AMWA Annual Meeting

CHICAGO – Technology advances are giving patients direct access to myriad health tests and their own health data, but what role do physicians have in responding to such patient-generated assessments?

Dr. Marc Triola of New York University in New York says that the growing reach of health care technology presents both challenges and opportunities for the physician-patient relationship. Dr. Triola spoke at the annual meeting of the American Medical Women’s Association about how physicians can embrace technology and use advancements to improve quality of care.

In this video interview, Dr. Triola speaks about the new ways in which patients can assess their own health data and how doctors should address the test results. He also discusses barriers posed by new technology and how physicians can help shape the changing delivery of health care.

[email protected]

On Twitter @legal_med

CHICAGO – Technology advances are giving patients direct access to myriad health tests and their own health data, but what role do physicians have in responding to such patient-generated assessments?

Dr. Marc Triola of New York University in New York says that the growing reach of health care technology presents both challenges and opportunities for the physician-patient relationship. Dr. Triola spoke at the annual meeting of the American Medical Women’s Association about how physicians can embrace technology and use advancements to improve quality of care.

In this video interview, Dr. Triola speaks about the new ways in which patients can assess their own health data and how doctors should address the test results. He also discusses barriers posed by new technology and how physicians can help shape the changing delivery of health care.

[email protected]

On Twitter @legal_med

CHICAGO – Technology advances are giving patients direct access to myriad health tests and their own health data, but what role do physicians have in responding to such patient-generated assessments?

Dr. Marc Triola of New York University in New York says that the growing reach of health care technology presents both challenges and opportunities for the physician-patient relationship. Dr. Triola spoke at the annual meeting of the American Medical Women’s Association about how physicians can embrace technology and use advancements to improve quality of care.

In this video interview, Dr. Triola speaks about the new ways in which patients can assess their own health data and how doctors should address the test results. He also discusses barriers posed by new technology and how physicians can help shape the changing delivery of health care.

[email protected]

On Twitter @legal_med

CHICAGO– To achieve greater personal and professional satisfaction, clinicians should evaluate their values, practice positive thinking, and perform acts of gratitude, Dr. Angela Nuzzarello said at the annual meeting of the American Medical Women’s Association.

Finding ways to work smarter and generate optimal productivity can also contribute to increased happiness, said Dr. Nuzzarello, associate dean for student affairs for Oakland University William Beaumont School of Medicine and course director for PRISM, a longitudinal course that focuses on the personal development of medical students.

“You have to know when you are most productive,’” Dr. Nuzzarello said during the meeting. “I happen to be a morning person. For me to get up, get into work where it’s quiet, I can get a lot of work done before the place opens up. You need to know for yourself, when are you most productive.”

Delegating duties, making lists, removing distractions, and building in breaks can also help, she said. Clinicians should focus on one task at a time and not be afraid to say, “No,” to projects or extra work.

Dr. Nuzzarello said clinicians can rise above stress by reframing their state of mind when it comes to what’s important. Understand situations and circumstances that are beyond your control and stop dwelling on the past, she said. Dr. Nuzzarello often encounters students who regret not studying more before a big test or midterm. She counsels them to focus on the present day.

“Think about what you can do starting today, going forward, not, ‘Why did I screw up, and what would I do differently?’” she said. “All it does is burn up our energy to put into the things we need to work on.”

Dr. Nuzzarello added that clinicians should examine their values and pursue their definition of success. Often, a mismatch in values professionally can cause dissatisfaction, she said. It helps to revisit what success means to you and what provides the deepest satisfaction.

“We run into trouble when we try to measure ourselves by someone else’s values,” Dr. Nuzzarello said during the meeting. “For me, for my success, it’s not really about making money. It’s not really about publication or about fame. What I set as my goal is at the end of the day, do I have one person [with whom] I came into contact [who] feels better understood?”

Rekindling a passion or forgotten goal also builds on inner happiness. Questions to ask yourself include: What activity provides you with a sense of calm? What would you like to do better? Is there something you have put off learning?

Additionally, never underestimate the importance of close relationships, Dr. Nuzzarello noted. Social media and text messages should not take the place of physical interactions with family and friends. It could be as simple as reconnecting with an old friend or nurturing a current connection, Dr. Nuzzarello said.

“Start the conversation,” she said. “Autopilot doesn’t work. Prioritize your relationships.”

