My recent discovery is that you can go to the Starbucks website and for $4.00 you can customize a Starbuck’s card. The card will go out from the company with your own return address.

How cool is this?!? You can check it out at www.starbucks.com

Intimate Partner Violence (IPV), the psychological, emotional, and physical abuse of your patients by a current or previous intimate partner affects close to four million women a year. A little over a third of these women report violent victimization. Like many other medical conditions, IPV often escalates in frequency and severity the longer it persists. For approximately 1,000 women each year the violence becomes fatal.

Few of us in healthcare are comfortable dealing with IPV. Couple this with the fact that many physicians feel that their patients do not have family violence issues and you end up with a devastating problem that goes unrecognized, unaddressed, and untreated.

The truth remains that IPV presents a major challenge to physicians in every practice setting and specialty, and the after effects of violence and abuse cast a long shadow on the patient’s current and future health.

Early recognition of IPV and an appropriate response to IPV goes a long way to getting patients the help they need to be safe and escape ongoing injuries and illness. In addition, a valuable added benefit occurs when the psychological and physical trauma of the abuse is addressed, laying the groundwork for the patient’s improved health and well being.

IPV problems can appear at any moment in any practice setting. In light of this fact, physicians and healthcare providers can improve patient care of IPV victims by implementing 10 Action Steps in their clinical settings.

Section One of our new book, Respond to Intimate Partner Violence—10 Action Steps You Can Take to Help Your Patients and Your Practice, provides guidance for the recognition and detection of IPV in the practice setting. Section Two stresses appropriate response to the identification of IPV by putting into place 10 action steps.

Action Step No. 1:  Respond Effectively to Patients Who Disclose Violent Relationships

When a patient tells you that IPV complicates her life, you have a unique opportunity to help her improve her health and well-being. Support her in making changes by validating the difficulties and challenges she is experiencing, as well as her need to make changes.

By validating victims and survivors of IPV, you give your patients a tonic more powerful than any prescribed drug. Validation occurs through therapeutic messages, listening, and providing supporting materials.

Some therapeutic messages that you tell the patient bear repeating several times during your time with the patient. Chief among these:

•    “You do not deserve to be hurt, no matter what.”
•    “You are not alone; help is available.”

Listening non-judgmentally is a therapeutic message in itself. Once you have validated your patient, you have her trust and can move to the next step in her care.

Action Step No. 2:  Respond to Your Patient’s Safety Needs

Start by determining how safe your patient is right now. There are numerous safety assessment tools you can us. One simple one is the Physical Abuse Ranking score. Ask about these ten things:

1.    Throwing things, punching the wall
2.    Pushing, shoving, grabbing, throwing things at the victim
3.    Slapping with an open hand
4.    Kicking, biting
5.    Hitting with closed fists
6.    Attempted strangulation
7.    Beating up (pinned to wall/floor, repeated kicks, punches)
8.    Threatening with a weapon
9.    Assault with a weapon

If your patient’s abuse-related incident ranked higher than five on this scale, your patient can be in extreme danger. However, even if the abuse ranks low on this scale, your patient may still be in danger. Any patient who feels in danger should be considered to be in danger.

Safety planning for your patient should be tailor made to conform to her needs. For instance, she may elect to stay in her relationship with her batterer because she feels that is safer than leaving at this time. Regardless of whether or not your patient elects to leave or stay with her batterer, she must not leave your clinical setting without a plan in place.

Action Step No. 3:  Manage Your Patient’s Referral Needs

Services available to help patients differ in each community. However, a fast call to the National domestic violence hotline, 1-800-799-SAFE, provides you with local resources that your patient can access. Be sure to identify yourself as a provider at the very beginning of the call.

Most patients dealing with the presence of intimate partner violence in their lives don’t need to be admitted to the hospital. If your patient has medical or mental health needs that require admission, and her perpetrator remains free or poses a threat to your patient, consider admitting her as a Jane or John Doe patient. Note that HIPAA provides that patients can request not to be listed in the healthcare facility directory. 

