Dr. Jeffrey Brenner, founder and executive director of the Camden Coalition of Healthcare Providers, and a 2013 MacArthur Foundation genius award winner, wrote this essay for The Field Clinic on Philly.com.
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.