Mental health in our youngest healers [PODCAST]

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“I was admitted to the hospital for psychiatric evaluation and stabilization just after my third year of medical school. Leading up to my episode, I thought I was fine – stressed, sure, overworked, definitely, but I thought that was normal for someone just finishing a year of clinical rotations. I deteriorated rapidly, and by the time I was admitted, I felt dazed, disoriented, and completely exhausted. I didn’t know what day it was or where I was, but I knew one thing with crystalizing certainty – I wanted to be dead. It was an incredibly isolating experience, one that left me feeling alone and terribly frightened. But since then, I’ve come to realize the harsh reality: I am not alone.

Mattie Renn and Thomas Pak are medical students.

They share their stories and discuss their KevinMD article, “The mental health jeopardy of our youngest healers.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Thomas Pak and Mattie Renn. They are medical students, and they co-wrote the KevinMD article “The mental health jeopardy of our youngest healers.” Mattie and Thomas, welcome to the show.

Mattie Renn: Thank you so much for having us. It’s really an awesome opportunity to spend some time with you.

Kevin Pho: So we’ll get into your article in a little bit, but first off, I’m going to ask each of you to share your story and your journey. Thomas, if you go first.

Thomas Pak: So I’m repping Iowa. I grew up in Des Moines, Iowa. I went to Baltimore for college, and then I came back to the University of Iowa to be trained as a physician-scientist. My story about going into advocacy and getting into student wellness really is a common story, and that story is that of burnout.

I was fixated on trying to do well in class. I was comparing myself to others, spent long nights, worked weekends, and really didn’t take time for myself. By the second year, I realized, or I just burned out, and had this issue where I couldn’t go on. To me, that served as a realization that there are a lot of issues in our medical education system that contribute to this burnout, and I want to change that.

Kevin Pho: All right, and we’ll get into those issues later on the podcast. Mattie, if you could share your story and journey to where you are today.

Mattie Renn: Yeah, absolutely. So I am originally an East Coaster. I went to undergrad out in Chicago, where I got a BA in cellular and molecular biology and a minor in human rights, and then I came back to the East Coast, to New York City, to pursue my MD. So I’m currently in Manhattan, and I’m a medical student, normally at Columbia University in New York City, but this year I’m actually taking the year off, and I’m working at the American Medical Student Association, which is actually where I met Thomas, as the KP education and advocacy fellow. So I’m spending my year working on medical education reform and advocacy, and political advocacy.

In terms of my journey into having conversations around mental health and advocating for the mental health of medical students and trainees, I grew up in a family where mental health was a big issue, so I knew going into medical school that I wanted to make sure that I was advocating for mental health rights and mental health access. Then I basically just found my way into a couple of leadership positions at my school, was deeply entrenched in conversations about substance use disorders among medical students, and also mental health access and mental health treatment, and then found myself needing help myself at the beginning of this year. And so I continued down a trajectory of needing to have conversations around mental health access and started working with Thomas along the way.

Kevin Pho: So let’s transition into that KevinMD article, “The mental health jeopardy of our youngest healers.” Now, Mattie, I was wondering if you could walk my audience through that article for those who haven’t read it, and maybe share a story of why you and Thomas decided to co-write it.

Mattie Renn: Of course. Well, this article was actually published as a part of Suicide Prevention Month, which is part of the American Medical Student Association’s programming. It’s a month that’s organized by our Wellness and Student Life Action Committee, which is actually headed by Thomas. We were talking a little bit about how to get the message out that medical students and health care professional trainees need access to mental health care, and I shared my story with Thomas, which I included in this article as well: I was actually hospitalized for psychiatric evaluation just at the close of my major clinical year, my clinical rotation year.

So we open up our article talking a little bit about that experience that I had, and then we broadened that out to talk about some of the different underlying causes of why this isn’t just my own story but a story of so many medical students who require mental health care and require, specifically, treatment for suicide prevention. So we speak a little bit about the issues around COVID-19, specifically the exacerbation, for many, of mental health issues. We speak a little bit about concerns about residency applications, and we speak a little bit about the crushing medical debt that so many students are facing.

