So I have gone from ten years in a micro clinic with one employee to a teaming anthill hospital clinic. In my old clinic we would mostly have three people: me, the patient, the front office person. Occasionally we had four or even five. But it was pretty quiet. The zen clinic.
Now I am in Mountain Group in the crowded hospital clinic. My office is the size of a reasonable size full bath, just big enough to hold three desks. Mine, a nurse practitioner's and a physician assistant's. Sometimes we are all there and two or three medical assistants or other staff are in the room and three conversations are running simultaneously. Hello zoo.
One morning this week, the boss doc was in talking to the PA. She ignored me because I got a patient complaint and am in the doghouse. I tried to be penitent but wasn't really. That is, I felt bad that the patient had sensed I was grumpy but I wasn't grumpy at the patient. I was grumpy at the terrible electronic medical record and the appalling previous care, so I glared at the computer a lot while I resisted smashing it. Today Dr. Boss and the PA were discussing a patient. He said that the patient was really emotional and wants loads of support and it feels like all the air is being sucked out of the room when he's with her. Dr. Boss says that of course we must remember she has a psychiatric diagnosis. They are trying to figure out what else is wrong.
I wait until Dr. Boss leaves the room.
"Could I add one thing?" I say.
"Sure," says the PA.
"From what you said about that patient, I would test her ACE Score."
"What's an ACE Score?"
"Stands for Adverse Childhood Experiences. Very large Kaiser study in the 1990s, surveyed every adult who came in and assigned them an ACE Score, from 0 to 10. Then they tracked their health. High ACE score showed linear relationship with depression. Higher score means increased risk of all mental health diagnoses, all addictions but also chronic medical problems."
"Wow."
"Here, google CDC ACE scores and you'll have the latest. We are still trying to figure out how to treat it. Patients will say "So I am damaged." but I don't think of it as damaged. I say "You survived your childhood. You have crisis wiring in your brain. It is species survival. You are wired differently than the Leave it to Beaver people."
He is looking at the website.
"I would bet money from what you said that she has a high ACE Score."
"Huh." he says. He is thinking about it and looking at the site.
Good.