Daily practices that can add to happiness include positive affirmations, performing acts of gratitude and demonstrating kindness. Studies have shown that practicing gratitude leads to more contentment, she said. Examples include writing a thank you note or making a list of all you are thankful for. If you’re having a bad day, the best thing to do is pay someone a compliment, Dr. Nuzzarello adds. Showing kindness to others can do wonders for a clinician's own satisfaction. Positive affirmations are also essential.

“You should start each day with an affirmation,” she said. “Something that says to yourself that you’re positive and that you’re going to have a positive day. You are what you think you are. Happiness is a choice. Choose happiness.”

CHICAGO– To achieve greater personal and professional satisfaction, clinicians should evaluate their values, practice positive thinking, and perform acts of gratitude, Dr. Angela Nuzzarello said at the annual meeting of the American Medical Women’s Association.

Finding ways to work smarter and generate optimal productivity can also contribute to increased happiness, said Dr. Nuzzarello, associate dean for student affairs for Oakland University William Beaumont School of Medicine and course director for PRISM, a longitudinal course that focuses on the personal development of medical students.

“You have to know when you are most productive,’” Dr. Nuzzarello said during the meeting. “I happen to be a morning person. For me to get up, get into work where it’s quiet, I can get a lot of work done before the place opens up. You need to know for yourself, when are you most productive.”

Delegating duties, making lists, removing distractions, and building in breaks can also help, she said. Clinicians should focus on one task at a time and not be afraid to say, “No,” to projects or extra work.

Dr. Nuzzarello said clinicians can rise above stress by reframing their state of mind when it comes to what’s important. Understand situations and circumstances that are beyond your control and stop dwelling on the past, she said. Dr. Nuzzarello often encounters students who regret not studying more before a big test or midterm. She counsels them to focus on the present day.

“Think about what you can do starting today, going forward, not, ‘Why did I screw up, and what would I do differently?’” she said. “All it does is burn up our energy to put into the things we need to work on.”

Dr. Nuzzarello added that clinicians should examine their values and pursue their definition of success. Often, a mismatch in values professionally can cause dissatisfaction, she said. It helps to revisit what success means to you and what provides the deepest satisfaction.

“We run into trouble when we try to measure ourselves by someone else’s values,” Dr. Nuzzarello said during the meeting. “For me, for my success, it’s not really about making money. It’s not really about publication or about fame. What I set as my goal is at the end of the day, do I have one person [with whom] I came into contact [who] feels better understood?”

Rekindling a passion or forgotten goal also builds on inner happiness. Questions to ask yourself include: What activity provides you with a sense of calm? What would you like to do better? Is there something you have put off learning?

Additionally, never underestimate the importance of close relationships, Dr. Nuzzarello noted. Social media and text messages should not take the place of physical interactions with family and friends. It could be as simple as reconnecting with an old friend or nurturing a current connection, Dr. Nuzzarello said.

“Start the conversation,” she said. “Autopilot doesn’t work. Prioritize your relationships.”

Daily practices that can add to happiness include positive affirmations, performing acts of gratitude and demonstrating kindness. Studies have shown that practicing gratitude leads to more contentment, she said. Examples include writing a thank you note or making a list of all you are thankful for. If you’re having a bad day, the best thing to do is pay someone a compliment, Dr. Nuzzarello adds. Showing kindness to others can do wonders for a clinician's own satisfaction. Positive affirmations are also essential.

“You should start each day with an affirmation,” she said. “Something that says to yourself that you’re positive and that you’re going to have a positive day. You are what you think you are. Happiness is a choice. Choose happiness.”

CHICAGO– To achieve greater personal and professional satisfaction, clinicians should evaluate their values, practice positive thinking, and perform acts of gratitude, Dr. Angela Nuzzarello said at the annual meeting of the American Medical Women’s Association.

Finding ways to work smarter and generate optimal productivity can also contribute to increased happiness, said Dr. Nuzzarello, associate dean for student affairs for Oakland University William Beaumont School of Medicine and course director for PRISM, a longitudinal course that focuses on the personal development of medical students.

“You have to know when you are most productive,’” Dr. Nuzzarello said during the meeting. “I happen to be a morning person. For me to get up, get into work where it’s quiet, I can get a lot of work done before the place opens up. You need to know for yourself, when are you most productive.”

Delegating duties, making lists, removing distractions, and building in breaks can also help, she said. Clinicians should focus on one task at a time and not be afraid to say, “No,” to projects or extra work.

Dr. Nuzzarello said clinicians can rise above stress by reframing their state of mind when it comes to what’s important. Understand situations and circumstances that are beyond your control and stop dwelling on the past, she said. Dr. Nuzzarello often encounters students who regret not studying more before a big test or midterm. She counsels them to focus on the present day.