Action Step No. 4:  Document Your Findings

Good documentation builds a bridge of communication among healthcare providers attending the patient and also assists when community advocacy and legal referrals are indicated. When taking care of victims of IPV, the three main modes of documentation consist of:

•    Charting
•    Body maps
•    Photo documentation

Action Step No 5:  Meet Your State and Local IPV Reporting Requirements

Mandatory injury reporting requirements vary considerably from state to state. To provide effective IPV intervention, you need to understand your state and local reporting laws, procedures, and the methods of enforcement, whether the issue is IPV, child abuse, elder abuse, abuse of someone with a disability, or assault involving weapons.

Specific information about state reporting laws can be found at the http://www.endabuse.org/ website.

Action Step No. 6:  Respond to Your Patient’s Stage of Change

Change is not easy. Leaving an abuser or staying in a relationship with new family dynamics often represents a major life change. You can best help your patient to bring about necessary changes in her life by understanding that change occurs in stages and that relapse is a normal part of the change process.

Action Step No. 7:  Address IPV in Special Populations

There can be additional barriers, special needs, and safety issues when working with IPV victims across age groups, gender, sexual orientation, and different cultures. You can best help individual patients in each of these groups by understanding the special needs each group has. For instance, a male victim of IPV struggles with issues separate from a teenage girl being abused by her partner or an elderly widow who remarries and then finds herself a victim of abuse.

Action Step No. 8:  Address Special Clinical Situations Involving IPV

In addition to separate populations, special clinical situations arise when treating IPV patients. For instance, the IPV victim and her perpetrator may both be your patient. Or your patient may be suicidal. Another special situation arises when her abusive partner manually strangled your patient during an assault.

Action Step No. 9:  Develop a System for Addressing IPV in Your Practice Setting

You need a team approach to lay the groundwork for effective IPV intervention in your practice setting. Two critical ingredients set the stage for success:

• Provide training for your staff to understand IPV and to respond to it.
• Designate a practice setting “IPV Champion” who becomes your local expert on policies, procedures, and local resource coordination.

Action Step No. 10:  Respond to Abusers

Although your first concern must be the safety of the IPV victim, who is not safe until the abuse and battering stops, you must also care about your patient’s abuser. Caring about IPV abusers can be a means of ending the abuse and ensuring the victim’s safety. Remember, even when victims leave their abusers and are safe, there is a high probability that their untreated abuser will victimize a new partner.

You can learn more about identifying IPV in your practice and preparing your practice setting for effective intervention in the book, Respond to Intimate Partner Violence—10 Action Steps You Can Take to Help Your Patients and Your Practice. The accompanying CD-ROM in the book contains resources such as medical record forms, patient handouts, and even a staff-training guide. The book can be ordered from the Virtual Lecture Hall of Medical Directions, Inc. by visiting their website or through Amazon.com. Online training with CME credits featuring the information in the book can also be found at http://www.vlh.com/.

Physicians and healthcare providers have a unique opportunity to identify and intervene with IPV in their practice settings. Doing so can save lives, promote their patients’ health, and enhance their patients’ well being. Los Angeles physician Bruce B. Ettinger sums this up quite well, “Set up a response system if one does not already exist, and take the risk and ask questions. The reward will equal anything you have ever done in medicine. You will save a life.”

Author’s note: You have permission to copy this article for distribution for web and print publications as long as you do not change content or remove hyperlinks in your online distribution. Notification of your use of the article is appreciated. For questions or to arrange for one of the  authors to speak at your event, please contact DrT at: DrTspeaks@gmail.com.

Not so long ago, a book came in the mail with a letter from author Tom Pace, CEO of the PaceButler corporation in Edmund, OK. Tom had recently joined the National Speakers Association (NSA) and sent every member a copy of the book. I rescued the book from my “books to read” stack a few days ago and sandwiched it into my reading time.

The book is delightful because it lends itself to short reading times or you can whiz right through it in a short time at a single reading. The book follows young Tony from his days in jail as a 19-year-old through his coming of age as a budding entrepreneur. He meets his mentor, a CEO named Malcolm, while in jail and then meets him again the day after he is released from jail. Under Malcolm’s guidance, Tony learns:

• “People that have self-esteem do esteemable things.”
• “It takes a lot of energy to be angry about something. You can be right or you can be happy. Sometimes it’s better to let the little things go so that you can be happy.”
• Exercise is one of the most important things he can add to his life

A short chapter at the end of the book advises the reader how to find a mentor. The author encourages the reader by noting that, “Most successful people want to share their stories and help because they owe their success to people who helped them.”

