Connecting the Dots to a Career in Population MH

As I look back on my life, connecting the dots that led to my choosing a career in the field of psychiatry and behavioral health is easy. But psychiatry was probably the furthest field from my mind when I entered medical school. As a college student, I couldn’t decide what I wanted to do with my life. I wasn’t sure I was cut out for medical school, and I was different from other “pre-meds” I knew. My grades suffered, and my test scores weren’t very good. So when I was offered an interview at the University of Oklahoma School of Medicine for the class of 2007, I was shocked but excited. I straggled in on the last day of interviews that year—2003.

I was generally prepared for the potential questions I thought my interviewers might ask, except for the softball: “Why do you want to go to med school?” I answered it the only way I knew how, which is exactly what medical school applicants are told not to do. I said, “To help people feel better.” It must have impressed someone, because I was accepted. (Incidentally, the year I applied to medical school was notable because of the unusually low number of applicants, so go figure!) Today, I’m hard-pressed to think of a better reason for going into medicine, or psychiatry. Throughout my life I’ve carried a spirit of gratitude and indebtedness that has led me to dedicating my life toward, quite simply, improving the lives of others. Now I have the opportunity to share that perspective.

Amid the fascination of anatomy and physiology, cadavers and pharmacokinetics, there lurked something more. Even in 2003 the writing was on the wall. People weren’t suffering from broken arms or strep pneumonia; they were suffering from poor health choices, their own behaviors, and mental illness. The health care system was (and still is) poorly designed to accommodate the needs of such patients. Several pivotal experiences in medical school brought this point home to me in stark relief.

During my first two years of medical school, I sought to explore the bigger systemic issues around health care and formed our first Public Health Interest Group at the University of Oklahoma. One of our first invited speakers was a psychiatrist whom I’d met through volunteer work with our state medical association—Dr. Gordon Deckert. Dr. Deckert was a passionate (to say the least) and dynamic speaker on mental health and introduced our medical school class to the concept of DALYs—disability-adjusted life years—as a marker of population morbidity and the staggering statistic that unipolar depression was at or near the top of the global burden of disease list. Health care had made inroads to managing many other illnesses, but depression remained stubbornly burdensome. This, coupled with the steady realization that human behavior was largely responsible for the majority of health outcome disparities across a population, made psychiatry an appealing choice to me from the big-picture perspective of public health.

It wasn’t until my psychiatry clerkship, however, that I found my true calling. I had an opportunity to spend a week with a psychiatrist working on an assertive community treatment (ACT) team. It was a call to work with the most marginalized and poorest people in our community and to rectify social injustice; it was the ultimate call to help others. By that time, in 2006, seminal reports had been published pointing out the mortality differences in people with serious mental illness served in the public sector. Since many people with severe mental illness qualifying for ACT services also suffer from physical health diseases—especially cardiovascular illnesses—I pursued combined training in family medicine and psychiatry to equip myself with the clinical skill set necessary to manage all their care. Within an appropriately designed health care delivery system, such individuals can thrive. In the 10 years since my medical school graduation, I’ve seen both the best and the worst that our health care system has to offer. Now I work with others to redesign the system so that we can offer the best to everyone.

From day one, I have felt somewhat like an outsider who is grateful for the supreme privilege of working in the house of medicine. But I didn’t go into medicine to become a psychiatrist—or a family medicine physician, for that matter—and I didn’t go into medicine to please myself or my family or to cure a specific illness. I went into medicine for the opportunity it has granted me to make a meaningful difference in the lives of others. This has been my north star from the beginning. I’ve met more people in the field of psychiatry with that vision than in any other. They are truly the most caring, thoughtful, and kind-hearted people I’ve been fortunate enough to know.

I’m sure that, 10 years from now, connecting the dots of my still-evolving career will be easy, but now the future is excitingly unpredictable. As we work to form a new path forward in health care, it is clear to me that my original investment in learning behavioral health will heavily influence my ability to help design health care systems that meet the needs of a 21st-century global population. I couldn’t be more grateful. ■