This video looks at the relationship between ACEs and hospital emergency rooms.
Dr. Jeffrey Brenner is founder and executive director of the Camden Coalition of Healthcare Providers, and a 2013 MacArthur Foundation genius award winner. He did groundbreaking work in Camden, N.J., by using data to identify people who were hospital emergency room “frequent fliers”. He found that between their trips to the ER, little or nothing was done to help them improve their health. So, he began putting basic services in place to help these people. His work was written up in a New Yorker article — The Hot Spotters, by Dr. Atul Gawande — in 2011.
That article sent a shock of electricity through me — not only because it was so well written, but because Brenner was on to a solution for markedly reducing health care costs. However, it seemed to me that there was a piece missing — if Brenner knew about the CDC’s Adverse Childhood Experiences Study, he (and other physicians) might be able to identify the people who suffer most in our society more quickly.
Today, an essay Brenner wrote about how the medical community has neglected the ACE Study, even though its findings were published in 1998, appeared on Philly.com’s The Field Clinic blog. It’s well worth a read. Here’s part of it:
For nearly 15 years we’ve had the secret to delivering better care at lower cost in America. The information has sat, hidden away in the medical literature, and barely mentioned among physicians. It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive. It’s also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare.
In the 1990’s, a physician at Kaiser Permanente in California, Dr. Vincent Felitti, conducted a mail survey with 17,000 middle class patients. He asked them questions about traumatic events that might have happened to them as children. Incredibly, over 70% of people receiving the survey responded, and they gave permission to connect their survey answers to their medical records.
….In the work that I do in the City of Camden building interventions for high-cost complex
patients, the issue of early life trauma and compounding later life trauma has become a core one. Many of our high utilizers of the local healthcare system tell us horrible stories of their childhood, when asked. We’ve recently published research on these findings. To read our report, click here.
In my training as a family physician, I was told not to pull up the lid on something you don’t have the time and training to deal with, like early life trauma. I am deeply embarrassed in looking back at my career caring for patients in Camden because I followed this advice too often. It’s likely that many of my patients had early life trauma that was probably sitting right below the surface, but I rarely asked. It’s frightening to open up a Pandora’s box in a 10-15 minute visit of an overwhelmed primary care office.