NEJM Catalyst reports on remarks by Corey Waller, M.D., about what, in NEJM’s words,
“drives the 5 percent of patients who cost 50 percent of healthcare dollars? Why are we unable to move the needle on that percentage?” Dr. Waller is senior medical director for education and policy at the National Center for Complex Health and Social Needs.
The article reports:
“Early life trauma affects the vast majority of patients in the 5 percent, according to Waller; it’s the brushfire that wipes away whatever genetic stability they had. These traumatic experiences could be adverse childhood events, sexual assault, being in a war zone, witnessing a loved one’s death, physical or emotional abuse, or neglect. ‘For this subset of patients, no matter what the genetic landscape looks like, they’re sliding down with the smallest amount of rain,’ explains Waller. ‘They’ve lost the buffer, that capability to interact with people around them and feel safe in that interaction. They no longer have authentic healing relationships with people where they can trust and they can interact and feel like they have a place to be.’
“Trauma often drives what Waller calls the sentinel syndromes, which in turn drive health care utilization for the 5 percent. Sentinel syndromes are addiction, mental health conditions, chronic pain, and cognitive disorders. If these syndromes are poorly treated, they significantly increase one’s risk of homelessness or incarceration.”
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