“You Should Smile More”—Why Authentic Joy Matters in Medicine

As a physician and as a quiet, serious woman, I’ve heard the words “You should smile more” more times than I can count.

At first glance, it can seem harmless—even well-intentioned. But over the years, I noticed how that simple sentence added to my stress, self-doubt, and the feeling that who I naturally am isn’t quite enough. And, of course, this type of feedback is often gendered.

In the context of physician burnout and leadership, this pressure can take on an even heavier weight. We’re often implicitly—and sometimes explicitly—encouraged to wear a mask of constant positivity. To appear endlessly cheerful, no matter what we’re carrying.

But here’s something I wish more people would remember:🌟 Your joy isn’t for others to dictate.🌟 True joy comes from reconnecting with your purpose and creating real balance—on your terms, not just performative smiles.

The hidden cost of performative positivity

In medicine, the stakes are high, and the work can be emotionally and physically exhausting. When we’re told to “smile more,” it can feel like what’s really being asked is:

Suppress your stress. Make others comfortable. Be less visibly human.

That expectation isn’t fair—and it isn’t sustainable.

Authentic well-being can’t grow in an environment where we’re rewarded for masking exhaustion and punished (even subtly) for showing real emotion. Over time, forcing positivity can deepen burnout, because it pulls us even further from our genuine purpose and feelings.

The other side of the story

Here’s the paradox I’ve come to recognize, though:Although I hated being told to “smile more” — and still bristle when I hear someone tell another woman or girl the same — the truth is, I do smile more now.

I was even a little shocked recently when someone told me, “You’re always so happy.”

They didn’t know me back when I was constantly getting the other kind of feedback: that I seemed too serious, too reserved, maybe even cold. At the time, when people told me to “smile more,” it felt like criticism — like I wasn’t okay as I was. And yes, I certainly didn’t take it as a caring observation.

Looking back, I can see that perhaps, in their own awkward way, they were noticing something real: I wasn’t okay. I was tired, stressed, and stretched so thin that joy felt distant.

What changed wasn’t forcing a grin. What changed was deeper: I started to find genuine joy again. I found it in small moments with my kids, in setting and holding boundaries, and in reconnecting with what made me feel fulfilled at work.

The smile came naturally—not because someone told me to perform it, but because joy started to feel possible again.

What's in a smile?

Why authentic joy matters

Real joy is quieter, deeper, and often less visible than performative cheerfulness. It’s the sense of fulfillment you feel when you see a patient truly understood, when your resident has a breakthrough moment, or when you leave work knowing you lived out your values—even if it was a hard day.

True joy isn’t about always being upbeat. It’s about knowing what matters to you, setting boundaries, and protecting your energy so that your presence stays meaningful—not automatic.

And here’s the paradox: when you prioritize authenticity over appearances, people often feel your warmth and sincerity more deeply—because it’s real.

If someone still tells you to “smile more”

It can help to have calm, confident responses ready—especially in professional settings. Here are a few to consider:

✅ Thanks, but I smile when it feels genuine.

✅ I’m focusing on finding real joy, not just appearances.

✅ I prefer authentic smiles over automatic ones.

✅ Joy shows up in many ways, not only as a smile.

✅ I’m working on joy from within first.

These aren’t combative—they’re grounded reminders that your well-being matters, too.

What really helps bring joy back

For anyone navigating burnout, especially in healthcare, know this: real joy returns when we protect what matters most. That might look like:

✨ Setting and enforcing clear boundaries around time and energy✨ Reflecting on your purpose and what makes the hard days feel meaningful✨ Letting yourself be serious and soft—both are human✨ Finding joy outside of work, too, so that your identity isn’t only tied to your professional role

The bigger message for healthcare professionals

If you’ve felt pressure to hide your serious side, remember: seriousness, thoughtfulness, and even quiet can be forms of leadership. Authenticity builds trust far more than forced smiles ever could.

As we work to reduce burnout in medicine, let’s move away from asking each other to look happy—and instead ask how we can be well, find meaning, and protect what truly brings us joy.

You deserve joy that’s authentic—not forced. And sometimes, when that joy is real, the smile shows up on its own.

🌿 Want to explore more ways to create real balance and joy in a demanding career?Join my free masterclass, “Simple Practices to Create Calm in a Demanding Career.”You’ll walk away with practical tools to protect your energy, reconnect with your purpose, and start feeling more like you again—no forced positivity required.

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