Family Practice Vol. 20, No. 5, 615
© Oxford University Press 2003
Book Review |
Family violence in primary care.
Stephen Amiel, Iona Heath (eds). (440 pages, £32.50.) Oxford University Press, 2003. ISBN 0-19-262828-3.
GP and senior lecturer in medical education
I write this review in the same week that I received the ‘Summary and Recommendations of the Victoria Climbie Inquiry’. The accompanying letter informs me that the full report would cost £42 to issue. The ‘Summary’ is 49 pages long and contains 108 recommendations. The booklet is destined to join other voluminous files in the practice library containing inaccessible and unreadable reports about child protection. Whatever the intention of their authors, they create the impression in the minds of the doctors to whom they are sent that, in the event of a tragedy, someone has ‘covered their back’. It was refreshing, therefore, to turn to this book and read such a comprehensive review of the problem of family violence. It is compiled by GPs able to call upon the expertise of authors, who can write plain English, who demonstrate an awareness of the context in which family violence presents to primary care health workers.
The three principal sections concern violence against children, against women by known men, and violence to older people. Each section covers the context, recognition of abuse, guidance on how to respond and recommendations for the future. Some chapters are best seen as reference material, but others—particularly those concerning the context in which abuse occurs and its recognition within the consultation—should be regarded as essential reading. The authors acknowledge difficulties in the diagnosis of family violence with the attendant danger that physical symptoms that do not have a clear cause are often exhaustively, and damagingly, investigated in hospital clinics. They suggest that part of the reason lies in undue reliance on the biomedical model of illness and recommend a variety of educational initiatives to help overcome this problem.
Although these may help, more impact will result from recent improvements in teaching students and GP registrars good inter-personal skills within the consultation. Less progress has been made in teaching clinical problem-solving skills, which are needed to reject inappropriate physical diagnoses quickly and safely and to promote the rapid recognition of the underlying issues such as covert family violence. Several chapters suggest indicators which powerfully predict such alternative explanations.
If improvements in the teaching of integrated consultation skills are factors indicating optimism for the future, the editors identify loss of continuity of care within primary care as a growing threat to better identification and management of family violence. In particular, the growth of alternative providers such as commercial out-of-hours care services, GP specialists and the increasing trend to part-time work are all likely to impair the service we offer to those abused within families. If the lessons to be learnt from this book are heeded, then great progress will have been made to prevent this from happening.
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