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The ACE Study

The ACE study compares childhood events (violence, sexual abuse, neglect) with adult health outcomes many decades later. The results are extremely disturbing. It turns out that early childhood negative experiences are VERY related to later physical, emotional, and social status. The correlation is not small; not trivial. It is shockingly predictive. It appears we do NOT get over our issues in most cases. In fact, adversity in childhood is directly related to poor outcomes as adults. The implications of this study are profound.

First, the information was obtained from a detailed questionnaire not from verbal interaction. More information than is ever obtained from a doctor-patient relationship for YEARS was obtained from a simple questionnaire. Doctor's visits are traditionally symptom-focused and do not get to any ROOT situations that make up an individual. So, our current system simply sweeps under the rug VITAL information that make true understanding of a person possible. The doctor-patient relationship rarely (if ever) gets to the core of the patients life situation. The current medical model is symptom based and rarely gets "deeper" than what is happening at current and on the surface. A simple one-time questionnaire is shown to be more predictive of health outcome than any conversation between doctor and patient and more than the standard risk factors for disease.

Next, the simple filling out of the questionnaire is associated with a decrease in the number of office visits in the next year. Thus, the simple act of revealing oneself (on paper only) has profound affects on the individual. The exact nature of the effects is unclear but such a large decrease in medical utilization is rarely seen in medicine. Thus, medical utilization decreases from the simple act of disclosure (to no one in particular). This would never be expected to standard medical theorists.

The implications from this profound study are enormous. It rattles the cage of all that "we" believe in standard medicine". The foundation of primary care should be embarrassed, shocked and motivated to change. However, these results have been available and known for 7 years and not even the smallest shift has occurred. It is too shocking for the current model to even address. What is the average primary care doctor to do? Ask a resistant patient about their childhood as they are walking out the door of their brief, symptom oriented visit? The average doctor fears the opening of Pandora's Box! This is way too much information to deal with. No one prepared doctors for this level of conversation. There is no time. These are just some initial responses.

But, this is exactly the problem in medicine. We are trying to put out a forest fire with water in buckets. The opposition is just too big! The issues are way deeper than the superficial problems we discuss and write about. The answer is way more than an already overwhelmed doctor or system can address. The only solution is a total paradigm shift. The game is different than we ever imagined. The old tools are irrelevant and antiquated. Radical change must come. It is the only way!

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