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ABC of Domestic and Sexual Violence is a long overdue practical guide to assist health professionals to help survivors of domestic violence.
With a lifetime prevalence of 31% for women and 18% for men (pp. xi–xii), this subject is relevant to all of us, but it receives little attention in undergraduate or postgraduate training. Consequently, when we suspect domestic violence we may not know how to react, or wrongly conclude that it is not our problem. Or else we may miss overt signals altogether as we are not equipped to recognise them.
A whole book on the subject seemed overwhelming at first, but on reading it I realised that this was just a reflection of my own ignorance. Each chapter is an approachable and manageable summary of the complex different facets of this epidemic. As well as ignorance, there may also exist apathy and confusion as to what the role of a doctor should be in this setting. We are wisely recommended to “recognise, empathise and witness and to refer to appropriate multi-agency services” rather than to try and fix or medicalise the problem (pp. 1–4).
This new ABC title, edited by Susan Bewley, a Professor of Complex Obstetrics and Jan Welch, a Consultant in HIV Medicine and Sexual Health, covers epidemiology and the diverse disease burden that violence creates. There is practical advice for health care workers in obstetrics and gynaecology, genitourinary medicine, general practice, emergency medicine and dentistry, on how to screen for and ask about domestic violence. It describes the current services available and how to access them, as well as other practical legal and documentation advice.
The ABC can act as a reference for which type of injuries and behaviours ought to raise concern, as well as providing example questions and statements to fall back on during difficult conversations. The language of domestic and sexual violence is a recurring theme, with many contributors advocating precision with the words we choose, to avoid implying blame or judgement while remaining accurate and objective.
Another strength of the book is the editors’ consideration of the issue of violence from all perspectives. The contributors identify groups at particular risk of violence such as children, the elderly and people in same-sex relationships, and debunk myths around sexual assault to men. The chapter on culture and violence examines how to remain sensitive to diversity whilst being willing to ask difficult questions. There is even a chapter on how to recognise and respond to perpetrators of violence.
The disadvantage of reading this book was the uncomfortable sinking feeling I experienced as it exposed the missed opportunities I have encountered in practice. Hopefully, if this book can find its rightful place on the reading lists of undergraduates, trainees, specialists, and all those working in primary care, this can be rectified.
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