By Cameron Cucuzzella
Fifth-year internal medicine-psychiatry resident Nicole Helmke, MD, started medical school at Duke with no expectation of pursuing psychiatry. More than anything, she knew from her prior global health experience that she was passionate about taking care of underserved populations. It wasn’t until her psychiatry rotations at Duke that Helmke saw psychiatry as a route for helping others in need and connecting with them in meaningful ways.
“Psychiatry allowed me to really get to know people more deeply,” she reflects. “On my [psychiatry] rotations, I got to hear people’s stories and understand what made them tick—and that really appealed to me.”
Originally from Wisconsin, Helmke came to Durham eager to start her career in medicine. She was attracted to the Duke School of Medicine because of its third-year research program and the accelerated curriculum. “I was really interested in doing hands-on work sooner, rather than spending a lot of time in the classroom,” recalls Helmke. “Because of this, Duke was a great fit for me.”
After finishing medical school, Helmke enrolled in Duke’s internal medicine-psychiatry (“Med-Psych”) residency program. Duke had become home for Helmke, and she was excited to continue her stay in Durham. She has since become a leader among her peers.
Last year, Helmke took on the role of assistant chief resident for the psychiatric emergency department, organizing medical student rotations and providing support for residents rotating overnight. This year, she serves as chief resident for the Med-Psych program. In this capacity, Helmke provides education support for her peers, assists in recruiting new residents and plans resident social events.
“I’m mostly there to check in with and support people—to be there when anyone has questions,” remarks Helmke. Through these leadership positions, Helmke has established herself as an important source of support and knowledge for fellow residents.
Although these roles entail a fair bit of administrative work, she says that she has most enjoyed the day-to-day problem-solving required of her position. “I’ve really enjoyed thinking of creative ways to make things better,” says Helmke. “When things do improve, I find that it is one of the most rewarding and exciting things.”
In addition to these leadership roles, Helmke has been involved in quality improvement, finding system-level ways to improve medical practice. She is well known for her efforts aimed at reducing inappropriate treatments for urinary tract infections in patients presenting to the hospital with psychiatric symptoms. In the future, Helmke intends to continue efforts in quality improvement, working to make treatment more accessible to vulnerable populations suffering from mental illness through innovative models of care. “It’s really hard to navigate our healthcare system, especially for this vulnerable population,” she says. “Targeting these populations [through quality improvement research] can help them better access the medical and mental health care that they need.”
When reflecting on what she has learned throughout her time in residency, Helmke points to her personal growth as a major takeaway. Many people, she notes, enter a career in medicine feeling a desire and responsibility to save the world. Helmke says that her residency has taught her that there are limits to what she can do, a realization that has helped her learn more about herself and her work in psychiatry and internal medicine.
Helmke also values her unique education in the integration of internal medicine and psychiatry. Other areas of medicine can be very specialized, says Helmke. The Med-Psych program integrates the treatment of the mind and body to provide comprehensive care for patients with overlapping medical and psychiatric problems. “Med-Psych gives us an opportunity to back up and look at the whole person—their medical care and primary care as well as their mental health and living situation,” says Helmke.
While mental illness affects an overwhelming proportion of the population, there are not nearly enough mental health professionals to provide care. This circumstance, in combination with the Med-Psych program’s emphasis on viewing patients more holistically, has taught Helmke the importance of finding integrated models of care. “I think as psychiatrists, we have the opportunity to figure out ways to better integrate behavioral health care into medical care—to really be leaders in figuring out models that provide mental health care to bigger, more diverse populations,” she reflects.
Following her residency, Helmke plans to continue her work in academic medicine, with interests in medical education as well as developing and implementing systems of integrated behavioral health care. She has accepted a joint faculty position, beginning this summer, with the departments of psychiatry (primary) and internal medicine, where she'll work in inpatient and outpatient med-psych, primary care and psychiatry services.