Opening Up About Mental Health: Osteopathic Medicine, Human Connection and Honest Conversation

May is Mental Health Awareness Month. To better understand the mental health challenges among the osteopathic medical education community, AACOM spoke with a medical resident physician and current medical student to investigate their perspectives regarding mental health and wellbeing.

Jordan Spencer, DO, is a third-year internal medicine and psychiatry resident physician at the Medical University of South Carolina. Dr. Spencer also recently served as Vice Chair for the American Association of Colleges of Osteopathic Medicine (AACOM)’s Assembly of Osteopathic Graduate Medical Educators Residents and Fellows Council. Dr. Spencer’s brother-in-law Tanner Dowell is a first-year student at the Arizona College of Osteopathic Medicine of Midwestern University and is a mental health advocate through USA men’s gymnastics.

The answers below have been edited for brevity and clarity.

Q: Dr. Spencer, your residency experience—training in two specialties at once—is somewhat unique. Did your osteopathic medical education, which emphasizes care of a patient’s mind, body and spirit, influence your decision to pursue both internal medicine and psychiatry, and do you hope to continue pursuing both paths going forward?

Dr. Spencer: I love that question! It’s actually the reverse. I chose osteopathic medicine because I knew I wanted to pursue both internal medicine and psychiatry. Osteopathic medicine’s holistic philosophy really spoke to me, so I knew I wanted to go to DO school early in my undergraduate career. I truly get to care for mind, body and spirit, and I hope to continue on this path going forward. My interests lie at the intersection of medicine and mental health—transplant psychiatry, psycho-oncology and addiction medicine—so we’ll see exactly where my path takes me.

Q: Tanner, you began your medical education at such a challenging moment. What has your experience been like entering medical school amid the COVID-19 pandemic?

Tanner Dowell: You interview, you prepare for medical school, all is normal, and then a few months before you start, everything changes. First year was definitely not what I envisioned, although it’s been a great experience. We started off with very limited availability to go on campus, and our anatomy and OMM labs were held only one to two times a week. It made meeting other students challenging and pushed a lot of the communication online, and all the way through first year that really didn’t change. All of our exams were online on lock-down browsers with video monitors going, and if you had a COVID-19 exposure, you were off campus for 10 days, so there were definitely challenges.

Q: Dr. Spencer, in an interview you conducted with Medium at the start of COVID-19 in March 2020, you recommended that medical students and trainees stay connected to their purpose to help safeguard their mental health. How do you define your purpose, and how have you remained connected to it this past year amid all the challenges brought on by the pandemic?

Dr. Spencer: Have I stayed connected to my purpose? Depending on the day, absolutely, or, no, not at all. One thing I do that helps—and this is always a very conscientious effort, because nothing about staying connected to your purpose is passive—is writing note cards that I put in little plastic bags and stick on the wall to remind myself of mantras or messages I want to ingrain in my head. So, for example, almost every day I read, “I am a man of charity. I am a man of hard work. I am a man of excellence.” By doing that, I have moments throughout the day when those words will pop into my head, particularly when I am not being one of those things. I also make it a point to have a human experience with my patients every day, even if it’s just cracking a joke or talking about the weather. I went into medicine to have these human experiences, and I’ve realized that I have to prioritize making that happen.

Q: Tanner, you are a part of a mental health campaign through USA men’s gymnastics. What attracted you to this work, and did osteopathic medicine’s holistic philosophy attract you to osteopathic medical school, along with, perhaps, the influence of your brother-in-law?

Tanner Dowell: Jordan was certainly influential in helping me gain a better understanding of what osteopathic medicine stands for. As college gymnasts, we used a lot of OMM techniques to treat injury, even though I didn’t realize it at the time, and I’m attracted to the osteopathic philosophy that everything is connected. When my physical health started to go, I saw the effects on my mental health, and realized how strongly those two were related. In gymnastics, like any other part of our society, there is a stigma around mental health. My coach at Berkeley, who is now a head coach at USA men’s gymnastics, was the first person to help me realize it’s okay to see a counselor or therapist and encouraged me to get help, and now as a medical student, he asked me to speak out for mental health in USA men’s gymnastics, to share my experiences with the next generation, and to make it feel easier to discuss this somewhat difficult topic.

Q: Now, as the physical risks of the pandemic are finally beginning to lessen, at least here in the United States, its impact on mental health may be on the horizon. Do you anticipate this being an issue, and what general strategies would you recommend to people who may experience mental health challenges once life eases back to normal and they have the space to begin processing trauma and grief?

