What is your score on the D.N.J.Q.? No it is not a standardized patient questionnaire. It's Dave's Non-Standardized Joy Quotient test that I self-administer periodically. Among the questions I ask are, “Do I feel harried and marginless? Do I dread returning calls? Am I indecisive or do I rush to make decisions to mark them off my mental to do list? Am I irritable with those that care for me? Do I have insufficient time for any hobbies? Am I withdrawing from friends or usually enjoyable events? Am I feeling like I need to escape?”

I had a particular joyless time when I was selling books door-to-door 75+ hours a week during a summer break from college. Doors were slammed in my face, dogs chased me, and some days I had Mormons give me more books than I sold! My escape was to go park in the middle of a cemetery to eat my lunch sandwich. Dead peace ... until I had to go knock on the next door.

Maybe these days, sitting in the cemetery sounds like a delightful pastime to you! You're fed up with intrusive paperwork and the increasingly complex business of medicine. You're working harder, longer, and seeing more patients but have, at best, a superficial relationship with most of them. You're sick - sick of contract negotiations, unfair reimbursement schemes, worthless regulations, and a constantly shifting healthcare landscape. You're tired of swimming against the undertow of financial incentives dragging at you to withhold necessary treatments, shun the very sick, and not serve the elderly. Hippocratic medicine is under attack and you feel like the dartboard.

Life is punching holes in your bottle of joy and it is draining away.

There are no quick transfusions that will cure joynemia. You can't just work harder or more efficiently. You can't run a marathon for long at a sprint speed. Buying new toys or taking an expensive vacation won't bring lasting satisfaction. So-called escapes - pornography, affairs, divorce, overeating, alcohol, and drugs - just imprison you. They squeeze a fleeting ecstasy from the bottle and then leave you worse off than ever.

Maybe you need a joynemia workup - a comprehensive life exam.

Here's how. Set a time to get away and involve your spouse or a trusted friend. Turn off the phone and forget about e-mail. Get some rest and exercise before you get under the microscope. Start with a time of concerted prayer that God will give you clarity and wisdom.

First examine what produces joy in your life. What is really important to you in the long run? Have you been prioritizing those things? Conceptualize a God-honoring ideal life personally and for your family and practice. Say it and write it down. Next examine what is lyzing your joy. What stresses you the most? What is least enjoyable and not really important? What things are you doing that only you can do? What things are you doing that others could do as well? Where do you need more margin?

Next, write a mission statement for yourself, your family, and your practice. Write down your values (what will guide you as your pursue your mission) and the key result areas that will able you to accomplish your mission. Prioritize that list of goals and put them on a realistic time line. You didn't get joynemic in a day and it takes time to fill the bottle back up. Don't try to do it all at one time. Instead, start with the most important things first. Blend reducing joylytics and adding joy producers. Then review your progress periodically with someone you trust to give honest feedback.

I'm not advocating selfishness but self-care. Get your relationship with God in order. Joy seeds are planted in good heart-soil (see Psalms 97:11). Only God can provide the strength and wisdom you need. Reaffirm you calling. Knowing God is in charge eases your burden. Prioritize nurturing at least a few close friendships with people with whom you can be completely honest. Joy comes in community. Develop a sense of humor and learn to laugh at yourself.

Make time to regularly participate in one hobby that you love to do. Simplify your life. The less you have to take care of, the more joy you will have. Lower your expectations. Joylessness is generated by unmet expectations. Learn to deal with problems, not tolerate them, and firmly establish your ethical principles and follow them against all onslaughts.

Joynemia is a serious, chronic disease that can bring on many other pathologies. That is why we have devoted this whole issue of TCD to dealing with this issue. By understanding your purpose, and with proper planning, you can understand God's life-map for you ... which always leads to JOY. †