Walter Reed National Military Medical Center, BETHESDA, Md.  –   Assisting patients to positive health outcomes is fundamental to finding the joy in medicine, shared various speakers during the annual Artiss Symposium, held at Walter Reed National Military Medical Center, June 5, 2024.

This year's theme for the one-day symposium focused on the joy in medicine, and those joys can come from patient interactions, discovering innovative ways to enhance patient care, teaching and mentoring the next generation of caregivers, and teamwork and collaboration among providers and across specialties for the benefit of patients and staff, speakers shared. They stressed that joy in medicine is multifaceted and can vary from person to person. It’s essential to find balance, prioritize self-care, and appreciate the meaningful moments that make the practice of medicine rewarding, they offered.

“It has to be a choice sometimes to find joy,” said U.S. Navy Capt. (Dr.) Melissa Austin, director of Walter Reed National Military Medical Center. “It may mean looking for joy in places you may not have thought to look,” she added. Austin said joy can be found in the mundane things we do every take and the things we take for granted, and she encouraged the attendees to take advantage of the day’s events to take time for themselves and think about those unexpected sources of sustenance and resilience.

Walter Reed's Directorate of Behavioral Health hosted the symposium, bringing together presenters who addressed post-traumatic growth, finding joy within academic medicine and operational psychiatry, and redefining leadership in the medical profession.

The symposium received its name from U.S. Army Lt. Col. (Dr.) Kenneth L. Artiss, who served as a research psychiatrist and instructor at Walter Reed Army Medical Center. He served for more than 20 years in the Army Medical Corps before retiring in 1964 as chief of the department of psychiatry in the division of neuropsychiatry at the Walter Reed Army Institute of Research. His work included development of treatments for combatants with severe psychiatric disorders. After he retired from the Army, Artiss was a senior consultant to Walter Reed's psychiatric residency training program. He died in October 2001 at 88. The annual Artiss Symposium continues his legacy of inspiring new and innovative care for veterans and other beneficiaries of the Military Health System, explained Army Col. (Dr.) Aniceto Navarro, director of Behavioral Health at Walter Reed.

“Lt. Col. Artiss was a quintessential educator. He had very high standards of training psychiatrists,” Navarro stated. He added the Behavioral Health has hosted the symposium for more than two decades.

TAKE CARE OF YOURSELF SO YOU CAN TAKE CARE OF YOUR PATIENTS

"If you can't take care of yourself, you can't take care of your patients," stressed Dr. Leon Moores, a specialty care physician board certified in pediatric neurological surgery and one of the symposium’s speakers, explaining the need for caregivers to avoid burnout.

Moores has spent much of his career serving in combined clinical and leadership roles. He was chief of neurosurgery at Walter Reed, chair of the Department of Surgery at Walter Reed, deputy commander for integration at the former National Naval Medical Center, and commander (CEO) of Fort Meade Medical Activity. He twice deployed to combat zones to care for service members in harm's way, and he co-authored the U.S. Army's physician leadership development program. He was the Army Surgeon General's Physician Leader of the Year as a lieutenant colonel in 2005 and again as a colonel in 2012.

Moores stated that a well-led team improves the environment of care, retention and recruitment, and most importantly, patient outcomes. "Leader behaviors affect team performance," he stressed, adding that "leadership can be taught and improved upon." He explained improved productivity and quality are the results from physicians more competent and comfortable leading high performing teams.

“Physicians lead the team, [but] they are not the center of the team,” Austin added. “There has to be physician leadership in order for patients to get good care in order for the health care system to function effectively.”

JOY IN OPERATIONAL PSYCHIATRY

Army Lt. Col. (Dr.) Daniel Hart, U.S. Army Special Operations Command psychiatrist, explained that the joy in operational psychiatry comes from personal resilience (off-duty pursuits, physical and mental health, spiritual care, etc.); efficiency in practice (“learning from the masters,” never stopping the search for learning proficiencies and efficiencies); and a culture of wellness (awards/recognition, visiting other practitioners, teaching, open door policies). He emphasized that striking a balance between rest and exhaustion, savings and expense, reserve and deployment, and algorithmic boredom and lack of predictability, are important to the joy in operational psychiatry.

Austin said for some, the operational environment can provide challenges “just enough to push people out of their comfort zones,” but can be rewarding and provide joy when those challenges are met and/or exceeded.

JOY IN TEACHING, MENTORING

Dr. Elizabeth Greene, director of tele/digital education in the Department of Psychiatry at the Uniformed Services University (USU), discussed the joy in medical teaching and scholarship. She served in the U.S. Air Force for nine years, deploying in 2008 in support of Operation Iraqi Freedom. She shared that the joy in teaching and scholarship can come from a number of sources, including discovery and curiosity and expanding one’s knowledge. She added that joy shields people from "burnout, encourages investment, protects from moral injury and preserves meaning."

In addition, Greene explained that joy inspires people's creative thought, effective work and improved learning.

"Joy stealers," Greene added, can manifest themselves in “rudeness, shaming and blaming, devaluing, dismissing, time pressures, cynicism, exhaustion, perfectionism, and ungrieved loss.”

"Joy can be cultivated and developed through practice," Greene said. She explained this can be done in a number of ways, including practicing gratitude, helping others, meditating, living your truth, slowing down, unleashing your inner child, spending time with loved ones, and recreating peaceful moments.

POST-TRAUMATIC GROWTH

Dr. Kyle Gray, a psychiatry specialist, discussed post-traumatic growth (PTG), explaining it "involves an event (broadly define 'trauma') wherein a person's basic assumption about their world is severely challenged, and the rebuilding of new schemas (mental models found in long-term memory) results in growth in one or more well-defined domains."

"Trauma responses, like PTG, are complex and nonlinear," said Gray, who served as a Navy resident at Walter Reed. She explained providers should ensure a patient’s basic and acute distress needs are met before engaging in meaning-making (personal growth, lifestyle changes, etc.). “The sign that your patient is building a 'before and after' narrative is fertile ground for meaning-making and post-traumatic growth," Gray shared.

Speakers stressed that the joy in medicine can arise from various sources, and it often depends on individual experiences and perspectives. They stated it’s important individuals look for and cultivate what brings them joy in medicine to reduce burnout and build well-being so that they – and their patients – thrive.