldom considered as ‘experts’, given the breadth of their clinical remit. However, a GP’s generalist expertise lies in managing the heavy burden of uncertainty, steadfastly shining a spotlight on the holistic needs of each patient, providing relationship-based care within a fragmented system, and making decisions that support people to appropriately navigate between healthcare settings and across interfaces.¹¹ General practitioners can distil an individualised, coherent narrative from a patient’s list of (perhaps completely unrelated) symptoms. They can provide explanations and form management plans despite a backdrop of uncertainty. Most remarkable though, is their ability to develop trusting, supportive relationships with patients without having all the answers.

Thomas et al. recently developed a framework that highlights the appreciation of deep, trusting GP-patient relationships among clinicians and patients alike. Working in this way can increase vocational joy and meaning for GPs, but of course may push the limits of an individual’s ability to balance their professional responsibilities with their own wellbeing. Clearly, adequate funding is required if general practitioners are to have the capacity to provide this crucial relationship-based care without being consumed by moral distress or burnout.¹² Personally, I believe that three is the magic number when it comes to the key components that each clinician must consider if they are to excel. Of course, clinical competence is the foundation; it has to be. The medicine is essential. Equally though, the attitude of a clinician is crucial, especially in truly understanding their role and propensity for therapeutic intervention through their attitude. Finally, without adequate resources, a practitioner is paralysed: all talk, no action.

My husband often asks me, ‘don’t you wish you were interested in something a little more chirpy so that you could talk about it at dinner parties without bringing the mood down?’ My answer has always been, ‘no’; perhaps because with two young children, we are not inundated with dinner party invitations. More importantly though, I believe that medicine is about making people feel better, not necessarily making people better. Perhaps I have developed this interest because of my personal character and life experience. Whatever the reason, it is something I truly care about and find fulfilment in. This is when any individual does their best work. Where there is meaning; there is joy.

References

1. Cuarón A. (Director) Harry Potter and the Prisoner of Azkaban [Film]. Warner Bros. Pictures; 2004.
2. Perlo J, Balik B, Swenson S et al. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.
3. Owen-Boukra E, Burford B, Cohen T et al. General practitioner workforce sustainability to maximise effective and equitable patient care: a realist review. British Journal of General Practice. 2025; BJGP.2025.0061.
4. Francesco Petrarch. “Delphi Collected Poetical Works of Francesco Petrarch (Illustrated)”, p.306, Delphi Classics; 2016.
5. Easthope L. Come What May: Life-Changing Lessons for Coping with Crisis. Hodder & Stoughton; 2025.
6. Jameton A. Nursing practice: the ethical issues: Prentice-Hall; 1984.
7. Molinaro ML, Shen K, Agarwal G, et al. Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care. British Journal of General Practice. 2024;74(738):e41-e8.
8. Davis M, Batcheller J. Managing moral distress in the workplace: creating a resiliency bundle. Nurse Leader. 2020;18(6):604-8.
9. Lamiani G, Montecalvo M, Luridiana Battistini C, Borghi L, Meyer EC, Vegni E. Coping with moral distress: a qualitative study exploring psychological strategies used by healthcare professionals. BMC Psychol. 2025;13(1):589.
10. Sternszus R, Steinert Y, Razack S et al. Being, becoming, and belonging: reconceptualizing professional identity formation in medicine. Frontiers in Medicine. 2024;111438082.
11. Fisher R. The role of general practice in the NHS in England. The Health Foundation; 2024.
12. Thomas H, Lynch J, Burch E et al. Where the joy comes from: a qualitative exploration of deep GP-patient relationships. BMC Primary Care. 2023; 24:268.

Featured Photo by Ashin K Suresh on Unsplash