This article focuses on pediatric patients whose difficult medical presentation includes both physical and psychological components. These patients do not have a known psychiatric diagnosis and often have had previous hospitalizations for presumed organic illness. Results of diagnostic testing are generally uninformative, and management is time-intensive, involving multiple health care providers and significant medical resources. Antagonism in the relationship between the physician and parent frequently develops. Although diverse in presentation and outcome, conceptualization of these “med-psych” cases into general categories may result in early recognition of these patients, decreased hospital length of stay and expense, improved quality of the physician–parent relationship, and increased treatment effectiveness. We describe 2 different types of cases, outline effective and ineffective interventions, and discuss unresolved difficulties with management. Due to a paucity of relevant research, this article is based primarily on clinical experience.

A 15-year-old male was hospitalized after 3 weeks of tachycardia, syncope,...

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