Improving domestic violence screening at Stanford: A Q&A

Photo by Kevin Lee

As part of the Clinical Observation and Medical Transcription fellowship at Stanford, Laurel Sharpless wanted to pursue a project that was personally important to her: intimate partner violence.

Her own experience with intimate personal violence during high school temporarily derailed her career plans of attending a four-year college and then medical school. So she knows how important it is to identify victims early and connect them with help.

During the fellowship — a one-year program that trains prospective health professionals to work as certified medical scribes alongside faculty physicians — Sharpless also looked at how to improve screening for intimate partner violence at Stanford clinics.

Now a San Francisco 49ers cheerleader, a clinical trials coordinator for Stanford immunology and rheumatology and a chief scribe for the COMET fellowship, Sharpless’ own dream is back on track.

I spoke with her recently about her work:

Why is it important for health care workers to screen for domestic violence?

“Intimate partner violence (IPV) is a silent epidemic affecting 1 in 3 women during their lifetime. It leads to injuries and death from physical and sexual assault, sexually transmitted infections, post-traumatic stress disorder, depression, substance abuse, suicide and many other health issues.

We need to promote intervention. This is a public health issue, and primary care and ob/gyn are the best portals for sharing that information. Otherwise, victims might not be aware of the resources they have.”

What are the barriers?

“Although the U.S. Preventive Services Task Force recommends physicians screen women of childbearing age for IPV, rates of screening in primary care settings are low. Physicians have limited time with the patient in the exam room and they have a lot to juggle when coordinating patients’ care. There is also a stigma around the topic with many patients and physicians feeling uncomfortable with the subject.”

What did you study and what did you find?

“I conducted a retrospective chart review at the five Stanford primary care clinics to understand how we were screening patients for intimate partner violence. Some clinics had medical assistants screen and others relied on the physicians alone, and I found a wide variation in screening rates.

Our study supports the national trend that medical staff should do the initial screening, and then physicians should counsel patients who screen positive and then refer them to a social worker and local victims resources.

I presented these results to the medical directors of primary care, which led to an initiative to standardize the way Stanford primary care and ob/gyn screen patients for IPV. I even got to choose the screening question we use. We now ask, ‘Because difficult relationships can cause health problems, we are asking all of our patients the following question: Does a partner, or anyone at home, hurt, hit, or threaten you?'”

What ‘s next?

 “My study results have just been accepted for publication.

I’m currently applying to medical school in hopes of becoming a physician. The COMET fellowship has really peaked my interest in primary care, but I’m going in with an open mind.

As a physician, I wish to become a champion of women’s health care, conducting research and seeing patients. I’ve seen the difference I can make in the quality of care provided to patients. I also aspire to teach the next generation of health care workers and the community at large through advocacy and education from the perspective of an academic physician.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

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Author: Jennifer Huber

As a Ph.D. physicist and research scientist at the Lawrence Berkeley National Laboratory, I gained extensive experience in medical imaging and technical writing. Now, I am a full-time freelance science writer and science-writing instructor. I've lived in the San Francisco Bay Area most of my life and I frequently enjoy the eclectic cultural, culinary and outdoor activities available in the area.

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