DrT's Blog from the Health After Trauma Project

The Physicians Guide to Intimate Partner Violence and Abuse

              Review by Ruth Shaber, MD

The facts are overwhelming. The Centers for Disease Control and Prevention (CDC) predicts that 5.3 million incidents of intimate partner violence (IPV) occur each year among US adult women and 3.2 million occur among men. Recent data from Group Health Cooperative demonstrates that about 46% of the female members have experienced physical, sexual, or emotional IPV in their lifetime, and data from the Kaiser Permanente Northern California Prevention Program estimates that in the previous year, at least 4% of women patients have experienced physical injury from an intimate partner--that is about 46,000 members in Northern California alone. The social and financial impact is enormous. The CDC estimates that the direct health care costs of IPV are over $4 billion a year. And, evidence has shown that IPV, along with its many comorbidities, is the number one cause of premature death, injury, and illness in women ages 15-­44 years.

It is difficult for even the most experienced clinician to recognize which of our patients are victims of IPV. The violence cuts across all socioeconomic and demographic categories. But we do know that routine screening of all patients in an effective way to identify victims and to offer them assistance. And we know that offering support and counseling to victims can improve the quality of their lives.

Now that we understand these facts, how can clinicians begin to care for patients who are victimized by this overwhelming social problem? The first step would be to open The Physician's Guide to Intimate Partner Violence and Abuse. This book is an essential tool for both experienced and new clinicians. It will help everyone better understand the impact of IPV and to start to comprehend the complicated issues that perpetuate the violence.Patricia Salber, MD, and Ellen Taliaferro, MD, have compiled the definitive handbook for health care professionals. Their chapters, along with those of their expert contributors, help us navigate through the complicated web of social, psychological, and medical issues that lie underneath the surface of IPV. Many clinicians are intimidaded by the thought of dealing with IPV: they are unfamiliar with the proper language to use to screen their patients and they dread the time when a patient will acknowledge the violence in their lives--for fear that they won't have the expertise or enough time to support them effectively. Fortunately, the authors help us realize the therapeutic value of simply asking the questions---even if our patients aren't able to make immediate changes in their lives. And they help clinicians better understand why immediate changes may be difficult and even dangerous. They provide simple tips for offering support and referral to identified victims. And they help explain the social dynamics and practical realities that limit the speed with which change will happen. The book also outlines effective strategies to set up IPV screening programs in our clinics.

A particularly interesting chapter entitled "What Do We Know About the Perpetrators of Intimate Partner Violence and Abuse" helps us understand the prevalence of alcoholism and personality disorders among perpetrators. There is also inspiring information about the effectiveness of batterer intervention programs--with some data suggesting  a re-arrest rate as low as 8% among batterers who completed an intervention program. Some of the chapters will help you better understand information that you already knew or suspected about IPV. But some of the chapters--such as the one on Adverse Childhood Experiences and IPV--will turn everything you thought your knew about medicine upside down.

The book is an extremely well-organized resource. With its easy references, clear bullet points and excellent summary tables, it makes for fascinating reading all the way through--on an easy reference book to take off the shelf for a quick review. Wherever you are in your journey of understanding IPV, I highly recommend this boo to take you further down the road.

1. Victoria Department of Human Services. The health costs of violence: measuring the burden of disease caused by intimate  partner violence--A summary of findings (monograph on the Internet). Victorial Health Promotion Foundation 2004 Jun [cited 2006 Nov 13.

Dr T comments: The Permanente Journal, published online, provides you an easy and effective way to stay current on patient-centered, patient-valued health care. You can subscribe to it by clicking here.

A Woman's Guide to Saving Her Own Life.

I recently met the amazing Mellanie True Hills from Austin, TX. We met at a convention for professional speakers and I was delighted to meet so many folks who had just written books based on their own true stories, books written to help others. Here is a review of the book.

A Woman's Guide to Saving Her Own Life

by

Mellanie True Hills

A book review by Marika Flatt

# 1 Female Health Hazard Nearly Killed Her – Now She Fights Back
National Heart Month, February

Heart disease kills more women than men in the U.S. and has for 20 years. How could we possibly lose almost half a million women each year in the U.S. to cardiovascular diseases (heart disease and stroke) and not hear more about it? The American Heart Association also reports that heart disease and stroke accounts for 40% of women’s deaths.

That is almost 1,400 women every day—1 every minute—10 times as many as we lose to breast cancer, and 5 times as many as to all cancers combined.  Forty percent of us – two of every five women – will get, and die from, cardiovascular disease. If you have a family history of heart disease, your risk is even higher.

Mellanie True Hills, Austin author of "A Woman’s Guide To Saving Her Own Life:  The Heart Program For Health And Longevity," is a heart disease survivor who nearly died in emergency heart surgery several years ago. Using her second chance, she coaches individuals on creating healthy lifestyles and works with organizations to create healthy, productive workplaces. She is also the founder and CEO of the American Foundation for Women’s Health, a non-profit organization dedicated to education and awareness about women’s health issues.

A Woman’s Guide covers the following:
•    Her surprising story of heart disease
•    What a heart attack is and why is it happening at younger ages than ever before
•    Why we lose more women than men to heart attacks
•    Why women are more vulnerable to workplace stress
•    The four main symptoms of a woman’s heart attack & how they differ from men’s
•    What men need to know about protecting their wives from her worst enemy
•    Why you’re still at risk even if you don’t smoke, don’t have high blood pressure, high cholesterol or family history
•    Stroke symptoms
•    An effective health regimen for women and how people can create a plan they can stick to

"A Woman’s Guide to Saving Her Own Life" is Hills’ story and a workbook designed to guide readers through the process of making permanent and life-saving changes. For more information: www.mellaniehills.com.

Do you want a happier, healthier life? Do you want a healthier, more productive organization? Then have Mellanie True Hills speak at your next event or work with your organization. Contact her at mhills@MellanieHills.com.