Dr. Miller: I’m Elizabeth Miller and I’m the Division Chief of Adolescent and Young Adult Medicine at Children’s Hospital of Pittsburgh of UPMC.
Susan Olmstead: So Dr. Miller we’re just going to talk a little bit about your article that appeared in our February issue on reproductive and sexual coercion, specifically about some of the counseling strategies you wrote about. First, let me ask, do you ask questions relating to intimate partner violence and reproductive coercion to all your patients or do you only initiate this conversation with patients who you suspect might have been victimized?
Dr. Miller: So I talk about partner violence and sexual violence with all of my patients really using a universal education and routine inquiry approach. So it’s less about asking the right leading question as much as I say I talk to all of my patients about this with every visit.
Susan Olmstead: I see, so it’s more of a discussion rather than specific questions?
Dr. Miller: Exactly. Now if I have a patient who, as we talk about in the article where maybe they’ve come in several times requesting emergency contraception or they come in multiple times for sexually transmitted infections, those are certainly red flags that tell me there might be something more going on. And in those instances I will say to patients, for example, “When I see a pattern of infections like this it makes me wonder and worry about people making you do things sexual that you didn’t want to do.” And I just kind of put that out there to see, you know, what the response might be. And I had a young woman in the clinic not too long ago when I used that as my opening and she looked at me and said “how did you know?” So you never know how these kind of openings to the conversation are going to go but as we point out in the article, the goal of having this conversation in the health care setting is not about identification, and much more about communicating to our patients that number one they deserve to be treated with respect and number two, that we’re here in a non-judgmental and safe place in the clinical setting to be able to talk about these issues and to connect our patients to relevant services, resources, and supports. And I think that’s a really big shift from just focusing on screening questions and waiting for a patient to check yes on a check box.
Susan Olmstead: Right. Now do you think of yourself as unusual in using this approach or do you know of colleagues who use this approach as well?
Dr. Miller: So an increasing number of colleagues have shifted to this more universal education and brief counseling approach. And I think it’s for two reasons; one, is that what we have found that to rely solely on screening questions and waiting for women to check yes or to say yes, that our disclosure rates are extremely low, maybe 1 to 2%. In places where they ask more routinely about this, it may be a little bit better, maybe 10%, but that means that we see a large number of our patients who could benefit from the messages that they deserve to be treated with respect and here’s this list of resources that are available to you. Such that by shifting to a universal education approach you are much more likely to have impact for our patients. When I am interviewing women who are survivors of intimate partner violence about what they want, one of the most important requests they have of health care providers is please don’t push me to disclose to you but let me know that you care and let me know that you can connect me to help when I’m ready. Now when we really shift what our goal is in healthcare to that sensibility of “I’m here for you whenever you’re ready to talk about these issues, and if it’s not you, maybe you’ve got a friend or a loved one who you want to bring in to clinic to talk about these issues.” And that really changed the tone for us in terms of what we get to do as healthcare providers. It’s not like I’m pulling this out of a hat, it’s really based on research that I conducted and my co-author Dr. Chang has conducted showing that when we have these conversations with our patients they’re significantly more likely to use interventions, whether to call a hotline or speak with an advocate or reach out to a counselor. And that’s huge.