Since its birth the specialty of emergency medicine has suffered from a lack of interest and attention to behavioural emergencies. Unfortunately this lack of interest has resulted in inadequate behavioural emergency training in residency programs in the USA and probably other countries. While our residents are extraordinarily well-trained in trauma, cardiac emergencies, etc., any hint of a behavioural disorder in academic medical centers often prompts a “call psych” consultation. While waiting for the consultation the emergency medicine resident moves on to other patients and likely never learns how to manage the behavioural disorder. This system may work well in a tertiary care academic medical center, but breaks down when our emergency physicians end up at their likely employment in community hospitals where there usually is no “psych” to call.
The effects of this inadequate behavioural emergency training are seen in prolonged patient suffering, emergency department (ED) patient recidivism, prolonged patient stays in EDs exacerbating overcrowding, patient dissatisfaction and increased health care costs,,,. As an anecdotal example, in my own experience as a faculty member in 3 different residencies, I found that the emergency medicine residents could not diagnose depression, a disease present in one in 5 of our patients,.
The care of other behavioural disorders besides depression suffers similarly in our emergency departments. Suicidality, an increasing problem worldwide, is under researched and lacks a consensus on how to assess risk. Anxiety disorders are often over treated with potentially addictive benzodiazepines. Opiate overuse in the past has contributed to widespread dependency, which now optimally should have treatment initiated in the ED rather than referral. Psychoses often sit for days waiting for a psychiatric bed to open up, while tying up an ED bed and staff.
Based on developed country ED usage extrapolated worldwide, there could be 250 million ED visits annually worldwide involving behavioural disorders in the near future. We can and should do a better job of taking care of these patients. Fortunately IFEM, honoring its mission “to advance the growth of high quality emergency medical care through education…” has now established a speaker bureau that addresses behavioural emergencies. Available speakers and topics can be seen here.
If you would like to schedule a speaker for your residency program or for a conference please send a request.
David Hoyer, MD FAAEM
Chair, IFEM Behavioural Emergencies SIG
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 Brickman K, et al. ED Patients with Prolonged Complaints and Repeat ED Visits Have an Increased Risk of Depression. West J Emerg Med. 2016 Sep.; 17(5): 613-616.
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