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By Lynda McCullough
Diana Dell, M.D., who became APA's member-in-training trustee in June, is not a first-time resident. She is now completing her second residency, one that represents not so much a dramatic change of mental gears as it does a natural progression of her developing interests.
Dell began her medical career in obstetrical nursing and later became an obstetrician and gynecologist (ob-gyn). She had a private practice in ob-gyn in Louisiana and a faculty position and clinical practice at Duke University in North Carolina. Three years ago she began a psychiatry residency in North Carolina, and she recently began a yearlong fellowship in Toronto.
Dell is also not new to serving in leadership positions in organized medicine. She has worked within several medical societies. She has been president of the American Medical Women's Association (AMWA) and currently serves as the AMWA's delegate to the AMA. She is a fellow of the American College of Obstetricians and Gynecologists and is active in the North Carolina Psychiatric Association.
Though she found ob-gyn rewarding, Dell injured her hand performing the heavy physical work demanded of her profession and decided to pursue psychiatry.
"I am a people person-I wouldn't be happy in radiology," she told Psychiatric News. "Considering how psychologically minded my practice was, it was the obvious place to turn."
Dell began a three-year residency at the University of North Carolina at
Chapel Hill in 1995, and in July she started a yearlong research fellowship in the Women's Health Program at the Toronto Hospital.
On the one hand Dell considers herself to be like any other psychiatry trainee in that she is new to psychiatry. On the other hand, she brings an experienced perspective to her position as member-in-training trustee. As trustee, she would like to focus on changes in APA's internal governance so that it is easier to coordinate member-in-training activities. She also plans to work with other member-in-training representatives to bring wellness and personal health issues for residents to the forefront of the group's concerns. A first workshop on resident wellness at this year's annual meeting was very successful, she said, and another will be held at APA's fall component meetings next month.
Dell said she developed an interest in wellness from her experience in medical societies. Working with and listening to other physicians, she saw how economic changes and the development of managed care have decreased physician autonomy as well as the amount of time doctors have with patients. The loss of the ability to treat patients the way physicians think is best and to experience the important interaction with patients is causing doctors to burn out very quickly, she said. New trainees, said Dell, "are coming into a system that is not people friendly, and they have to be empowered to address their own vulnerabilities."
Having trained in physical medicine earlier and psychiatry more recently, Dell said she has seen that dealing with chronic mental illness can be far more taxing on the emotional life of the trainee than dealing with physical illness. "I was surprised by the intensity of the demands made on residents during training," she said.
In addition, she noted that because residents are no longer required to undergo psychoanalysis or psychotherapy and trainees will not necessarily deal with their own emotional issues, psychiatrists are "taking a step backward in addressing wellness issues for themselves."
In her varied medical experience, Dell said that she has found the richness of practice to come from observing and experiencing the depth of people's coping skills and their strength under adversity. As a faculty member, she saw a need to inspire students to be aware of the importance of the human interactions in their profession, she said.
Her own interest in treating the whole person has been influenced by her undergraduate studies in psychology as well as her training in nursing. As a practicing ob-gyn, she found it came naturally for her to address the emotional lives of her patients along with their physical needs. "Word got out that I was a person who would listen," said Dell.
She also found others who share her interests in holistic treatment in the North American Society for Psychosomatic Ob-Gyn. Practitioners in this association recognized "the meaning that reproductive events have in people's lives, whether it is the loss of a pregnancy, birth of a child, or the inability to conceive. All of those things are more than turning ovaries on and off," she said.
After completing her fellowship at the Toronto Hospital, Dell would like to establish a combined practice and teaching program using both her ob-gyn and psychiatry expertise.