PolicyLab

ABSTRACT: “Daniel,” a previously healthy teenager, complained of chest pain at his annual well child visit. His doctor, a second-year pediatric resident, quickly and confidently evaluated Daniel for cardiac or pulmonary causes of chest pain. She recognized that his pain was associated with anxiety and provided Daniel with a referral to a clinical psychologist. After several counseling sessions, his symptoms improved and the two agreed he no longer required therapy. But when Daniel returned to primary care several months later, his depression screen was positive. He had been having frequent panic attacks on the subway, difficulty concentrating at school, and feelings of hopelessness. The pediatric resident caring for him realized he needed additional mental health treatment, but she was unable to persuade him to seek care with a psychologist or psychiatrist. He was firm in his refusal to see a specialist, leaving his resident provider unsure what to do next. Her skills and expertise were not sufficient to deliver initial therapies for depression and anxiety, nor was she able to coordinate follow-up with a mental health specialist.