“Think about what you can do starting today, going forward, not, ‘Why did I screw up, and what would I do differently?’” she said. “All it does is burn up our energy to put into the things we need to work on.”

Dr. Nuzzarello added that clinicians should examine their values and pursue their definition of success. Often, a mismatch in values professionally can cause dissatisfaction, she said. It helps to revisit what success means to you and what provides the deepest satisfaction.

“We run into trouble when we try to measure ourselves by someone else’s values,” Dr. Nuzzarello said during the meeting. “For me, for my success, it’s not really about making money. It’s not really about publication or about fame. What I set as my goal is at the end of the day, do I have one person [with whom] I came into contact [who] feels better understood?”

Rekindling a passion or forgotten goal also builds on inner happiness. Questions to ask yourself include: What activity provides you with a sense of calm? What would you like to do better? Is there something you have put off learning?

Additionally, never underestimate the importance of close relationships, Dr. Nuzzarello noted. Social media and text messages should not take the place of physical interactions with family and friends. It could be as simple as reconnecting with an old friend or nurturing a current connection, Dr. Nuzzarello said.

“Start the conversation,” she said. “Autopilot doesn’t work. Prioritize your relationships.”

Daily practices that can add to happiness include positive affirmations, performing acts of gratitude and demonstrating kindness. Studies have shown that practicing gratitude leads to more contentment, she said. Examples include writing a thank you note or making a list of all you are thankful for. If you’re having a bad day, the best thing to do is pay someone a compliment, Dr. Nuzzarello adds. Showing kindness to others can do wonders for a clinician's own satisfaction. Positive affirmations are also essential.

“You should start each day with an affirmation,” she said. “Something that says to yourself that you’re positive and that you’re going to have a positive day. You are what you think you are. Happiness is a choice. Choose happiness.”

CHICAGO– To achieve greater personal and professional satisfaction, physicians should evaluate their values, practice positive thinking, and perform acts of gratitude, Dr. Angela Nuzzarello said at the annual meeting of the American Medical Women’s Association.

Finding ways to work smarter and generate optimal productivity can also contribute to increased happiness, said Dr. Nuzzarello, associate dean for student affairs for Oakland University William Beaumont School of Medicine and course director for PRISM, a longitudinal course that focuses on the personal development of medical students.

“You have to know when you are most productive,’” Dr. Nuzzarello said during the meeting. “I happen to be a morning person. For me to get up, get into work where it’s quiet, I can get a lot of work done before the place opens up. You need to know for yourself, when are you most productive.”

Delegating duties, making lists, removing distractions, and building in breaks can also help, she said. Physicians should focus on one task at a time and not be afraid to say, “No,” to projects or extra work.

Dr. Nuzzarello said physicians can rise above stress by reframing their state of mind when it comes to what’s important. Understand situations and circumstances that are beyond your control and stop dwelling on the past, she said. Dr. Nuzzarello often encounters students who regret not studying more before a big test or midterm. She counsels them to focus on the present day.

“Think about what you can do starting today, going forward, not, ‘Why did I screw up, and what would I do differently?’” she said. “All it does is burn up our energy to put into the things we need to work on.”

Dr. Nuzzarello added that physicians should examine their values and pursue their definition of success. Often, a mismatch in values professionally can cause dissatisfaction, she said. It helps to revisit what success means to you and what provides the deepest satisfaction.

“We run into trouble when we try to measure ourselves by someone else’s values,” Dr. Nuzzarello said during the meeting. “For me, for my success, it’s not really about making money. It’s not really about publication or about fame. What I set as my goal is at the end of the day, do I have one person [with whom] I came into contact [who] feels better understood?”

Rekindling a passion or forgotten goal also builds on inner happiness. Questions to ask yourself include: What activity provides you with a sense of calm? What would you like to do better? Is there something you have put off learning?

Additionally, never underestimate the importance of close relationships, Dr. Nuzzarello noted. Social media and text messages should not take the place of physical interactions with family and friends. It could be as simple as reconnecting with an old friend or nurturing a current connection, Dr. Nuzzarello said.

“Start the conversation,” she said. “Autopilot doesn’t work. Prioritize your relationships.”

Daily practices that can add to happiness include positive affirmations, performing acts of gratitude and demonstrating kindness. Studies have shown that practicing gratitude leads to more contentment, she said. Examples include writing a thank you note or making a list of all you are thankful for. If you’re having a bad day, the best thing to do is pay someone a compliment, Dr. Nuzzarello adds. Showing kindness to others can do wonders for a physician’s own satisfaction. Positive affirmations are also essential.

