Family Medicine Vital Signs

By Brian Hill, MD

I recently spent a month on my inpatient pediatrics rotation.  As I had heard innumerable times, adult medicine and pediatric medicine are very different animals.  So, as an intern having only one month of prior inpatient pediatrics exposure (as a third year medical student), new information, diagnoses, and experiences came at me daily.  Behavioral health topics were something I did have more experience with previously, but I was equally surprised by that realm of pediatric medicine.

 

I was shocked by the number of behavioral health cases seen on an inpatient basis.  Almost every day, we had at least one patient on our service who had been hospitalized for reasons related to behavioral health.  This included inability to walk due to conversion disorder, constant twitching from uncontrolled anxiety, and functional abdominal pain (MUPS).  However, the overwhelming majority consisted of children with suicidal ideation and suicide attempts.

 

Typically, if a patient presented to the emergency department with suicidal thoughts or acts, they would be evaluated and likely admitted to an inpatient psychiatric facility for further evaluation and treatment.  When there are no available inpatient psych beds available in the area, the patient is admitted to the hospital for observation, insurance of safety, and for medical management in the event of a suicide attempt.  So, during my month on pediatrics, we were constantly admitting patients to our team because the inpatient facilities were at capacity.  During the course of one overnight shift I worked, there were five different children admitted to the inpatient pediatrics teams due to suicidal thoughts/actions.

 

To me, this seemed to be a huge number of suicidal children and kids with uncontrolled anxiety and functional abdominal pain.  The only comparison I could make was to my one-month medical school pediatrics rotation.  Thinking back to that medical school rotation, I don’t recall seeing a single patient on the wards hospitalized for a purely behavioral health reason.  It seemed there was an obvious difference between then and now, but I wondered if what I experienced on my recent residency rotation was “normal”.  When discussed amongst the team, it seemed that others were also noticing the same things.  Even our attending physician, with years of clinical experience, voiced concern and confusion about the number of behavioral health cases we were seeing.

 

I couldn’t help but to brainstorm about possible factors at play.  These questions crossed my mind:

– Is there really an uptrend in psychiatric/behavioral health concerns?  Or is it due to increasing population, access to care, or improving diagnostic ability?

– Is there a link to the time of year (the school year was coming to an end)?

– Is this happening only in the Salt Lake Valley, or is it a nationwide (or worldwide) concern?

– Is social media contributing to suicidal tendencies amongst children?  Has technology in general contributed?

– Is there a link to increasing violence in video games, movies, and television?

– Has an increase in bullying led to worsening behavioral health issues?

– Has parenting gotten worse?  Are children under too much stress?  Do children have too much freedom?

– Are we too hard on children?  Conversely, is there too little discipline?

 

In order to maximize the health and safety of our pediatric population, these questions (and others) might be worth considering for all of us.

Brian Hill, MD is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.