Medically clear doesn't mean okay

I mentioned in my last post that one of the jobs of the third (non-emergency-medicine) attending at the main ED is medically clearing the psychiatric patients. Denver is one of the few cities with an inpatient pediatric psych unit (we referred to them from KC) and has a lot of resources and a lot of patients. Many of the families of patients in the Medical Day (psych) program-or who have recently gone home from inpatient-are instructed to bring their kids to the ED if they are having behavior issues. Here there is 24-hour psychiatric coverage and the ability to be monitored or admitted to the psych unit if necessary. These behavior issues can be anything from a patient saying "I want to die" to being handcuffed by the police for violent behavior. And all of them need medical clearance before they can be appropriately placed.

I suppose one could easily walk in and out within a minute and a half, make sure the kid's heart is beating and then order the urine tox screen. But that feels like a dismissal of someone who has spent their whole life being dismissed. And though they put up a tough front-acting like they don't care about the scars on their arms or the fact that they are living in a group home-you can easily hear the cry for help, and I want to show them that I see them as a person and care about them, even in that briefest of encounters. It's one of the hardest parts of my job so far, knowing that I can easily say "medically clear" and walk away, but that they are likely in for a lifetime of conflict, heartache, and ER trips just like this. I wish we did a better job with pediatric mental health from the beginning, teaching parents how to discipline and set boundaries, but also how to show affection and listen. Teaching kids how to express their frustrations in appropriate ways and to treat others with kindness. Screening for family history of mental health or risky social situations so we could watch for it.

Instead we see probably an average of 40-50 kids a week hitting the ER because there aren't a lot of other options. I'm glad we have the safety net, but sad that we need it at all, and doubtful that it's making any lasting changes. I guess I would just encourage all of you who interact with children or teenagers in any way to let them know they are loved and worthwhile every chance you get, and that they don't have to do anything alone.