“You should start each day with an affirmation,” she said. “Something that says to yourself that you’re positive and that you’re going to have a positive day. You are what you think you are. Happiness is a choice. Choose happiness.”

[email protected]

On Twitter @legal_med

CHICAGO– To achieve greater personal and professional satisfaction, physicians should evaluate their values, practice positive thinking, and perform acts of gratitude, Dr. Angela Nuzzarello said at the annual meeting of the American Medical Women’s Association.

Finding ways to work smarter and generate optimal productivity can also contribute to increased happiness, said Dr. Nuzzarello, associate dean for student affairs for Oakland University William Beaumont School of Medicine and course director for PRISM, a longitudinal course that focuses on the personal development of medical students.

“You have to know when you are most productive,’” Dr. Nuzzarello said during the meeting. “I happen to be a morning person. For me to get up, get into work where it’s quiet, I can get a lot of work done before the place opens up. You need to know for yourself, when are you most productive.”

Delegating duties, making lists, removing distractions, and building in breaks can also help, she said. Physicians should focus on one task at a time and not be afraid to say, “No,” to projects or extra work.

Dr. Nuzzarello said physicians can rise above stress by reframing their state of mind when it comes to what’s important. Understand situations and circumstances that are beyond your control and stop dwelling on the past, she said. Dr. Nuzzarello often encounters students who regret not studying more before a big test or midterm. She counsels them to focus on the present day.

“Think about what you can do starting today, going forward, not, ‘Why did I screw up, and what would I do differently?’” she said. “All it does is burn up our energy to put into the things we need to work on.”

Dr. Nuzzarello added that physicians should examine their values and pursue their definition of success. Often, a mismatch in values professionally can cause dissatisfaction, she said. It helps to revisit what success means to you and what provides the deepest satisfaction.

“We run into trouble when we try to measure ourselves by someone else’s values,” Dr. Nuzzarello said during the meeting. “For me, for my success, it’s not really about making money. It’s not really about publication or about fame. What I set as my goal is at the end of the day, do I have one person [with whom] I came into contact [who] feels better understood?”

Rekindling a passion or forgotten goal also builds on inner happiness. Questions to ask yourself include: What activity provides you with a sense of calm? What would you like to do better? Is there something you have put off learning?

Additionally, never underestimate the importance of close relationships, Dr. Nuzzarello noted. Social media and text messages should not take the place of physical interactions with family and friends. It could be as simple as reconnecting with an old friend or nurturing a current connection, Dr. Nuzzarello said.

“Start the conversation,” she said. “Autopilot doesn’t work. Prioritize your relationships.”

Daily practices that can add to happiness include positive affirmations, performing acts of gratitude and demonstrating kindness. Studies have shown that practicing gratitude leads to more contentment, she said. Examples include writing a thank you note or making a list of all you are thankful for. If you’re having a bad day, the best thing to do is pay someone a compliment, Dr. Nuzzarello adds. Showing kindness to others can do wonders for a physician’s own satisfaction. Positive affirmations are also essential.

“You should start each day with an affirmation,” she said. “Something that says to yourself that you’re positive and that you’re going to have a positive day. You are what you think you are. Happiness is a choice. Choose happiness.”

[email protected]

On Twitter @legal_med

CHICAGO– To achieve greater personal and professional satisfaction, physicians should evaluate their values, practice positive thinking, and perform acts of gratitude, Dr. Angela Nuzzarello said at the annual meeting of the American Medical Women’s Association.

Finding ways to work smarter and generate optimal productivity can also contribute to increased happiness, said Dr. Nuzzarello, associate dean for student affairs for Oakland University William Beaumont School of Medicine and course director for PRISM, a longitudinal course that focuses on the personal development of medical students.

“You have to know when you are most productive,’” Dr. Nuzzarello said during the meeting. “I happen to be a morning person. For me to get up, get into work where it’s quiet, I can get a lot of work done before the place opens up. You need to know for yourself, when are you most productive.”

Delegating duties, making lists, removing distractions, and building in breaks can also help, she said. Physicians should focus on one task at a time and not be afraid to say, “No,” to projects or extra work.

Dr. Nuzzarello said physicians can rise above stress by reframing their state of mind when it comes to what’s important. Understand situations and circumstances that are beyond your control and stop dwelling on the past, she said. Dr. Nuzzarello often encounters students who regret not studying more before a big test or midterm. She counsels them to focus on the present day.