Those are just a couple of the structural issues that exacerbate the problems that medical students and future health care professionals face. That’s a little bit about what we talked about, and we end with a discussion of why we think that Suicide Prevention Month through the American Medical Student Association is so important.

Kevin Pho: Thomas, can you give some specific examples of some of the mental health issues that you personally have seen other medical students face?

Thomas Pak: As I mentioned with my own story, burnout is surprisingly common. One 2008 study said 50 percent of students experience symptoms of burnout, and I see that so much in my medical student friends, especially during the first year. Before you start med school, there’s so much excitement and a lot of energy, but by the winter, or by the end of your first year, I see a lot of students tend to be a lot more withdrawn and tend to not socialize as much. That’s at a general base level.

I’ve seen other students who have really struggled. I’ve had friends who’ve had addiction issues, and they would turn to drugs to try to help cope with these issues, or I had other friends who, honestly, were experiencing something similar to what Mattie had, with the suicidal ideation. In that same 2008 study, 10 percent of students experienced suicidal ideation, and it’s really scary to see that. Again, as noted, it just really highlights what more can be done. Can we help destigmatize mental illness? Can we really work to let them know that it’s OK to feel that you’re struggling and to be able to ask for help?

Kevin Pho: And Thomas, these students that you’ve seen with these symptoms, whether they’re withdrawn, depressed, do they recognize that they were being burnt out, and did they go and seek help?

Thomas Pak: It has gotten a lot better. We’ve had talks, sessions where we had older classmates say, “We’ve been burned out. This is what’s happened.” But for a lot of students, especially med students, they have this notion of, “Oh, it won’t affect me. I’m better than this. Mental health isn’t going to affect me.” Or they have this other thing: When they start performing low, or they have this lack of concentration, sometimes they tend to either blame themselves or they try to compensate with something else, like drugs.

Kevin Pho: And Mattie, you open up your article with a powerful story of how you were hospitalized. Can you share how that changed you as a medical student after that ordeal?

Mattie Renn: Well, I have to go back to something that Thomas actually said, that as a medical student, you kind of hear these stories, but you don’t imagine that they could happen to you. I was involved with advocacy around mental health access and mental health treatment access, but I couldn’t imagine that I would actually require that help myself. So I think, more than anything, my experience was really humbling, realizing that in really difficult times, under really difficult circumstances, it’s OK to ask for help. It’s OK to lean on the people around you, and if you need it, it’s also OK to receive professional help as well, if that’s what’s troubling you. So I think humbling, that’s one.

And I would also say, this sounds potentially a little strange, but my experience when I was in the hospital has felt a lot like a driver: interacting with other patients and being a patient myself, recognizing that my capacity to move through this very difficult health care system is at least partially based on the fact that I’m in training, and that I have had a huge number of resources and opportunities that a lot of my fellow patients when I was hospitalized didn’t have. And so that experience, and being a patient myself, pushes me to want to continue to advocate for other patients.

Again, I guess, there’s the drive that I just mentioned, but there’s also a feeling of empathy, or a feeling of connection, because it’s not as though a patient can be separated from myself. As a future physician, I am a patient myself, and therefore have a deep, intimate relationship with that illness narrative, and that connection to needing help and receiving help when needed.

Kevin Pho: And Mattie, as part of the American Medical Student Association, you talk to medical students across the country. Now, are medical student burnout and mental health issues in medical students universally recognized by most medical schools? And where are we in terms of support for these medical students across the country?

Mattie Renn: Yeah, absolutely. That’s a great question. I can at least say that it’s getting much better. There are large organizations, such as the American Medical Student Association, who are recognizing that wellness is important, that mental health care is important for medical students, and the Wellness and Student Life Action Committee is a perfect example and testament to that. There isn’t a unified effort, however, where I can say every medical school across the country is having conversations and caring for our youngest healers in that way. So unfortunately, I can’t say that there’s a nationwide initiative to support mental health care access for future physicians.

