tag:blogger.com,1999:blog-8184208181444239184.post1339485936118578087..comments2024-03-14T13:25:42.698-04:00Comments on Child in Mind: Early Relationships and Brain Development as the Core of Medical PracticeClaudia M. Gold, MDhttp://www.blogger.com/profile/13081419560269676730noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-8184208181444239184.post-52851677707146675962011-03-27T18:07:09.748-04:002011-03-27T18:07:09.748-04:00I am assuming this is the Nadine Burke of the New ...I am assuming this is the Nadine Burke of the New Yorker Article. I am thrilled to read your response. I think that you are doing an amazing kind of work. I am also happy to read about the interdisciplinary rounds in more detail-perhaps this aspect of the work did not come through in the article as clearly as you describe it here. I agree that the science is an important point of entry, though do feel that in the training of primary care clinicians more attention could be paid to the emotional impact of the work on the clinician and to the therapeutic value of the relationship with the patient. What does come thorough in the New Yorker article is that you have such a relationship with your patients. <br />In my forthcoming book(August 30) I describe a treatment intervention that I have been using in my pediatric practice for a number of years that draws upon contemporary research at the interface of developmental psychology, neuroscience and genetics.Claudia M. Gold, MDhttps://www.blogger.com/profile/13081419560269676730noreply@blogger.comtag:blogger.com,1999:blog-8184208181444239184.post-17022916008961080982011-03-26T13:04:18.319-04:002011-03-26T13:04:18.319-04:00Dear Dr. Gold,
Thank you for your thoughtful comm...Dear Dr. Gold,<br /><br />Thank you for your thoughtful comments about the article. Your question about whether using a medical framework allows us to keep the emotional suffering of our patients at a distance is a good one. In fact, it is exactly the opposite. I believe that the mental health community understands and is responding to the longterm impacts of child trauma on emotional health. What breaks my heart is that the kids I see are more likely to suffer and die of heart disease, chronic lung disease, hepatitis and cancer and there has been very little response or intervention from the medical community. It seems that many believe that poor health is simply a condition of poverty, rather than the result of a lifetime of neurologic, endocrine and immune insults. I treat children, but anyone who does this work understands that a pediatrician, particularly in a low-income urban setting, must treat the whole family. There is no way to do this work without feeling the pain of children who are abused, neglected and abandoned . . . or of their parents who almost uniformly had the same experience in their childhoods and yet repeat the behavior with agonizing reliability. My multidisciplinary team gives me tools to manage the challenges that come along with that. I focus on the medical sequelae because that is my training and because I see a huge void in this field. <br /><br />I believe that the success of this work comes from our multidisciplinary model. I work extremely closely with mental health and social work professionals on my team to provide comprehensive care to our kids. During rounds we discuss how the emotional health of the family can create barriers to adequate health care. A depressed or psychotic parent is much less likely to give daily asthma controller medicines. If we are serious about eliminating health disparities then we must deal with the medical sequelae of child trauma. This begins with adequate training of physicians to recognize the symptoms, understand the mechanism of pathology and utilize the appropriate treatments which may include psychologic, behavioral and medical interventions.<br /><br />This is certainly a complex problem and Paul Tough does an amazing job in his research and explanation of issue. I hope that it helps to move us closer to effective solutions.<br /><br />Sincerely,<br />NadineUnknownhttps://www.blogger.com/profile/13991865187195428281noreply@blogger.com