How true. While there is no substitute for live and present mentors who are dedicated to helping you succeed, many more mentors wait for you at your local bookstore or library. Some have left this earth, but their words stay behind to offer guidance and encouragement.

You, too, can be a mentor. Have you ever had a major turning point that presented you with the choice of giving up and suffering or moving forward and overcoming the misery? If so, you have a story. When you write it out with all the details of how that turning point changed your life, you experience the healing of disclosing your pain and perhaps your long-held secrets. When you write the details of the journey you took to overcome the pain and distress of the turning point, you lay the groundwork to help others achieve relief and success in their own lives. Detail who helped you along the way. Then you can fictionalize your experience by writing about a mentor (you) who then helps another who suffers what happened to you.

When it’s all done, you may even have what publishers call a “pass-along” book. These books are bought in quantity for “passing the book on” to friends, family, and clients.

Did Tom Pace, in his book Mentor, The Kid & the CEO, believe that he wrote a “pass-along” book? I suspect so, because the letter he sent with the book ends with an amazing postscript: “I also want to extend you a personal guarantee; which is if you read my book and believe it to be a waste of your time, then I will personally give you $100.”

Tom won’t be sending this reader the $100.

____________________

Notes:

1. Christopher Vogler: The Writer’s Journey, Mythic structure for writers.

Learn to write your story for healing and helping

Handout for January 31, 2008 workshop

by

Ellen Taliaferro, MD

Overview

The stories you hear and observe each day weave the rich fabric of your work and personal life. No wonder that at least one friend or relative has no doubt said to you, “You should write a book.” If so, did you want to faint at such a daunting thought? Or did you just wish for more time to write a book while at the same time harboring a secret knowing that there would never be enough time.

Think again. You do have enough time. This workshop shows you how to:

• Develop a writing practice in the middle of your busy life
• Turn your life experiences into rich, captivating stories
• Decide to self-publish or find and work with a publisher

Discover the benefits of writing your story from true life experiences

The unexamined life is not worth living.
–Socrates

When you begin to write and immerse yourself in the writing process dedicated to relating your life experiences, you begin to live an examined life. Living an examined life provides insight and the healing effects of disclosure. Moreover, as reflected in Eastern philosophy, when you heal and help yourself, you heal and help others.

Dr. Robert Sommer, in his 2003 article “The Use of Autobiography in Psychotherapy,” notes that a recent explosion of published memoirs reflects the “public hunger for authenticity, a preference for the real over the fictional life.” (J Clin Psychol. 2003 Feb;59(2):197-205.) When you walk into a bookstore, you will find that nonfiction memoir books compete with novels for front-row billing.

Dr. Sommer notes that the benefits of memoir reading provide the reader with:

• An inside view of the issues and challenges of the author
• Personal and strong story lines that pull the reader through the book
• Identification with the author

I think that the compelling narrative of memoirs gives readers safety through distance. As they read about the struggles of the author they can see with clarity some of the struggles in their own lives and they have hope when they rejoice with the successes of the author. Such vicarious victory may be the next best thing to “being there.”

What a gift you bestow on the reader when you undertake the challenge of capturing your own stories and turning them into compelling memoirs.

Develop a writing practice to write your book

People working in the healing and helping professions refer to their professional activities as practices. What makes their work a “practice?” A practice implies a set of activities performed often and repeatedly to set the stage for habitual engagement and proficiency.

Make the practice of writing your own

To add a writing practice to your routine, take my 90-day WellWriting® challenge:

• Write 32 minutes every day at least three times a week
• Write fast, without thinking or editing
• Write about emotionally charged experiences
• Every 3 to 7 days read and reflect on what came out of these writing sessions–jot down any insights that arise from your review and reflection

Supplement your writing practice with writing your book exercises

On the days that you are not writing about emotionally charged experiences in life, write 32 minutes each day about your book:

• What is your life story about?
• How will writing your life story help you?
• What benefits will your readers reap from reading your story?
• What 10 to 15 points do you want to make in your book?

How to turn life experiences into rich, captivating stories

Writing for story marks the beginning of your successful writing journey. The trip doesn’t end until readers are interested in reading what you write.