There are initiatives. There are efforts underway to increase knowledge and increase access to mental health care services. One example that I can think of is the film “Do No Harm,” which is a documentary depicting the issues that we’re talking about here among medical students across the country. So there are efforts underway to increase the conversation, but I can’t say that we’ve really nailed it down. There’s still a lot of work that needs to be done in actually setting up support systems for medical students and for future health care professionals, and that’s some of the work that we’re doing at AMSA, and some of the work that I think Thomas and I can speak to as well.

Kevin Pho: And Thomas, if I was a medical student and started to have symptoms that may be due to burnout, what kind of advice can you give me, and what kind of resources can you advise me to turn to?

Thomas Pak: What I like to impart to medical students, and I’m an MD-PhD student, so I’ve been around for seven, eight years, is really to take a check on yourself. Look into yourself and find things that really matter to you, things that you value, things that you’re grateful for. And if you do find that you’re having difficulty enjoying things that you usually do, struggling, really reach out. Build up a community. It’s OK to ask for help. It’s OK to ask questions. You don’t need to put on this facade that everything is going to be OK.

There’s a famous quote: If you ask a question, you look like a fool for a minute, but if you don’t ask that question, you’re a fool for a lifetime. And that runs similarly to help: If you don’t get that help, that’s something that’s going to vary with you.

And as Mattie was alluding to, there are a lot of med schools that have initiatives in place working to destigmatize mental illness, and they maybe have their own counselors. I highly recommend just even visiting and saying hi, so that they know who you are, and just being there. It’s OK to be vulnerable.

Kevin Pho: We’re talking to Thomas Pak and Mattie Renn. They are medical students, and they co-wrote the KevinMD article “The mental health jeopardy of our youngest healers.” Thomas, from a policy standpoint, what ideally needs to be done? What are medical students not doing that they should be doing to address this issue?

Thomas Pak: From a policy standpoint, there are system issues, and then there are also more local university issues. What we’re trying to advocate for nationwide is to really get two main stressors that I feel underlie medical student stress. One is the limited number of residency spots, how competitive residency is, and that’s something that has been advocated, to increase the number of residency spots, because if you’re worried that you’re going to match, then that makes everything else more stressful. It’s hard to create friends, hard to do things that you feel help, that are cathartic for you, because you’re like, “I need to study for this test,” or “I need to do these specific extracurriculars that’ll get me into residency.” So, working on making the residency process better, more holistic.

And second, really also fighting against this ridiculous debt that medical students have to have. The average debt is nearing 200,000. Yes, if you graduate med school and match into residency, you’ll be able to pay that off. But that fear that you can’t make it: I have had friends who had to drop out of medical school, and they have this hundred-thousand-plus debt. That’s a very scary thought.

Kevin Pho: So I’m going to end by asking you both the same question: your take-home message for the KevinMD audience. Mattie, let’s start with you.

Mattie Renn: It’s actually pretty simple, to be honest. It’s that it’s OK to ask for help. I think that we’ve talked about that over the course of this conversation, but if you are a medical student, or a physician for that matter, if you find yourself experiencing mental health problems, the most important thing to do is to lean on those around you, to ask for help, and to not be afraid to do that, because it shows a remarkable amount of strength to recognize when things aren’t going right and when something needs to change.

Kevin Pho: And Thomas, what is your take-home message that you want to leave with the KevinMD audience?

Thomas Pak: I’d like to end this with kindness. Even with medical students, anything that we experience, a physician taking the time to say, “How are you doing?” “Show us the procedure.” Show thought. Kindness is so important. No act of kindness, no matter how small, is ever wasted.

Kevin Pho: Mattie and Thomas, thank you so much for your time and insight, and thanks again for being on the show.

Mattie Renn: Thank you very much for having us.

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