Every DO has the quote, “Mind, Body, Spirit,” ingrained in their minds. These words resonate when we step on campus, open a lecture, and discuss osteopathic medicine. These tenets are the foundation for osteopathic medicine when working with patients. While I always understood what that meant, it was only during my psychiatry rotations that I fully grasped the importance of focusing on holistic care and the mind, body, and spirit.
In psychiatry, vitals, labs, and past medical history can provide insight into any underlying organic or physiological reasons for a mental illness, but interviewing the patient remains a vital part of understanding and connecting with them on a deeper level. We have the opportunity to understand who patients are at their core, teasing out nuances of their lives that result in emotional and physical turmoil. It is a privilege to understand a patient at that level; however, as a medical student, it is a difficult skill to develop. Knowing where to begin when diving into a patient’s life, how far to push for answers, when to chime in versus letting the patient lead, and how to navigate difficult conversations about past traumas and recent pain are challenging skills to hone. As a fresh medical student just out of the classroom, it was often tricky to apply what I learned to an actual patient sitting before me. Interestingly enough, during my first time interviewing patients, I was surprised to find that the most helpful information wasn’t the psychopharmacology or psychotherapeutic modality; instead, it was the holistic teaching of mind, body, and spirit.
One of the first patients I had the opportunity to interview was a young person who referred himself because of concerns related to generalized anxiety disorder/social anxiety disorder. I took time to get to know the patient more, understanding the context of his symptoms, observing physical cues such as eye contact or nervous twitches, while simultaneously unraveling his past history. I learned that he had friends, worked as a bartender, and traveled the world with strangers, which didn’t diagnostically sound like someone with social phobia or anxiety. However, the patient kept mentioning that he always got startled, started sweating, and avoided picking up his cell phone, all of which began after an altercation with his friends years back. I inquired further, trying to understand what happened, and could tell the patient was guarded, stating that it was a traumatic experience he didn’t want to discuss. I listened, understood the hesitation, and worked around the matter by asking relevant questions.
“So when you hear the phone ringing, you start feeling shaky and sweating.” “Yes,” he responded. “Do you have any sense of doom, like the world is ending? Do you get nervous about that feeling, and those symptoms might happen again?” I asked. “Not really, no, it’s not that serious, but I notice it.” “Do you avoid picking up the phone? Does it remind you of your past experiences?” “Yeah, I tend to leave it on mute and not pick up any random numbers that call.” “That must be hard, especially since we have so many calls with no ID nowadays. Any nightmares about those experiences?” “Actually, yeah, I have trouble sleeping, wake up with cold sweats, and can’t fall back asleep.”
While much of the dialogue and intake is paraphrased for confidentiality, anyone who has experienced this or knows the DSM-V criteria can recognize these are textbook PTSD symptoms. As a medical student, figuring out the diagnosis and developing a treatment plan during my first-ever intake in the field was rewarding.
As a DO, my thought process while working with this patient went beyond just asking questions. I holistically understood what was going on in his mind, how it affected his body, and how to help him work through these issues to free his spirit from constant worry. It was about having a conversation, making the patient feel comfortable, and allowing me into his life to understand him better. This type of holistic thinking helped me understand the history of who the patient was, what he was going through, why he was going through it, and how to treat it beyond memorized answers of therapy and medication. While many experienced physicians adopt this holistic approach, as an osteopathic medical student, it helped me avoid automatically choosing the therapeutic modalities we memorized. It broadened the scope of diagnosing and treating patients by viewing all aspects of their lives rather than focusing solely on specific symptoms. As a new medical student, it’s easy to fall into traps when developing treatment plans for patients. In psychiatry, avoiding these pitfalls is especially important, as many symptoms overlap. Understanding the timeline of a patient’s issues, the context in which they occur, and other external factors such as trauma, substance use, legal history, and family history all culminate in giving a better picture of what is going on. My training reminded me of this holistic approach needed to provide the best care to the patients I see daily.
Psychiatry utilizes the biopsychosocial approach to understanding, empathizing with, and treating patients. It considers all factors that contribute to a patient’s mental illness and attempts to work through those factors to help the patient recover. It is holistic medicine. As an osteopathic medical student, I can use the tenets of osteopathy to better understand patients and do my best for them. Any doctor, MD, DO, or health care worker knows and understands the value of holistic patient care. I am grateful to have had early exposure to this methodology as a medical student, which I hope to refine as I continue my medical journey.
Fahad Molla is a medical student.
