If you told your physician: "I have an ACE...or three or four", what would you want your doc to tell you?

Interesting thought.  I think I would, at least, want to know what my physician knew what I was talking about!  I'd want my physician to ask me why I brought this up, and to ask "what happened to me?"

sam

I agree, Sam. It would be nice if doctors and their staff even knew what we were talking about.

I think the best response would be something sympathetic or empathetic. Abuse and trauma are so wrongfully normalized by our culture. If the conversation comes up, I think many folks would feel relief that someone/anyone knew that their abusive/neglect-filled past was related to their current health problems. That ah-ha moment can be therapeutic in itself. 

I'm not sure doctors would say much more since they are taught to practice universal precautions and not make people think they are worse off than they already are. One would have to be a very educated patient to press their doc for specific life course risks.

One thing that might be helpful is if the doctor shared the statistics of how many people have ACE scores similar to their patient's. If a patient was interested, maybe the doc could provide a handout or tell them about : http://tiny.cc/gotyouracescore

Jane, I asked my rheumatologist if he had ever heard of ACEs. He said no, so I gave him a copy of the study, and told him my score (4). I also said "no doctor EVER asked me what happened to me in my childhood, and yet, they are dealing with the consequences of that trauma now. I hope he passes it along, and Iwill follow-up with him when I see him in June.

Thank you.  This is a fantastic resource.  

Jane,

What comes to mind is what happens already - I'm the one telling my doctor or chiropractor or massage therapist about ACEs, etc. and educating them.  Some are interested, some are not. As Dr. Felitti said on the recent video on this site: doctors/practitioners get furious and are often resistant to the ACE information. But that's been the plight of things that are innovative throughout history - people don't recognize innovation and often they resist it. ACE is no different.

Ted

Ted, Yes, we're all "educating them."

At times like this I remember Schopenhauer:

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."

Timely this book review:

BOOK REVIEW: 'The Last Best Cure': Science Journalist Expands Treatment Horizons for Her Debilitating Autoimmune Disorders - West Virginia

http://acesconnection.com/profiles/blogs/book-review-the-last-best-cure-science-journalist-expands

Nice quote!!!

I'd want him or her to ASK, not SAY.  And I'd want my doctor to ask how I thought those experiences were affecting me later in life.  Of course, the unaddressed issue is how this would ever come up.  Basically, patients never bring this up, and physicians are no more likely to.  We found, in 440,000 adult patients  where we routinely inquired, that this is best done initially by a well-devised, comprehensive medical history questionnaire that is filled out at home.  This bypasses all sorts of time and interpersonal problems and then lets the doctor bring it up by saying, "I see on the questionnaire that.......  Can you tell me how that has affected you later in your life?  

That's great, Brenda. I'll be interested to learn what he says. 

Did you learn anything about ACEs or trauma-informed practices in medical school, Sam? 

Very helpful, Chris. I'm assembling a chapter for a white paper that members of the Academy on Violence and Abuse and the National Health Collaborative on Violence and Abuse are putting together for health practitioners.  The white paper "seeks to advise clinicians regarding useful “next steps” after learning their patient has experienced adverse childhood experiences." 

The chapter I'm putting together provides resources -- handouts, books, organizations, etc., online and otherwise -- that practitioners can provide their patients and clients. 

I agree that physicians should know something about ACEs, because if a patient tells them, they'll know how to respond. I told my OBGYN that I'd been sexually abused as a child. His response -- "It took you so long to tell me!" and then he changed the subject. I would have preferred that he ask more questions, specifically if there was something he could do to make the exams more comfortable for me. Another physician I told -- a woman who was getting ready to grab a piece of vaginal tissue for a biopsy -- looked shocked and then tried to rush the procedure, poking at me to relax. Yep, that worked oh so well. 

Here's a thesis related to this discussion topic.

Do community mental health staff ask about and respond to adverse childhood experiences and attachment histories?

https://researchspace.auckland.ac.nz/bitstream/handle/2292/19790/whole.pdf?sequence=2

By Maria Elisabet Sampson

A thesis submitted in partial fulfillment of the requirements for the degree of Doctorate of Clinical Psychology, The University of Auckland, 2012

I think I would want him/her to then ask if this impacts my experience at the doctor and ways to make it more effective. In terms of information, I would like to be told how to take action to prevent ace specific health problems from developing and things to maybe keep an eye on that otherwise might be overlooked in the future.

Thanks, Erica. Good points. 

Thanks for these resources, Chris. Very helpful. 

I've been very pro-active with my doctors sharing the ACE Study and trauma-informed care. Most doctors don't have the time to deal with this subject, sadly. One rolled her eyes as if to say, 'so whatelse is new?' One of my doctors, a physiatrist, had an ah-ha moment when I shared this information with her. She disclosed to me that this is making so much sense w/ the majority of her patients. My physical therapist was also receptive and wanted information. These are professionals who see the physical effects of the psychic trauma directly and the inability of the body to heal with the Cartesian/dualistic mind-body division that they are traditionally taught. My physiatrist recommended a book called 'Figuring Out Fibromyaligia'. The author is an MD who was afflicted with fibromyalgia symptoms while she was in medical school. It's a very interesting read. She also talks about how there have been connections to PTSD and CSA if my memory serves me. Another validating book worth reading is 'The Body Bears the Burden' written by a neurologist who decided to write what he felt was the truth late in his career. He discloses that if he wrote this book earlier in his career he would have been ostracized by his peers/profession.

Jane, sad that your OBGYN put the blame on you for 'not bringing it up sooner.' Unbelievable.

Brenda, FYI Ginerva Liptan MD, in the first book, talks about rheumatism.

I forgot to include this in my last post. I think this is a good one-page, two-sided handout: http://www.voamn.org/TIC-Poster

 

Brenda, I had to do a double take b/c I have actually heard "your" story before. Adult survivors not wanting to attend the funeral of an abuser or a funeral where the abuser will be present. I'm thinking now, it's obvious this scenario would present itself years later in just this setting. And, of course, the family is in so much denial they blame the victim and retraumatize him/her. I remember Ashley Judd saying her sister and mother denied her allegations (hate that word) of CSA. Someone told me they recanted later but I did not see that part of the story. So many times the victim gets retraumatized again by just telling their truth. At the end of 2012, PLOS published an article called: Trauma – The Importance of the Post-Trauma Environment and stated:

"...That the environment just after the event, particularly other people’s responses, may be just as crucial as the event itself."

This puts the onus on bystanders/witnesses who in our society don't take on the responsibility they should (think Penn State). I am reminded of, yet again, another quote by Cynthia Ozick, a writer who has studied the Jewish holocaust:

”Indifference is not so much…choosing to be passive…it is an active disinclination to feel. Indifference shuts down the humane,…does it deliberately, with all the strength deliberateness demands. Indifference is as determined--and as forcefully muscular--as any blow.” 

Maybe these pages can help:

tiny.cc/tic-models

tiny.cc/tic-toolkits