“Think about what you can do starting today, going forward, not, ‘Why did I screw up, and what would I do differently?’” she said. “All it does is burn up our energy to put into the things we need to work on.”

Dr. Nuzzarello added that physicians should examine their values and pursue their definition of success. Often, a mismatch in values professionally can cause dissatisfaction, she said. It helps to revisit what success means to you and what provides the deepest satisfaction.

“We run into trouble when we try to measure ourselves by someone else’s values,” Dr. Nuzzarello said during the meeting. “For me, for my success, it’s not really about making money. It’s not really about publication or about fame. What I set as my goal is at the end of the day, do I have one person [with whom] I came into contact [who] feels better understood?”

Rekindling a passion or forgotten goal also builds on inner happiness. Questions to ask yourself include: What activity provides you with a sense of calm? What would you like to do better? Is there something you have put off learning?

Additionally, never underestimate the importance of close relationships, Dr. Nuzzarello noted. Social media and text messages should not take the place of physical interactions with family and friends. It could be as simple as reconnecting with an old friend or nurturing a current connection, Dr. Nuzzarello said.

“Start the conversation,” she said. “Autopilot doesn’t work. Prioritize your relationships.”

Daily practices that can add to happiness include positive affirmations, performing acts of gratitude and demonstrating kindness. Studies have shown that practicing gratitude leads to more contentment, she said. Examples include writing a thank you note or making a list of all you are thankful for. If you’re having a bad day, the best thing to do is pay someone a compliment, Dr. Nuzzarello adds. Showing kindness to others can do wonders for a physician’s own satisfaction. Positive affirmations are also essential.

“You should start each day with an affirmation,” she said. “Something that says to yourself that you’re positive and that you’re going to have a positive day. You are what you think you are. Happiness is a choice. Choose happiness.”

[email protected]

On Twitter @legal_med

CHICAGO– Inappropriate treatment by physicians of women who have undergone female genital cutting (FGC) can block access to further care and harm patients psychologically, according to Dr. Nawal M. Nour, director of the ambulatory obstetrics practice at Brigham and Women’s Hospital and founder of the African Women’s Health Center in Boston.

Doctors who are unfamiliar with patients who have FGC can say or react to patients in ways that harms, rather than helps such women, Dr. Nour said at the annual meeting of the American Medical Women’s Association. Dr. Nour is the lead author of Female Genital Cutting: Clinical Management of Circumcised Women, published by the American Congress of Obstetricians and Gynecologists.

During her presentation, Dr. Nour shared cases in which doctors made teaching examples out of FGC patients, provided inaccurate information about vaginal deliveries, and focused on the FGC procedure, rather the woman’s reason for seeking medical attention.

In this video, Dr. Nour shares some common ways that physicians inappropriately respond to women who have undergone FGC, and how doctors can act more sensitively.

[email protected]

On Twitter @legal_med

CHICAGO– Inappropriate treatment by physicians of women who have undergone female genital cutting (FGC) can block access to further care and harm patients psychologically, according to Dr. Nawal M. Nour, director of the ambulatory obstetrics practice at Brigham and Women’s Hospital and founder of the African Women’s Health Center in Boston.

Doctors who are unfamiliar with patients who have FGC can say or react to patients in ways that harms, rather than helps such women, Dr. Nour said at the annual meeting of the American Medical Women’s Association. Dr. Nour is the lead author of Female Genital Cutting: Clinical Management of Circumcised Women, published by the American Congress of Obstetricians and Gynecologists.

During her presentation, Dr. Nour shared cases in which doctors made teaching examples out of FGC patients, provided inaccurate information about vaginal deliveries, and focused on the FGC procedure, rather the woman’s reason for seeking medical attention.

In this video, Dr. Nour shares some common ways that physicians inappropriately respond to women who have undergone FGC, and how doctors can act more sensitively.

[email protected]

On Twitter @legal_med

CHICAGO– Inappropriate treatment by physicians of women who have undergone female genital cutting (FGC) can block access to further care and harm patients psychologically, according to Dr. Nawal M. Nour, director of the ambulatory obstetrics practice at Brigham and Women’s Hospital and founder of the African Women’s Health Center in Boston.

Doctors who are unfamiliar with patients who have FGC can say or react to patients in ways that harms, rather than helps such women, Dr. Nour said at the annual meeting of the American Medical Women’s Association. Dr. Nour is the lead author of Female Genital Cutting: Clinical Management of Circumcised Women, published by the American Congress of Obstetricians and Gynecologists.

