According to the Centers for Disease Control and Prevention (CDC), more than 90 million Americans now live with chronic diseases. These chronic diseases such as diabetes and arthritis result in a decreased quality of life, limited activity, and extended pain and suffering.

When you suffer with a chronic healthcare problem, you deal with many factors that compose that problem. Some of these factors overlap, augment each other, or oppose each other.  And each factor may call for its own physician or treatment. If you want to succeed in your quest for wellness, the first thing you must do is drop out of the “I just do what my doctor tells me” school.

Join your healthcare team. Indeed, take over:

Any why not? You have the disease, not your doctor.

Growing evidence supports your role as a collaborative team member and captain. Remember, about 90 percent of what’s needed to help you improve comes directly from you, the person with the chronic health disorder.

When you become a team caption on your healthcare team, your care will improve as well as your satisfaction as a patient.

To learn more about the growing area of “patient self management,” check out the Stanford programs on self management by clicking here.

Many of us have ongoing struggles with our weight. We find that “diets” don’t work for the most part nor do most of the “gimmicks” that go around.

But here’s a question: Can a writing practice help you lose weight? Writing guru Julia Cameron of The Artist’s Way book says, “Yes.”

Check out an interview with her in Newsweek where she reports that she went from a size 16 to a size 10 once she put her program into place. Better yet, visit Amazon to take a peek at her book by clicking here.

by
Ellen Taliaferro, MD
Zita Surprenant, MD, MPH

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.

Please mark your calendars and plan to attend the Saturday, January 10, 2009, NSA/NC Chapter Meeting at the Sheraton Gateway hotel near the San Francisco airport. The program will start at 9:00 a.m. and end at 3:00 p.m. This informative day will help you move beyond a speaking platform to products and publications that reach many.

Lunch is included in your low registration fee of $45.00 for chapter members or $65.00 for nonmembers and guests.

Grow your idea into products and a National Day

Jeff Rubin

The day will begin with speaker Jeff Rubin, founder of National Punctuation Day®. His presentation, “How I turned a national holiday into a branded, moneymaking enterprise” describes how he turned a publicity stunt into a brand, and then developed a speaking program for children and an instructional DVD for teachers. These products have now become major business enterprises. You will learn how to take an idea that might come to you in the middle of the night, develop it, and market it, and become known as THE expert in that discipline and make money from it.

Grow your speech into a published book

Michael Larsen

Have you often wished for a published book to support your speaking work and mission? Perhaps you have heard the advice that “If you have a speech, you have a book.” Speakers who have attempted to turn a speech into a book, however, realize that this task can be an enormous challenge because they:

• Have little or no time to write
• Love to speak but dread penning words to a page
• Lack an agent

The good news is that speakers can be authors without also being “writers.” Michael Larsen and his selected panel members will show attendees how to:

• Understand the publication process
• Find and work with an agent
• Promote and market their published work
• Work with a collaborator of ghost writer to produce their book’s content

Networking lunch

Your low registration fee includes lunch. An experienced speaker will sit at each table to facilitate a fun networking experience. Be sure to bring your business cards!

Proposal writing afternoon workshop

Elizabeth Pomada                               Michael Larsen

San Francisco agents Michael Larsen and Elizabeth Pomada will wrap up the day with a proposal-writing workshop. Between the two of them, Mike and Elizabeth have written or coauthored fourteen books, including Mike’s popular, must-have book, How to Write a Book Proposal.

An appealing and tight proposal will help you find an agent and, in turn, will help your agent sell your book. Even if you don’t choose to seek an established publisher, a proposal will help you to test market the potential of your book idea. The other major benefit a proposal provides is that the tough work of outlining your ideas and organizing them comes near the first of the process. Once the outline is firmed up, the writing and research can flow in an orderly fashion.

If you have a proposal already written, bring it with you and either Michael or Elizabeth will look at it and give you feedback if time permits.

To read more about this upcoming meeting visit the NSA Northern CA website by clicking here.

Save the Date

Who: National Speakers Association/Northern CA chapter meeting featuring writer Linda Vanderwold, CSP

Where: SFO Sheraton Gateway Hotel, 600 Airport Road, Burlingame, CA

What: A one-day conference (lunch included in your registration fee)

Do you have a turning-point-in-my-life story to tell? Speakers and writers often refer to these as “signature stories.” This type of story is what we tell ourselves and others about what we do, want, and seek to achieve.

If so, think about joining others at this event for a full-day meeting (lunch included) for the one low price of $45.00 for members and $65.00 for non-members.

The speakers are quite good and will tell you how to enhance your speaking activities through marketing and “power thinking” and “power writing.”

If you are in or near northern CA, the hotel is right off of 101 just south of the San Francisco airport.

Coming from further away? Hop on a plane to SFO and catch the shuttle to the hotel. The rooms are nice, food is good, and the hotel rates are very reasonable if booked ahead on the internet. If you call the hotel for a room, make sure you tell them you are with the host organization.

To learn more or to register for this event, click here or call (650) 871-4220.

This morning’s work started where last evening’s work left off. I recently created a slide presentation in Keynote on my iMac computer. When it came time to export the presentation to Powerpoint so that I could show it on a PC computer, I could not successfully export the presentation to Powerpoint in MS Office.

This morning, while struggling with the same problem, I remembered to visit the discussion groups on the Apple websites. Sure enough, I was not the only user having this problem. After reading through a number of exchanges, I found an easy fix. (Delete all notes made in Keynote.) After doing this, voila. The export went through without a hitch. So simple.

This reminded me, once again of the power of forums and discussion groups where participants help each other.

So if you are a writer, please share your tricks and tips with the other writers in your groups. To see an example of writers and speakers helping each other in this manner, visit SpeakerNet News.

Consider creating a social network to support your current writing efforts. Or, if you don’t want to start and maintain one, find and join one that focuses on your area of interest.

The benefits of a social network include:

• A built-in community of people with your same concerns and interests
• Personalized forums
• Active discussion groups
• A place to post your art
• A place to post your video clips
• Many of them can be started with free software packages. (I chose www.ning.com to start mine.)

Should you consider starting a social network on your website, consider getting your own domain name for the network.

For the Saving Cinderella Network, I purchased the domain name, www.savingcindy.com. This makes it easy for folks to find after you tell them about it. They may not be able to remember “www.yourwebsite.ning.com” when they get home from the party where you met them, but they can remember a catchy name.

To see the social network that I started to support my current book, please visit www.savingcindy.com. There you can check out the details of a social network.

To start your own social network, visit www.ning.com and follow the instructions on their home page.

In case you don’t believe that a few words can make a big difference, click on the link to view a short, creative, and very beautiful documentary that was the winner of the Short Film category in Cannes. I promise that this will not be a waste of your time.

Click here to see the “Story of a Sign.”

OK, deadlines loom and work piles up. But everyone needs a break now and then. 

Today I saw a former neighbor in the Safeway parking lot in Half Moon Bay. 

“Remember our friend Kathryn who came over to see your PleasureWay RV when you still lived next door to us? Well, she bought a PleasureWay and is now on a six month trip across the country.”

So home I came and typed in Kathryn’s blog address and up came her blog. Most entries have a link to her photos stored in Google Picasa.

I love the photos she took in the Grand Canyon. You can see them by clicking here.

Happy PleasureWay trails to you