White Coat, Black Art

We need empathy in the ER for teens with anxiety: Dr. Brian Goldman

Dr. Brian Goldman weighs in on what Emergency Departments can do to better help kids who come through the door with anxiety.


By Dr. Brian Goldman

On this episode of White Coat, Black Art, Charlotte Masemann tells a vivid story of bringing her young son Leo to the emergency department after he had an emotional outburst brought on by his anxiety. 

Now 15, Leo was formally diagnosed with generalized anxiety disorder at the age of 10.

 He is one of a growing epidemic of teens who have been diagnosed with anxiety and related mental health conditions.  

As we found out in our interview, Leo's untreated and often unmitigated anxiety led to bursts of anger. It was during one of the more egregious occasions that Charlotte felt compelled to bring her son to the Emergency Department .   

It's Charlotte's impression that no treatment was offered because they didn't think Leo was suicidal or would harm anyone else. This determination was made even though Leo had expressed suicidal thoughts.

As Leo recalls it, by the time he had arrived in the ER, and had spent some time in the waiting room, he had calmed down. 

Charlotte remembers a resident questioning her parenting skills, suggesting she give Leo "time-outs" or consequences, but offering little in the way of concrete advice.  Pointedly, she recalls that she was offered no referral to a mental health professional.

As Leo put it aptly, walking away from that experience, "Hospitals are good at fixing broken bones but not broken minds."

That's both true and an indictment of the services my colleagues and I provide.    

One can argue that the failure of the ER doctors on that occasion and others contributed to Leo's two-year wait to receive expert help with his anxiety.

As an ER physician, I have sat in judgment over parents like Charlotte, (especially in my younger years), blaming their kids' anxiety on poor parental coping skills even though I didn't know much about parenting then, and even less about individual moms like Charlotte. 

Alternatively, I might have met her and Leo and saw them as an incredibly stable and supportive family unit, and concluded that both were fretting for nothing. 

And my judgement would have been wrong on both assessments.  

If we who work in the ER have nothing to offer to kids with anxiety and their parents, the least we can do is find someone who can help.  At the very least, we can be more kind and empathetic to their plight.

Leo's two-year wait for treatment belies a health care system ill-equipped to deal with teen anxiety as is.  

And the problem is only going to get worse.

Teens are living in an age of anxiety.  So too, is our healthcare system.  

We need to do better. 

*PROGRAMMING NOTE: In the new year, we'll have a show the highlights new approaches to treating teens with mental health issues, including dialectical behaviour therapy and other treatments.