During her presentation, Dr. Nour shared cases in which doctors made teaching examples out of FGC patients, provided inaccurate information about vaginal deliveries, and focused on the FGC procedure, rather the woman’s reason for seeking medical attention.

In this video, Dr. Nour shares some common ways that physicians inappropriately respond to women who have undergone FGC, and how doctors can act more sensitively.

[email protected]

On Twitter @legal_med

CHICAGO – Physicians can play a leading role in identifying patients who are human trafficking victims by knowing the signs to watch for during visits and taking immediate steps to address their suspicions, according to Dr. Holly G. Atkinson.

Key indicators include discrepancies between history and clinical presentation, multiple sexually transmitted diseases, and the accompaniment of a controlling third-party who is not a guardian, said Dr. Atkinson, director of the human rights program at Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai in New York City.

“This is an underground problem,” Dr. Atkinson said. “We have a number of issues that we need to address in the medical profession. Health care providers are missing the opportunity to intervene.”

The prevalence of U.S. citizens being trafficked is higher than some people may think, Dr. Atkinson said at the annual meeting of the American Medical Women’s Association. In 2014, the National Human Trafficking Resource Center, operated by the antislavery organization Polaris, received 3,598 reports of sex-trafficking cases inside the United States. And Homeland Security Investigations of the U.S. Immigration and Customs Enforcement in fiscal 2013 opened 1,025 investigations involving possible human trafficking, an increase from 894 from 2012.

The National Center for Missing & Exploited Children estimates that 1 in 6 endangered runaways reported to their organization in 2014 were likely sex trafficking victims.* The average age of entry into the commercial sex trade for girls is between 12 and 14 and for boys between ages 11 and 13, Dr. Atkinson said. Factors that contribute to a higher risk for human trafficking include childhood sexual abuse, involvement in the foster care system, and poverty. Runaway and minority youth also are at higher risk.

Research and personal accounts show human trafficking victims regularly come in contact with health providers during the course of their exploitation. In a 2014 survey of domestic sex-trafficking victims, 88% said they encountered one or more health professions during the period in which they were being trafficked, yet none was identified as a victim by physicians during the visits.

In another 2014 survey of survivors, 39% of victims reported having contact with emergency departments; 29%, with primary care physicians; 17%, with ob.gyns.; 17%, with dentists; and 3%, with pediatricians, according to data cited in Dr. Atkinson’s presentation.

“This really points out that we all need to pay attention to it across the entire span of the health care system,” Dr. Atkinson said during the meeting.

Physicians should pay close attention to physical signs that could denote the possibility of patients being trafficked, she added. This includes visible tattoos with “daddy,” “property of,” or a trafficker’s street name. Perpetrators often brand their victims so that they are easily recognizable and can be returned if they escape, Dr. Atkinson explained.

Dehydration, malnutrition, multiple sexually transmitted infections, and multiple pregnancies or abortions could also be clues. Doctors should watch for a history of discrepancies and confusion in how patients answer questions, for example, the inability to provide an address, confusion about their current location, an appearance younger than the stated age, and answers that sound scripted.

Signs of human trafficking may also be apparent in the relationship between patients and third-party visitors, Dr. Atkinson said. A controlling third party who does not let the patient answer questions or who interrupts or corrects the patient is a red flag. Other indicators include a patient who appears fearful or avoids eye contact.

“Understand that there is a lot of fear and distrust,” Dr. Atkinson said.

Several health care centers and medical systems have started developing protocols for health providers to follow to address possible human-trafficking victims.

The Via Christi Health system in Wichita, Kan., recently published guidance for clinicians on how to proceed if they suspect a patient is a victim of human trafficking. Steps include following child abuse or domestic violence protocols; separating the patient from the controlling third party; providing the patient a comfortable, safe area; and ensuring a patient interview is performed by a trauma-informed social worker or nurse.

Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.

More efforts are underway on the state and federal levels to fight human trafficking, Dr. Atkinson said.

All states have criminal laws that address human trafficking, and 14 states now have educational laws specifically about trafficking. In late April, the U.S. Senate passed a measure that would increase penalties on human trafficking.

In addition, AMWA recently launched Physicians Against the Trafficking of Humans (PATH) to help educate health providers about trafficking in their communities. The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.

“As physicians, we are trained to act, and we’re trained to solve problems,” AMWA Immediate Past Resident President Kanani Titchen said in the video. “It’s important in these situations to remember that we are not going to fix this person’s life in one visit. Many of these patients have been in their situations for years, and many times the path to recovery is a long one, and we are one stepping stone in that path. It’s important to listen to our patients, to provide the information that they need, the resources that they need, and it’s important for us as physicians, to know what those resources are.”

