ENT and psych

Got to shadow an ENT pediatric clinic today. It's amazing how psychiatry rears its head everywhere I go. Although I was shadowing the attending I also served as her translator for the many Spanish-speaking patients she saw her day. One particular Latino family stood out. There was a young man who came in with his mom to be evaluated for persistent throat pain and problems with swallowing.   The attending asked him some review of systems questions and it seems like everything she asked was positive.  "do you have any chest pain?" "Yes."  "do you get headaches?"  "Yes." And on and on.  After she had done a laryngoscopy and told him that everything was normal he finally piped up and says, "do you think it's okay to take a pill for stress?   I think I'm really stressed."  At the same time before the attending could answer mom says in Spanish do you think that trauma might have anything to do with this? With tears in her eyes she revealed that that prior April her husband this young man's father had died trying to cross the desert in Arizona back to United States.  When the police came initially to their home they handcuffed him and took him away to deport him back to Mexico and the young man never got a chance just talk to him or say anything to him.  The attending and I were speechless.  When we had first come out of the room the first time the attending said this guy is depressed.  We could never have guessed what trauma lyed below the surface of what this young man was able to communicate to us about how he felt.  It's unfortunate that this was revealed the ENT office where all she could do was reassure him that he was okay reiterate to him that potentially this stress and trauma was causing him harm by giving him stomachache and throat pain and headaches and possibly even chest pain.  The attending referred them to a counselor and make sure to send a letter to his primary care physician. I offered mom a Kleenex and we moved onto the next patient.

I am beginning to realize that primary care really is the intersection of psychiatry mental health and our physical well-being.  I'd like to think that for the most part most primary care physicians when they have a relationship with their patients are able to pick up on these cross sections intersections. But I also realize that as primary care physicians we have so little time with each patient and are not always able to pick up on these cues.   I worry that even with my dual training sometimes I won't be able to pick on up on these cues.  Because there's so little time.