Hyperventilation Syndrome

I feel like I’m playing a bit of “round robin” lately. Mostly due to the lack of a single preceptor, I’ve been floating around from department to department—eager to gain as much experience as possible without getting too much in anyone’s way. So it’s off again to the Outpatient Department (OPD), where I know I can vicariously see a large volume of patients by following a single resident.


Indeed, the patient volume in the OPD is overwhelming. It averages around 400 patients each day, split between six resident physicians and one attending. Doctors here function mostly like urgent care providers. It is tiring work. Each resident churns through about 20-30 patients in the morning, and the same number in the afternoon. Compare that to the 6-8 patients that a U.S. resident might see in a morning or afternoon time slot, and it really puts things into perspective.

But there are other things here in the OPD that are actually quite in common in the U.S. This morning, for example, Dr. R, the OPD director, lectured us on something called “hyperventilation syndrome.”I had no idea what that meant when I first heard it, but it seemed familiar the more he described it. Turns out it’s a common cluster of symptoms amongst school age kids that includes headaches, fast breathing, chest pain, and tingling in the extremities—usually due to psychological stress and/or trauma. I remarked to Dr. R that he was describing something that sounded an anxiety or panic attack. He agreed, saying that lot of the young OPD patients coming in complaining of “chest pain” were actually stressed-out kids studying at the school located across the street from the hospital.

Dr. R continued to talk to the residents about presentations of “bread-and-butter” psychiatry in Cambodia, which pretty much boils down to anxiety and depression. Unfortunately, there isn’t much that can be done in the OPD other than what brief amount of counseling can take place in the 4-5 minutes they spend with each patient. Most patients are usually told to seek outside help.

I thought back to the many patients I saw in the U.S. who were being followed up in primary care clinics for anxiety and/or depression. Day in and day out, there always seemed to be so much need for mental health care in our patients. I don’t believe I could even start to imagine the scope of the need that’s present here at AHC.

In the broad scheme of things, psychiatric disorders still make up a minority of the diseases that present in the OPD, especially compared to the amount usually seen in U.S. clinics. But they are still present. In the two days that I’ve been here, I’ve seen both a kid with “hyperventilation syndrome,” as well as another one with “hair loss” that turned out to be due to trichotillomania.

Dr. R, coincidentally, has been working hard for many years to get the Khmer health professionals at AHC to pay more attention to issues “outside” of medicine, especially palliative care. His battle has been an uphill one, unfortunately, due to the fact that the healthcare needs in Cambodia are still so acute. In general, doctors here don’t feel that things like mental health and pain control are important when you have loads of kids dying of malnutrition and infectious diseases.

Certainly, I can understand their general reasoning. But I still wish the Khmer medical profession could better understand the need for more mental health and palliative services. With so many children suffering from chronic disease, anxiety, and depression—conditions from which there is often no medical cure—it would seem worthy to help these kids feel better in other ways.