Thin and dark-eyed, the teenaged boy first entered my primary care clinic a few years earlier when I was beginning my pediatric residency and he was beginning adolescence. During the time I have known him, I have helped him and his family manage his attention disorder, acne, and appendicitis. I thought one of his follow-up appointments would be routine. As I entered his clinic room that day, I was smiling, looking forward to learning how he had been doing in school.

Yet, on that day, his mood was somber. My enthusiasm was out of place. Usually bright and engaging, my patient was quiet at this visit. He looked exhausted. 鈥淲hat鈥檚 going on?鈥� I asked. 鈥淪omething seems different today.鈥� Haltingly, he recounted a story about a fight with his friends and a sense of despair.