Happiness at work. If you’re like so many of the seasoned physicians in my life, this might seem like an oxymoron. But that’s exactly what Shawn Achor suggests can be your status quo. The old axiom that if you are successful you will become happier is out-dated and, as it turns out, not evidence-based. It seems like many things in medicine, we may have had it backwards. Maybe, he suggests, if you find a way to make yourself happier – you’ll actually be a better doctor…


Conventional wisdom may be wrong. Success doesn’t beget happiness – ‘happiness fuels success’. That is the core message behind Shawn Achor’s book. In his book he describes seven principles behind happiness that you might immediately apply to your life. These are:

  • Principle 1: The Happiness Advantage
  • Principle 2: The Fulcrum and the Lever
  • Principle 3 The Tetris Effect
  • Principle 4: Falling Up
  • Principle 5: The Zorro Circle
  • Principle 6: The 20-second rule
  • Principle 7: Social Investment

Though I don’t have room to summarize all of these principles, the ‘Tetris Effect’ is most easily summarized. Psychologists have found that after playing hours of Tetris, test subjects started seeing the game pieces (L-shape, S-shape, etc..) everywhere they looked. Similarly then, if your mind is primed to see positive occurrences (through, let’s say journaling 3 things you’re thankful for every day), you’re more likely to see positive things around you.


Mr. Achor is one of many psychologists who have come out a long line of published authors from Harvard University’s hallowed halls. He was a teaching assistant for one of Harvard’s most popular undergraduate courses (Dr. Tal Ben-shahar’s ‘Happiness’ course).

Positive psychology is a branch of psychology that studies positive human functioning. Researchers in this branch of research hope that by studying the exceptionally happy, we might find effective interventions that enable individuals, families and communities to thrive. Shawn Achor’s TEDx talk has clocked more than 3 million views. Talk about knowledge translation.

“We’ve pushed happiness over the cognitive horizon.”

– Shawn Achor, “TEDxBloomington: The happy secret to better work”, Video, 9min58sec

For emergency physicians, sometimes it can be particularly hard to be happy at work. Wait times, bed blocking, gridlock. Emergency departments have become the port of entry for nearly all acute care patients, and try as we may, we can never really catch up.

It is paramount then for us to shift the paradigm. If we keep chasing an impossible goal (e.g. clear the waitroom), we will never see success. And traditionally, if you’re never successful, then you’ll never be happy.

”..[T]o find out if positive emotions could possibly affect how well doctors make their diagnoses, a trio of researchers decided to send a group of experienced doctors back to school by giving them…sets of symptoms to analyze [and list a differential diagnosis]. The doctors were split into three groups: one primed to feel happy, one given neutral but medicine-related statements to read before the exercise, and one, the control group, given nothing… The goal of the study was not to see how fast they performed the correct diagnosis, but also how well they avoided anchoring. As it turns out, the happy doctors made the right diagnosis much faster and exhibited more creativity. On average, they came up to a correct diagnosis only 20 percent of the way through the manuscript – nearly twice as fast as the control group – and showed about two and half times less anchoring.”

– Shawn Achor, “The Happiness Advantage” p. 47

Wait. What? If you’re happier, you might be a better doctor? Yes, that’s what at least one study suggests this is true. Reading the original study by Estrada et al. (1997), the data is phenomenal. The ‘Happy Doc’ arm showed the consideration of the correct diagnosis (liver disease) significantly earlier (p=0.008) with less anchoring (p=0.031). And do you know what the intervention was? A bag of unopened candy that the participant could eat AFTER the conclusion of the study.

Happiness in the Emergency Department

By definition, the Emergency Department isn’t really a ‘happy’ place. By nature, it’s a place where people come when they’re sick, or hurt, or worse… dying. So it’s no wonder that most of us go to work, and regardless of our moods before we got there, feel immediately emotionally drained. Reading this book gave me hope, however, because Mr. Achor reminds us that only about 10% of our happiness is predicted by the outside world. Which means I’m intrinsically able to control about 90% of my own happiness. What have I tried since reading this book?

  • Bringing treats to work
  • Make eye contact, smile and say hello and thank-you to everyone – patients, healthcare aides, nurses. When you smile, others will usually smile back. And did you know that recent studies have found that even forced smiling (i.e. faking it) can alter your physiology?
  • Write random thank-you emails with interesting articles and videos targeted to interests of my friends and family
  • Investing in my social network.*

*Sometimes this means surprising random people with acts of kindness (coffee for a co-worker in the Coffee Shop line… A card or text to say hi…).

Take Home Points

  • You are in control of your own happiness. Do something about it.
  • Being happy is a skill. You have to practice it.
  • Show people around you that you appreciate them. Who knows? Maybe it’ll spread.
Book Club Question Corner
  1. Question 1: What are the barriers to happiness in the Emergency Department?
  2. Question 2: Has your hospital tried any strategies for increasing happiness? Please let us know!

Post your responses to our questions or comments below or tweet us using the Twitter hashtag #ALiEMbook.

We will post a curated commentary of the October #ALiEMBook club Twitter and Blog discussions about 1 week after the release of this review.

Stay tuned!

Achor S. The Happiness Advantage. Broadway Business; 2010.

Disclaimer #1: Neither I nor this website have any affiliations, financial or otherwise, with the book or Amazon.com.
Disclaimer #2: By participating in this online discussion, we reserve the right to publish your attributed thoughts in a synopsis for future print publications.

Teresa Chan, MD, MHPE
ALiEM Associate Editor
Emergency Physician, Hamilton
Associate Professor, McMaster University
Assistant Dean, Program for Faculty Development, McMaster University Ontario, Canada
Teresa Chan, MD, MHPE


ERDoc. #meded #FOAMed Own views expressed. Contributor to @ALiEMteam, @WeAreCanadiEM, ICE Blog, #FeminEM. @MedEdLIFE founder. Works @McMasterU & @HamHealthSci