Approaching Gun Violence in the Clinical Setting: A New Paradigm?
Firearm ownership and gun violence in the United States are controversial subjects that become a hot topic of conversation after an incident is reported by the media. Whether the incident is known or suspected terrorism, a mass shooting, or a period of unusual violence in a major American city, the incident usually triggers a common set of responses from politicians, media pundits, relatives of the victims, medical professionals and the National Rifle Association.
Federal, state and local measures have been proposed, and some already are in place, to assure responsible access to firearm purchase, ownership and/or use. Nevertheless, the incidence of gun violence remains a significant challenge, particularly in certain areas of our country, such as some inner cities. Physicians often are on the front lines of the early response to these incidents, and have an opportunity to identify at-risk populations in less acute settings.
Emergency physicians Marian Betz, MD, MPH, an associate professor of emergency medicine at the University of Colorado School of Medicine, and Megan Ranney, MD, MPH, associate professor of emergency medicine at the Warren Alpert Medical School of Brown University, recently delivered a compelling presentation at American Medical Association’s State Legislative Strategy Conference in Amelia Island, Fla. The physicians advocated for more active involvement and intervention by physicians to potentially reduce the incidence of gun violence, citing a multitude of statistics that quantify the extent of gun violence beyond the headline-inducing events noted above. In fact, the majority of deaths due to firearms are not due to terrorism, mass shootings or tensions during long, hot weekends in large cities; the individuals most likely to die from firearm abuse are white males, most frequently due to suicide, according to their research.
Drs. Betz and Ranney believe if physicians take relatively simple measures with at-risk populations to prevent gun violence, the approach might have the same success as efforts to reduce morbidity and mortality from public health issues such as automobile accidents, smoking, heart disease, diabetes and HIV/AIDS. Efforts would target a variety of groups, such as firearm owners (especially those with children), adults and children who live in areas with above-average incidence of gun or gang violence, and individuals with evidence of depression and/or at risk for harming themselves or others (hopefully with involvement by family members and/or responsible parties).
Last June, the American Medical Association adopted a policy declaring gun violence a public health crisis that demands a comprehensive response, including research. Given the dynamics and variety of opinions on gun ownership and the Second Amendment in this country driven by the political and cultural divide and fueled by the media, perhaps the medical profession can lead the way in fostering an approach that focuses on reducing the incidence of gun violence and reducing morbidity and mortality. Such an approach must be apolitical and focus on the needs of the patient as well as the community. It should use a sensitive and compassionate approach that fosters safety and common sense, in conjunction with family and mental health professional support, without threatening to forcefully and permanently reduce or eliminate an individual’s right to firearm ownership.
Clinicians will need to take into account that the history of exposure to violence, potential for harm, access to firearms, experience and risk of individuals with whom such discussions will occur will be wide-ranging. At-risk individuals can include anyone from the innocent child and parent who live in a gang-infested inner city neighborhood to the woman who purchased a handgun and obtained her concealed carry permit – with minimal training and practice - for self-protection to the older white male professional who shoots recreationally but is undergoing marital and/or professional stress and the individual who has obtained advanced training on firearm safety, use, maintenance, storage and laws.
How will clinicians respond to this concept of active intervention when the risk of gun violence is evident during a clinical encounter? The answer will be wide-ranging and likely depend upon a variety of factors, such as state of residence, opinion about firearm ownership, political views, and professional and personal experiences with violence, including gun violence.
Time will tell how this initiative will unfold, but physicians and other healthcare professionals have a duty to do and advocate for what is in the best interests of our patients’ health and welfare. Our support for a common sense, patient-focused approach can lead the way to a safer country and fewer fatalities.
Rebecca Parker, MD, FACEP, is a practicing attending emergency physician at Vista Health in Waukegan, Illinois. She also serves as senior vice president of practice and payment integration for Envision Healthcare and executive vice president for leadership development and education for EmCare. Dr. Parker serves as president of the American College of Emergency Physicians (ACEP).