*Clarification, 6/3/2015: This story was updated to reflect a more accurate estimate of children at risk for sex trafficking.

[email protected]
On Twitter @legal_med

CHICAGO – Physicians can play a leading role in identifying patients who are human trafficking victims by knowing the signs to watch for during visits and taking immediate steps to address their suspicions, according to Dr. Holly G. Atkinson.

Key indicators include discrepancies between history and clinical presentation, multiple sexually transmitted diseases, and the accompaniment of a controlling third-party who is not a guardian, said Dr. Atkinson, director of the human rights program at Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai in New York City.

“This is an underground problem,” Dr. Atkinson said. “We have a number of issues that we need to address in the medical profession. Health care providers are missing the opportunity to intervene.”

The prevalence of U.S. citizens being trafficked is higher than some people may think, Dr. Atkinson said at the annual meeting of the American Medical Women’s Association. In 2014, the National Human Trafficking Resource Center, operated by the antislavery organization Polaris, received 3,598 reports of sex-trafficking cases inside the United States. And Homeland Security Investigations of the U.S. Immigration and Customs Enforcement in fiscal 2013 opened 1,025 investigations involving possible human trafficking, an increase from 894 from 2012.

The National Center for Missing & Exploited Children estimates that 1 in 6 endangered runaways reported to their organization in 2014 were likely sex trafficking victims.* The average age of entry into the commercial sex trade for girls is between 12 and 14 and for boys between ages 11 and 13, Dr. Atkinson said. Factors that contribute to a higher risk for human trafficking include childhood sexual abuse, involvement in the foster care system, and poverty. Runaway and minority youth also are at higher risk.

Research and personal accounts show human trafficking victims regularly come in contact with health providers during the course of their exploitation. In a 2014 survey of domestic sex-trafficking victims, 88% said they encountered one or more health professions during the period in which they were being trafficked, yet none was identified as a victim by physicians during the visits.

In another 2014 survey of survivors, 39% of victims reported having contact with emergency departments; 29%, with primary care physicians; 17%, with ob.gyns.; 17%, with dentists; and 3%, with pediatricians, according to data cited in Dr. Atkinson’s presentation.

“This really points out that we all need to pay attention to it across the entire span of the health care system,” Dr. Atkinson said during the meeting.

Physicians should pay close attention to physical signs that could denote the possibility of patients being trafficked, she added. This includes visible tattoos with “daddy,” “property of,” or a trafficker’s street name. Perpetrators often brand their victims so that they are easily recognizable and can be returned if they escape, Dr. Atkinson explained.

Dehydration, malnutrition, multiple sexually transmitted infections, and multiple pregnancies or abortions could also be clues. Doctors should watch for a history of discrepancies and confusion in how patients answer questions, for example, the inability to provide an address, confusion about their current location, an appearance younger than the stated age, and answers that sound scripted.

Signs of human trafficking may also be apparent in the relationship between patients and third-party visitors, Dr. Atkinson said. A controlling third party who does not let the patient answer questions or who interrupts or corrects the patient is a red flag. Other indicators include a patient who appears fearful or avoids eye contact.

“Understand that there is a lot of fear and distrust,” Dr. Atkinson said.

Several health care centers and medical systems have started developing protocols for health providers to follow to address possible human-trafficking victims.

The Via Christi Health system in Wichita, Kan., recently published guidance for clinicians on how to proceed if they suspect a patient is a victim of human trafficking. Steps include following child abuse or domestic violence protocols; separating the patient from the controlling third party; providing the patient a comfortable, safe area; and ensuring a patient interview is performed by a trauma-informed social worker or nurse.

Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.

More efforts are underway on the state and federal levels to fight human trafficking, Dr. Atkinson said.

All states have criminal laws that address human trafficking, and 14 states now have educational laws specifically about trafficking. In late April, the U.S. Senate passed a measure that would increase penalties on human trafficking.

In addition, AMWA recently launched Physicians Against the Trafficking of Humans (PATH) to help educate health providers about trafficking in their communities. The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.

“As physicians, we are trained to act, and we’re trained to solve problems,” AMWA Immediate Past Resident President Kanani Titchen said in the video. “It’s important in these situations to remember that we are not going to fix this person’s life in one visit. Many of these patients have been in their situations for years, and many times the path to recovery is a long one, and we are one stepping stone in that path. It’s important to listen to our patients, to provide the information that they need, the resources that they need, and it’s important for us as physicians, to know what those resources are.”

