20 Minutes with Melissa Currie, MD
University of Louisville pediatrician Melissa Currie, MD, recently passed the 2009 child abuse pediatrics certifying exam, making her one of a handful of physicians nationwide who are certified in this newly designated medical specialty.
This accomplishment is especially meaningful in light of Kentucky's serious problem with child abuse. A national child advocacy group recently announced that in 2007 Kentucky had the highest rate of child deaths from abuse and neglect in the country. That's 41 children killed in the past 12 months, nearly three-fourths of them less than 3 years old.
UofL Today spoke to Currie about her specialty and what these new developments mean for Kentucky children.
The American Board of Pediatrics has just named child abuse medicine an official pediatrics subspecialty. What is child abuse pediatrics?
Child abuse medicine is a specialty within the field of pediatrics. We assess children who are suspected victims of maltreatment, whether it is physical abuse, sexual abuse or neglect. We review the medical charts, analyze the injuries, screen for other injuries and pull all the pieces together to make the best assessment we can. Sometimes the child has underlying medical conditions, such as a bleeding or bone disorder, that mimic abuse.
When it is abuse, we work with our child protection colleagues and law enforcement to help them understand what has happened to the child. We also testify in child abuse cases. It really helps lift the burden off referring doctors who must cancel patients to appear in court. We also have the expertise to offer evidence-based information to the courts when we're testifying.
You were in the first group to take the board certification exam. What was that like?
It was quite an experience to take a test that no one had taken before, because we had very limited resources to use to study for it. We were given two sample questions and a 100-page list of topics. It was daunting. It was also interesting because it felt like an honor to be in the first group. When I showed up to take the test, I saw colleagues of mine who have been more like mentors, people who have been doing this for 20 years. To take the test with the people who did the research that my practice is based on was an amazing experience.
Why did you go into child abuse pediatrics?
To do a good job in these kinds of assessments you must be comfortable asking uncomfortable questions. You have to be kind of nosy and I am, so I took to this kind of interview very quickly. The histories I took routinely, even on children who were admitted with asthma, tended to be a little more in depth, especially the social aspect. Child abuse pediatricians ask questions about the child's whole life, much more than a typical medical history would. We want to know what their daily life looks like, who takes care of them and how are they doing in school.
I also really like working with and learning from other subspecialists. In child abuse pediatrics we don't operate in a vacuum. We depend very heavily on our pediatric radiology colleagues. We also interact with our colleagues in general pediatrics, forensic pathology, pediatric surgery, critical care, emergency medicine. I really like that.
Tell us about UofL's child abuse program.
UofL has had a child abuse program since the mid 1990s. It started in the Department of Pathology with the Medical Examiner's Office. In 2007, that program transitioned to UofL Pediatrics. That's when I joined as director of Pediatric Forensic Medicine and the approach changed from a retrospective chart-review format. Our team now becomes involved at the very beginning of the case and we make recommendations and assessments throughout the entire process. That allows us to guide the investigators regarding what is plausible and what isn't.
Our volume continues to increase. In UofL Pediatrics' first year, we saw 400 patients. If we continue at our current pace, we'll see 850 child abuse cases in 2010. Our goal is to reach a plateau and see the number of cases drop off so we can focus more on education and prevention areas. I don't think we're there yet.
What does your certification mean for UofL's child abuse program and for Kentucky, which has just been designated the nation's leader in child abuse deaths?
I think my certification helps most in court because it helps legitimize my training and explain my role. Unfortunately, as in many other court cases, there are other people who come to court and represent themselves as child abuse experts and they are not. This is one way to help filter out some of those folks.
In addition to allowing me do a better job educating judges and juries, this designation may bring more resources to the area of child abuse. There's the whole issue of payment for these services. We don't charge for our services; we depend on philanthropy. Now that there's an accredited subspecialty, we may be able to be reimbursed by insurance companies. It also makes us more able to fund research.
Finally, it will hopefully raise awareness of the field so that we can recruit more bright, young doctors to the field. There aren't nearly enough child abuse specialists to meet the need, so it's important to encourage pediatricians-in-training to consider this as a career.
Why do you think Kentucky's child abuse numbers are so high?
It's a combination of issues, some good and some not so good. One thing that sometimes overlooked is that Kentucky's medical examiner system is very good. The medical examiners across the state do an excellent job recognizing abuse. Unfortunately, there are so many places where a child dies as a result of abuse and the person doing the autopsy doesn't recognize that maltreatment played a role. Or, there is no autopsy. The fact that we recognize it when it happens is going to increase our numbers.
We have lots of teenage parents and lots of people with poor education, poverty. Drug abuse - methamphetamine use - is really increasing and we absolutely see a link between substance abuse and domestic violence and child abuse. Also, I think Kentucky's criminal code is not as punitive toward child abuse perpetrators as some other states. I don't know to what degree that it affects our numbers but I don't think that it helps.
What about prevention? What can people do?
Like my colleagues, I'm always thinking about prevention. That's one reason why having this new subspecialty will help a lot. It will bring with it the recognition and the resources we need so we can do more robust research, not just research about specific injury types but also about prevention. In a perfect world we could put ourselves out of business.
It is so common for domestic violence, substance abuse and untreated mental health to be linked to child abuse. So many times it starts when kids are young, when they've gotten into bad relationships or they've been raised in households where discipline is done in an inappropriate manner. They don't know a better way. My number one recommendation is to incorporate parenting and relationship education in the public schools. Not just for young women but young men too.
What does the future hold for pediatric forensic medicine here?
Things are definitely looking up. We have another doctor joining us in late June. She also took and passed the exam, so we'll have two board-certified child abuse pediatrics specialists which is important if we want to have a fellowship.
The research component of UofL Pediatrics' program has been neglected because we've been so focused on the clinical service. With additional faculty we'll have more time to devote to research and seeking funding. I would like to see our program become a national model for how to address child abuse from the prevention, research, education and clinical aspects-both diagnosis and treatment - so that it is as comprehensive and multidisciplinary possible.
What's my ultimate goal? I want to make Kentucky last (in child abuse deaths).