Health Care's Role in Reducing Gun Violence

Health Care’s Role in Reducing Gun Violence


Doctors cut through the gun control and mental health debates to do what they do best: keep patients safe

South Florida doctor Heather Sher has seen things no one should ever have to see. As a radiologist in one of the busiest trauma centers in the country for 13 years, she is no stranger to gun injuries. But as one of the attending physicians for victims of the Parkland, Fla. school shooting on Feb. 14, 2018, she was confronted with a CT scan she couldn’t make sense of.

She wrote in The Atlantic, “In a typical handgun injury, which I diagnose almost daily, a bullet leaves a laceration through an organ such as the liver. To a radiologist, it appears as a linear, thin, gray bullet track through the organ.”

But in the young victim she saw that day, there were “only shreds of the organ that had been hit by a bullet from an AR-15,” she wrote. “Nothing was left to repair—and utterly, devastatingly, nothing could be done to fix the problem. The injury was fatal.”

Since the Sandy Hook Elementary School shooting in 2012, where a gunman with an assault rifle killed 20 first graders and six adults, there have been at least 239 school shootings nationwide—averaging about five per month, reported The New York Times. And that doesn’t include other mass shootings, such as the massacre at Las Vegas concert in October 2017 that killed 58 people.

What will it take to cut through the gun control debates and the partisan politics to enact real change at last? Doctors and health care organizations are speaking up. “It’s time we faced facts and did something about the public health crisis of gun violence,” wrote Claire McCarthy, M.D., on the Harvard Health Blog.

Gun control vs. mental health

In the aftermath of the Parkland shooting—just as with other mass shootings—the gun control debate has reached a fever pitch. And in each instance, the focus is shifted away from gun control and onto mental health.

“A reporter asked House Speaker Paul Ryan about gun control, and he replied, ‘As you know, mental health is often a big problem underlying these tragedies,’” reported The Atlantic. And on Feb. 20, Florida’s state legislature voted against considering a ban on AR-15-type rifles, 71 to 36.

ER doctors to politicians: We cannot overlook the fact that the use of deadly AR-15 rifles is the common denominator in many mass shootings.

“If politicians want to back comprehensive mental-health reform, I am all for it,” wrote Dr. Sher. “But the president and Congress should not use this issue as an excuse to deliberately overlook the fact that the use of AR-15 rifles is the common denominator in many mass shootings.”

She continued: “As a doctor, I feel I have a duty to inform the public of what I have learned as I have observed these wounds and cared for these patients. It’s clear to me that AR-15 and other high-velocity weapons, especially when outfitted with a high-capacity magazine, have no place in a civilian’s gun cabinet.”

Retailers are taking action where politicians are not: Walmart and Dick’s Sporting Goods have announced they will no longer sell guns to customers under 21, and both have ended the sale of military-style semi-automatic rifles or “modern sporting rifles” like AR-15s.

“For many reasons, as a country we have struggled to take actions that limit access to guns,” noted Dr. McCarthy. “People kill, gun rights advocates say, not guns. And that is true. But without the guns, especially without guns like the one used in Parkland, they would be killing many fewer people, perhaps none at all. It isn’t just about the people and their mental health problems. It’s also about the guns.”

Doctors pledge to be proactive in talking to patients about guns

Every year, 1,300 children under the age of 18 die from firearm-related injuries and 5,790 are treated for gunshot wounds, according to the medical journal Pediatrics. According to the CDC’s most recent data, there is an average of 96 deaths from firearm violence per day in the U.S. Almost two-thirds of those deaths are suicides.

For a related post, see Bringing Awareness to Doctors’ Mental Health Crisis

In light of these staggering statistics, the idea that doctors could have any impact on the problem may seem impossible. “But there is a critically important and beneficial action that we physicians can take, right now and on our own initiative,” wrote Garen Wintemute, M.D., M.P.H., in the Annals of Internal Medicine. “We need to ask our patients about firearms, counsel them on safe firearm behaviors, and take further action when an imminent hazard is present.”

People who commit firearm violence and people who sustain it often have well-recognized risk factors that doctors can identify and address.

This is not a random attempt at fixing a problem, because to some extent firearm violence can be predicted, according to Dr. Wintemute. “People who commit firearm violence—whether against others or themselves—and people who sustain it often have well-recognized risk factors. What’s more, these factors often bring high-risk individuals into contact with physicians.” Risk factors include abuse of drugs or alcohol, a history of violence (including a suicide attempt), poorly controlled severe mental illness, and an abusive partner.

Dr. Wintemute has called on his fellow doctors to make a commitment to help reduce firearm-related injuries and deaths. The online form where you can make your pledge is available through April 16, 2018. Medscape reported that as of March 1, more than 1,000 physicians had signed on. One wrote: “We can prevent suicides and other firearm injuries and deaths through respectful, nonjudgmental discussions with patients. This is not gun control—it’s helping our patients and their families stay healthy and safe.”

For resources on educating yourself and talking to your patients, the Annals of Internal Medicine has made all of their gun-related content free to the public. And the Massachusetts Medical Society offers a variety of resources for talking to patients about gun safety, including patient education materials and an online CME course.

Do you talk to your patients about gun safety? Why or why not? Tell us in the comments.

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