BOOKS : Domestic violence and health The response of the medical profession By Emma Williamson The Policy Press University of Bristol 220 pages £14. 99

Domestic violence has occurred throughout history. Only since being identified by feminists as a serious social issue in the late 1960s and early 1970s, however, has it been brought to the attention of the wider public. As the author, a Wellcome research fellow in the centre for medical ethics, Bristol University, points out, a body of research then emerged to ascertain the extent, causes and responses to domestic violence, as well as other forms of violence against women.

It is only very recently, though, that research emanating from the UK has focused on the role of healthcare professionals.

Despite Home Office recommendations in 1995 for the implementation of multi-agency professional forums to deal more adequately with the issue of domestic violence - and other international and government impetus encouraging healthcare professionals to address it - research has found them reluctant to be involved in multi-agency initiatives.

And while welcoming the recent Department of Health domestic violence and health resource manual specifically targeting health practitioners, the author feels it is unclear how such information will impact on a profession that has avoided calls for a greater understanding of domestic violence.

The book, based on an in-depth qualitative study to investigate the interaction between a variety of healthcare professionals and women who have experienced domestic violence, examines why health professionals have been reluctant to take action. Ten women who had experienced domestic violence, and 23 primary healthcare practitioners, mainly GPs, health visitors and practice nurses, were interviewed.

The study explores a wide range of issues and addresses specific questions, such as whether domestic violence has undergone a process of medicalisation on the lives of women. One section includes the physical and non-physical injuries domestic violence patients receive, their treatment experiences and their wider experiences of seeking help from other agencies such as the criminal justice system and social services. A second part examines clinicians' knowledge and clinical experience of domestic violence, and part three covers clinicians' training and inter-agency collaboration.

There is sombre reading: for instance, most women assumed their medical records would record years of violence and abuse, which could later be used to prosecute the perpetrator. In practice, most health professionals are reluctant to record this.

Key findings presented in the conclusion are that:

women present to healthcare professionals for the validation of their experiences;

healthcare professionals use cultural myths and stereotypes about women who experience domestic violence;

differentiation was made between identification, documentation and treatment of physical and non-physical injuries;

with women who have domestic violence-related issues;

the existence of a medical hierarchy undermines the potential of health professionals such as health visitors to interact positively domestic violence has not undergone medicalisation and is unlikely to.

This is essential reading for those involved in training all health professionals, for their managers, and for those who remain reluctant to address the issues. If this reluctance extends to reading a whole book on the subject, the excellent summaries at the end of each section provide the key points healthcare professionals need to address to improve the service they offer to women who experience domestic violence.