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Choosing Psychiatry: Reflections from a Fourth-Year Medical Student

I entered medical school with the intention of becoming a primary care physician. In my previous years, I was an engineer and researcher, and my affinity for problem solving combined with deeply held interests in quality improvement, patient safety, integrative medicine and nutrition, naturally led me in the direction of primary care.

Early in my third year of medical school, however, I found myself disillusioned. The primary care I had experienced was not quite what I had hoped for. While I approached my remaining rotations with an open mind, I came to the realization that my previous passion for primary care was somewhat dulled; I felt lost.

Several months after this realization, I moved to the Berkshires of Massachusetts for my psychiatry clerkship, completely unaware of what it had in store. After only a few days, I noticed something had shifted within me: I noticed a smile on my face as I made the cold winter walk across the parking lots which separated the student housing from the medical center.

I found each patient was viewed as a member of a larger community. Multidisciplinary teams reached out to loved ones and placed biopsychosocial stressors at the forefront of patients’ treatment plans, significantly improving the likelihood of sustained benefit. Each patient was given the needed combination of medications and therapies to gain an edge over their genetic predisposition, to live the life they wanted and valued.

During this time, I also felt a change in myself. I was not only enjoying my time on my clerkship, I was taking better care of myself outside of the hospital—exercising regularly, eating well and living the very advice I offered so frequently. I recognized similar growth in my patients; I watched as many began giving attention to the symptoms waved as warning flags by their bodies and minds, in turn experiencing a plethora of positive effects they never could have anticipated. Relationships improved, medical issues resolved, and the need for some medications often vanished.

Health and well-being in the long term replaced mitigation of fear and anxiety in the short term. This indeed was the avenue I had been looking for all along, where I could address root causes and positively impact all aspects of a patient’s experience.

In hindsight, it should be no surprise I feel at home with psychiatry. After all, it was a longtime interest in neuroscience and therapy that helped me cope with my anxiety following my diagnosis of Hodgkin’s lymphoma. I found the most significant relief not from chemotherapy, which of course saved my life, but from the attention the disease brought to my inner experience and the life I was living. I learned about nutrition, yoga, meditation and therapies, including acceptance and commitment therapy, all of which brought me tremendous benefit and allowed me to begin following my valued path.

I have worked on several initiatives to improve health care for the local and underserved community here in Worcester, including free evening medical programs and student-led integrative medicine classes. These experiences have shown me that psychiatry is the key, not only to the future of primary care through collaborative care models, but to how we view health and wellness as a society. Effective integration with primary care will ultimately allow for true preventive medicine and help facilitate a shift in focus from tertiary care to community wellness.

Psychiatry’s ability to integrate modern neuroscience and medical illness into a holistic model focusing on the mind and patient experience has been largely underutilized in current health care. This, coupled with the general focus on parts rather than whole person, has contributed to an epidemic of disease inadvertently promoted by modern treatment practices. In many ways, psychiatry is the final frontier of medical science—to explain the mind-body connection will ultimately validate the holistic approach patients need to be well.

Psychiatry training provides tools to understand an individual in order to advocate for better patient care, which is ultimately determined by how a patient experiences their life, not by what a biomarker may suggest. I believe healing begins with the recognition that not only do our experiences shape our minds, but our minds also shape our experiences.

Reza Hosseini Ghomi Reza Hosseini Ghomi (3 Posts)

Contributing Writer Emeritus

University of Massachusetts Medical School

I entered medical school after some wandering, not having a clue I would be here only five years after finishing college. I spent several years trying to find a place that felt right and eventually learned to quiet the torrent in my head enough to hear the messages from my heart and gut. I spent a short while in systems engineering for the Navy, but my experience as a patient with Hodgkin’s Lymphoma soon led me elsewhere. I ended up finding myself in basic science and imaging research, eventually leading to a graduate degree in biomedical engineering. I still didn't quite feel at home and realized what I really sought was the doctor-patient relationship I've read about, experienced, and admired. I felt I finally knew how I could feed my appetite for solving problems from the core and improving systems while also maintaining close contact with those I serve. This is a quote that has helped many times in my life.

"Until one is committed, there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative there is one elementary truth the ignorance of which kills countless ideas and endless plans: That the moment one definitely commits oneself then providence moves, too. All sorts of things occur to help one that would never have otherwise occurred. A whole stream of events issues from the decision, raising in ones's favor all manner of unforeseen incidents and meetings and material assistance which no man could have dreamed would come his way. Whatever you can do or dream you can, begin it! Boldness has genius, power, and magic in it." -Johann Wolfgang von Goethe