The difference between a written memoir and a written-and-read memoir rests lin good storytelling. A good story draws readers in, challenges them, and then provides resolutions to the conflicts put forth in the story. Successful stories:

• Have a beginning, middle, and end
• Are rich with details that call forth the five senses of the reader
• Are fueled by conflict and resolutions

While bringing all of this together might seem overwhelming, don’t fret. Start with baby steps. Here’s how you do it:

• Outline your story
• Draft your story
• Craft your story

When I listen to successful writers, I often hear them refer to outlining as the “O” word. Once they introduce the concept of outlining, different writing styles emerge. Some writers outline in great detail, others start to outline and faint along the way, and others just plunge in with no outline. Each approach provides advantages and disadvantages.

One simple five-step approach has saved my writing soul and serves me best when it comes to story writing.

Every step consists of three-word sentences, each consisting of a noun, verb, and predicate. The first three-word sentence introduces a complication to set the stage for conflict. The last three-word sentence proclaims the resolution of the conflict. The three sentences in between detail the route the protagonist’s journeys between the first step and the last step.

Write the five steps in this exact order:

• Step one–complication
• Step five–resolution
• Step two
• Step three
• Step four

The inherent wisdom to this approach is that you set up your story by introducing the conflict. Next you decide how your story will end. From there, you fill in the middle.

Here is an example of this five step, three-sentence progression:

1. Boy loves girl
2. Boy charms girl
3. Girl charms boy
4. Boy loses confidence
5. Boy loses girl

Steps two, three, and four would have been quite different had the author of the outline decided that the story would end with “boy gets girl.” The charm of this approach is that it is easily remembered and that it gives the writer a compass and map at the beginning of the journey.

How to decide whether to self-publish or work with an established publisher

Pros and cons exist for each publishing process. The following guidelines can help you choose.

Choose to self-publish if:

• Your book is a nonfiction book
• You want to revise it often
• You want the book to come out sooner rather than later
• You want complete control of the book from content to cover and from marketing to distribution
• You don’t have an agent and don’t want to undergo the expense of time and money to get one.
• You are working with a small niche market

Choose to work with a publisher if:

• Your book is a work of fiction or poetry
• You have a wide audience and want to reach as many readers as possible
• Your main concern is the content of the book. You are happy to leave cover and related details to an experienced publisher
• You are new to the book writing business and want the guidance of an experienced publisher
• You already have an agent or want to work with one

Today’s technology for publishing changes from day to day. As the technology changes, so do the cost and benefits change. Your best approach is to research the decision to work with a publisher or self-publish as much as you can before you make your choice.

Ellen Taliaferro, MD, has written three books and given numerous presentations on the healthcare aspects of family violence prevention and intervention, WellWriting® (a form of expressive writing aimed at healing), and stress management. She is the Medical Director of the Keller Center for Family Violence and Intervention at the San Mateo Medical Center in San Mateo, CA. Dr. Taliaferro is the co-founder and former executive director of Physicians for a Violence-free Society. In 1998, she founded the Violence Intervention Prevention Center at Parkland Memorial Hospital in Dallas, TX, and served as its first medical director. Dr. Taliaferro invites you to visit her website at www.healthaftertrauma.com and sign up for her free newsletter.

Dr. Robert Sommer, in his 2003 article, The Use of Autobiography in Psychotherapy, notes that a recent explosion of published memoirs reflect the “public hunger for authenticity, a preference for the real over the fictional life.” Now when you walk into a bookstore, you often find that the memoir has replaced the novel for front-two billing.
Memoir writing serves to provide therapeutic relief for you, the author, because you will gain insight and experience the benefits and healing effects of disclosure. When you produce a well-written and interesting memoir, you also give the gifts on understanding and healing to the reader by providing therapeutic guidance that readers can use as self help for themselves or for friends or family members.

Other benefits noted in Dr. Sommer’s article, include:

• An inside view of the issues and challenges of the author
• Personal and strong story lines that pull the reader through the book
• Identification with the author

I believe that the compelling narrative provides reader safety as well. It gives the reader enough distance to see similar issues in their own life while at the same time sympathizing with the struggles of the author and rejoicing in the success of the author. Vicarious victory may be the next best thing to “being there.”

So pull out your pen and paper and start writing your own “Best Teller” right now.