Andrea Asnes: Evidence-based approach to child abuse

Each new diagnosis takes knowledge, experience, wisdom and time

Andrea Asnes, MD, MSW,

Andrea Asnes, MD, MSW, was a social worker in New York City, working with teens and young adults who were struggling with depression, anxiety and other mental illnesses, when she decided to get her medical degree. “It came from a real interest in helping younger people in a way that addressed all their needs,” she said.

Today, she is a practicing pediatrician specializing in evaluating suspected cases of child abuse, a task that is emotionally laden, but rewarding. Dr. Asnes has worked in the Primary Care Center and the Child Abuse Program at Yale-New Haven Hospital since 2005, and routinely receives calls from physicians in the Yale-New Haven Children’s Hospital who need her to determine whether or not certain injuries in children are a result of physical abuse. The Connecticut Department of Children and Families relies on her services as well.

Although her work is high stakes and has important social implications, her approach is similar to other medical diagnoses. “We have a literature basis that we apply to cases—for example, a bruise in one location is more worrisome than a bruise in another location,” she said. “It’s like any other kind of medicine; you apply an evidence-based approach and rely on experience and wisdom to come to a correct diagnosis.

Listening carefully to the history

One thing Dr. Asnes has that colleagues in other specialties lack is time. “Many clinicians can’t sit for an hour and have a parent carefully explain everything that led up to a child’s presentation, but I make that time,” she said.

“My favorite days are the days I can make a medical diagnosis and it’s not abuse,” she said. About a year ago, a young couple brought their baby to the hospital with bleeding in the brain that made doctors suspect abuse. Dr. Asnes took a history, reviewed the medical evidence and was convinced otherwise. It turned out the blood in the baby’s brain was caused by congenital blood vessel malformations. The family remained intact. “I felt as if I used good clinical skills and solid, evidence-based medicine to approach the case,” she said.

Dr. Asnes feels she helps many of the children she sees, but she would like to extend the reach of the prevention programs currently in place in the Yale Child Abuse Programs, such as the Nurturing Families Network, a home visiting program for socially high-risk first-time parents. “I would prefer prevention to diagnosis,” she said.

Name: Andrea Gottsegen Asnes, MD, MSW

Title: Assistant professor of pediatrics

Area of expertise: Child abuse, pediatrics

Place of birth: Colorado Springs, but I spent my childhood in New Orleans

Age: 46

College: Yale College

Med School: Mount Sinai School of Medicine

Training: Mount Sinai School of Medicine (pediatric residency); University of Michigan (Robert Wood Johnson Clinical Scholars Program)

Family: Husband: Jeremy Asnes, MD, pediatric cardiologist in the Yale Department of Pediatrics; Children: Simon, 10; Caroline, 8

What is most challenging to you in academic medicine? Finding the time to engage in all the different educational and research projects that interest me

What is most rewarding? Teaching and advising medical students and residents. They are the reason that I love my job.

What do you like most about your practice? The opportunities I have to work with physicians of many different specialties and to work with many non-physician colleagues in our community.

Personal interests or pastimes? Spending time with my husband and children, cooking, reading and knitting

Last book read: “The History of Love,” by Nicole Krauss

What would you do to improve our clinical environment if you had a magic wand? I would increase medical providers’ awareness of the negative health consequences of traumatic experiences in childhood.