Tanner Dowell: Be as proactive as possible. Don’t wait until it’s too late. Now is the time to get ahead of your mental health, and to help others in your life do the same.

Dr. Spencer: Agreed. Anticipate that it’s going to happen. There’s not a soul on Earth who hasn’t been affected by the pandemic, and a great way to be prepared and proactive is by finding and starting to see a therapist. I think everyone should see a therapist at least a few times in their lives, and there should be no shame in that. It’s also important to remember that everyone has their struggles, even the social media influencers, so it’s unfair to yourself to think that you won’t have them too.

Q: Dr. Spencer, what advice would you give to incoming residents on how they can approach wellness as they start the academic year in July, and Tanner, what would you tell incoming medical students about prioritizing their wellness while in medical school? Can any of the same mental health strategies used by gymnasts also help medical students or others who may be struggling?

Dr. Spencer: Ask questions! As an intern, you don’t know anything, and that’s okay. You feel like you’re expected to know everything, but you are still learning, so be open when you don’t know things. Asking questions and having conversations will help you solidify your learning. Also, expect that you are going to fail, and fail hard, but have a plan in place as to how you’re going to react to that, who you’re going to reach out to, and have a list of things that make you happy that you can reach for. Prepare for war, because medicine is a battle of character. You are being shaped into a very unique human as a physician, and to assume that will come without some stretching is foolish. So, prepare to be stretched, and expect it. And like in gymnastics, prepare to be injured, and know what you are going to do when that happens so you can bounce back as fast as possible.

Tanner Dowell: I love the point about preparing for injury, because you always do that in sports, you try to get ahead of it. As future medical students, we came into this field to help and care for others, and there’s not much we can do while we’re still learning, but we can look out for one another. If you see one of your classmates struggling, be the person to support them. Paying attention for signs of struggle while you are in medical school will help you better recognize them in your patients in the future. Make time to see a doctor when you need to and encourage others to do the same. Don’t delay or ignore your mental health even if it feels like studying is all you have time for. Mental health is something to get after early in your medical education because this is a demanding field. You will be faced with challenges during your education, into your training and throughout your career.

Q: Dr. Spencer, from your perspective as a third-year resident physician, what can residency programs do to better support the mental health of their trainees, and Tanner, from your perspective as a first-year medical student, what can medical schools do to further prioritize and protect the mental health of their students?

Dr. Spencer: I love mindfulness and meditation, I do it just about every day, but when the system itself is the problem, when we need to have national conversations about the mental health issues of all medical students, all medical resident physicians, everywhere around the country, that tells us that the problem isn’t just you or your program and can’t be fixed by individuals practicing mindfulness on their own. So, aside from sending us meditation recordings and mindfulness practices, what can residency programs do? One thing that would help is cutting down on paperwork and prioritizing medical work and human interactions with patients. Those experiences will ultimately help prepare us to be better doctors while keeping us connected to our purpose.

Tanner Dowell: As medical students, we trust and rely on our medical schools to teach us. The more they can normalize mental health concerns, the more comfortable we would be seeking out help. If you feel like you’re the only one accessing mental healthcare, that can be an ostracizing experience. Another thing, and Jordan helped me a lot with this, is realizing that everyone in medical school is smart, but not everyone learns at the same pace and in the same way. If medical schools can share the message with students that the path to learning can look different for different people, and as long as you’re trying your best, studying hard, learning more every day, and remaining passionate and motivated, then you’re on the right track, you belong and you can do this.

Q: Unfortunately, there continues to be a stigma around mental health issues, especially in the medical field. What is one action everyone can take this Mental Health Awareness Month to help reduce this stigma, even on a small scale?

Dr. Spencer: I would challenge everyone to have just one conversation about your mental health with someone else. You will be pleasantly surprised when you open up about something like that. It can lead to very fulfilling and rewarding conversations and true human connection.

Tanner Dowell: That is really well said, and I agree with him. You can’t be an advocate for mental health if you go to others and you say, “I’ve never had a problem with mental health in my life!” Showing that you’re a normal person and you too have had those struggles and then talking about ways to get through them and get past them is huge, and it starts with one person, with one meaningful connection.

If you are inspired to take action on behalf of health professionals’ mental health, you can advocate on this important issue by urging Congress to sign on to the Dr. Lorna Breen Health Care Provider Protection Act, which aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among healthcare professionals. The bill is named after Dr. Lorna Breen, the New York City emergency room physician who died by suicide after treating COVID-19 patients. Take action today.

If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (Español: 1-888-628-9454; deaf and hard of hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.