*Clarification, 6/3/2015: This story was updated to reflect a more accurate estimate of children at risk for sex trafficking.

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CHICAGO – Physicians can play a leading role in identifying patients who are human trafficking victims by knowing the signs to watch for during visits and taking immediate steps to address their suspicions, according to Dr. Holly G. Atkinson.

Key indicators include discrepancies between history and clinical presentation, multiple sexually transmitted diseases, and the accompaniment of a controlling third-party who is not a guardian, said Dr. Atkinson, director of the human rights program at Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai in New York City.

“This is an underground problem,” Dr. Atkinson said. “We have a number of issues that we need to address in the medical profession. Health care providers are missing the opportunity to intervene.”

The prevalence of U.S. citizens being trafficked is higher than some people may think, Dr. Atkinson said at the annual meeting of the American Medical Women’s Association. In 2014, the National Human Trafficking Resource Center, operated by the antislavery organization Polaris, received 3,598 reports of sex-trafficking cases inside the United States. And Homeland Security Investigations of the U.S. Immigration and Customs Enforcement in fiscal 2013 opened 1,025 investigations involving possible human trafficking, an increase from 894 from 2012.

The National Center for Missing & Exploited Children estimates that 1 in 6 endangered runaways reported to their organization in 2014 were likely sex trafficking victims.* The average age of entry into the commercial sex trade for girls is between 12 and 14 and for boys between ages 11 and 13, Dr. Atkinson said. Factors that contribute to a higher risk for human trafficking include childhood sexual abuse, involvement in the foster care system, and poverty. Runaway and minority youth also are at higher risk.

Research and personal accounts show human trafficking victims regularly come in contact with health providers during the course of their exploitation. In a 2014 survey of domestic sex-trafficking victims, 88% said they encountered one or more health professions during the period in which they were being trafficked, yet none was identified as a victim by physicians during the visits.

In another 2014 survey of survivors, 39% of victims reported having contact with emergency departments; 29%, with primary care physicians; 17%, with ob.gyns.; 17%, with dentists; and 3%, with pediatricians, according to data cited in Dr. Atkinson’s presentation.

“This really points out that we all need to pay attention to it across the entire span of the health care system,” Dr. Atkinson said during the meeting.

Physicians should pay close attention to physical signs that could denote the possibility of patients being trafficked, she added. This includes visible tattoos with “daddy,” “property of,” or a trafficker’s street name. Perpetrators often brand their victims so that they are easily recognizable and can be returned if they escape, Dr. Atkinson explained.

Dehydration, malnutrition, multiple sexually transmitted infections, and multiple pregnancies or abortions could also be clues. Doctors should watch for a history of discrepancies and confusion in how patients answer questions, for example, the inability to provide an address, confusion about their current location, an appearance younger than the stated age, and answers that sound scripted.

Signs of human trafficking may also be apparent in the relationship between patients and third-party visitors, Dr. Atkinson said. A controlling third party who does not let the patient answer questions or who interrupts or corrects the patient is a red flag. Other indicators include a patient who appears fearful or avoids eye contact.

“Understand that there is a lot of fear and distrust,” Dr. Atkinson said.

Several health care centers and medical systems have started developing protocols for health providers to follow to address possible human-trafficking victims.

The Via Christi Health system in Wichita, Kan., recently published guidance for clinicians on how to proceed if they suspect a patient is a victim of human trafficking. Steps include following child abuse or domestic violence protocols; separating the patient from the controlling third party; providing the patient a comfortable, safe area; and ensuring a patient interview is performed by a trauma-informed social worker or nurse.

Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.

More efforts are underway on the state and federal levels to fight human trafficking, Dr. Atkinson said.

All states have criminal laws that address human trafficking, and 14 states now have educational laws specifically about trafficking. In late April, the U.S. Senate passed a measure that would increase penalties on human trafficking.

In addition, AMWA recently launched Physicians Against the Trafficking of Humans (PATH) to help educate health providers about trafficking in their communities. The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.

“As physicians, we are trained to act, and we’re trained to solve problems,” AMWA Immediate Past Resident President Kanani Titchen said in the video. “It’s important in these situations to remember that we are not going to fix this person’s life in one visit. Many of these patients have been in their situations for years, and many times the path to recovery is a long one, and we are one stepping stone in that path. It’s important to listen to our patients, to provide the information that they need, the resources that they need, and it’s important for us as physicians, to know what those resources are.”

*Clarification, 6/3/2015: This story was updated to reflect a more accurate estimate of children at risk for sex trafficking.

[email protected]
On Twitter @legal_med