Dear Doctor : A Patient’s Personal Case Study of Adverse Childhood Experiences

This powerful letter is quite different from most usual clinical articles, and it is frankly painful to read. It should be considered a “case study,” ie, an individual patient report. But this case study is written by a patient, not by a health professional. Dear Doctor has been reviewed by the Editorial Board, who agree that it is a unique accompaniment to “The Effect of Adverse Childhood Experiences upon Adult Health: Turning Gold into Lead” by Vincent J Felitti, MD. It makes the problem (ie, that health professionals often do not recognize the true, underlying basis for the problems they see) much more real and personally accessible. This writing is strong, highly subjective, and poetic (even with a refrain). Once started, it should be read through to the end—or the essence might be lost. The reader (or, at least, this reader) must, at times, surrender scientific medical objectivity to try to understand how the lens of partial or incomplete comprehension by our patients can recreate what we say. Problems of communication (both ways) are actually the issue. The writer is a woman who is not currently a Kaiser Permanente Medical Care Program member. The letter was signed. We do not like to publish anonymous articles and, in this instance, the issue of whether to leave in the signature occasioned repeated intense debate among the members of the Editorial Board. The author’s words about the matter are memorable: “I would like to have my full name used for the article. I no longer feel shame about the events of my life. The shame belongs to the perpetrators. Rather, I feel sorrow. They are people who need forgiveness, and I forgive them.” While we support the author’s feelings and admire her courage, we have decided to withhold her identity to preserve the anonymity of any involved persons. — Arthur Klatsky, MD, Editor

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