Violence against Women: A Physician's Guide to Identification and Management
http://www.100md.com
《新英格兰医药杂志》
It has been over a decade since the American Medical Association's Council on Scientific Affairs stated that "the medical community — along with the criminal justice system — is the most likely to see women victims [of abuse] and as such constitutes a frontline of identification and intervention." Now, in the new millennium, the abuse of women remains a major public health problem, health care providers are still the most likely first point of contact between a woman in difficulty and the formal health care system, and books continue to be written to help providers know what to do when they are faced with a patient who may be a victim of abuse.
Liebschutz et al. have brought together a clinically useful and comprehensive guide made up of contributions that are linked across key areas of clinical care — identification, treatment, and ongoing management — with a section that addresses the needs of pregnant women, women with disabilities, women in same-sex relationships, and other special populations. The chapter on the abuse of older women is notable, because this is an area in which both research evidence and guidance for clinicians are sorely lacking. The case vignettes in the final section of the book breathe life into the issues and should prove valuable to clinicians, as should chapter 6, which deals with "self-care" for health care providers who treat victims of abuse.
This book touches on a number of issues related to the abuse of women, from interventions by the law-enforcement and criminal-justice systems to genetic and prenatal testing to end-of-life care. At times, and by necessity, the treatment of such subjects is cursory. For example, analysis of the maltreatment of children (and adult women with a history of maltreatment during childhood and with child abuse and partner abuse in the home) could be the topic of entire books. Other chapters provide basic information to help providers understand the connection between one phenomenon and another, such as the degree of overlap between partner violence and substance abuse, and suggest additional resources for those in need of them. Most important, this guide provides a thorough treatment of not only the physical consequences of abuse but also the mental health sequelae, including, in particular, a chapter on post-traumatic stress disorder.
Perhaps the most significant contributions made by the book are its treatment of the abuse of women as a complex, multidimensional clinical problem and its provision of specific practical suggestions and resources relevant to the continuum of care, from identification to diagnosis, immediate intervention, and long-term management. Many would feel it premature to assume, as these authors do, that all women who come to health care settings should be asked about abuse, whether or not there are clinical indications of violence, but the guidance this book provides for what can be done from the point of disclosure onward is practical and detailed.
Providing a supportive, violence-aware practice environment, using sympathetic and empowering language that is appropriate to each patient, knowing how to conduct a physical examination to confirm sexual assault, and being aware of local services to which women who are abused can be referred may seem to be obvious messages, but they clearly bear repeating if we hope to be able to say in the next decade that the abuse of women is no longer a major public health problem.
C. Nadine Wathen
University of Western Ontario
London, ON N6C 5B1, Canada(Edited by Jane M. Liebsch)
Liebschutz et al. have brought together a clinically useful and comprehensive guide made up of contributions that are linked across key areas of clinical care — identification, treatment, and ongoing management — with a section that addresses the needs of pregnant women, women with disabilities, women in same-sex relationships, and other special populations. The chapter on the abuse of older women is notable, because this is an area in which both research evidence and guidance for clinicians are sorely lacking. The case vignettes in the final section of the book breathe life into the issues and should prove valuable to clinicians, as should chapter 6, which deals with "self-care" for health care providers who treat victims of abuse.
This book touches on a number of issues related to the abuse of women, from interventions by the law-enforcement and criminal-justice systems to genetic and prenatal testing to end-of-life care. At times, and by necessity, the treatment of such subjects is cursory. For example, analysis of the maltreatment of children (and adult women with a history of maltreatment during childhood and with child abuse and partner abuse in the home) could be the topic of entire books. Other chapters provide basic information to help providers understand the connection between one phenomenon and another, such as the degree of overlap between partner violence and substance abuse, and suggest additional resources for those in need of them. Most important, this guide provides a thorough treatment of not only the physical consequences of abuse but also the mental health sequelae, including, in particular, a chapter on post-traumatic stress disorder.
Perhaps the most significant contributions made by the book are its treatment of the abuse of women as a complex, multidimensional clinical problem and its provision of specific practical suggestions and resources relevant to the continuum of care, from identification to diagnosis, immediate intervention, and long-term management. Many would feel it premature to assume, as these authors do, that all women who come to health care settings should be asked about abuse, whether or not there are clinical indications of violence, but the guidance this book provides for what can be done from the point of disclosure onward is practical and detailed.
Providing a supportive, violence-aware practice environment, using sympathetic and empowering language that is appropriate to each patient, knowing how to conduct a physical examination to confirm sexual assault, and being aware of local services to which women who are abused can be referred may seem to be obvious messages, but they clearly bear repeating if we hope to be able to say in the next decade that the abuse of women is no longer a major public health problem.
C. Nadine Wathen
University of Western Ontario
London, ON N6C 5B1, Canada(Edited by Jane M. Liebsch)