Doctors advised to discuss gun violence with patients
Doctors need to take a more active role in addressing guns and gun violence with their patients, according to one of the nation's leading medical journals.
That could mean requiring physicians to learn more about firearms or having hospitals and specialty organizations develop continuing education programs on gun safety.
Dr. Garen Wintemute, an emergency department physician at UC Davis Health in Sacramento, Calif., says providers shouldn't wait for mass shootings like the one this month at a Las Vegas music festival where nearly 60 people died and more than 500 others were injured.
"Doctors have a unique role to play because we are in a position to talk to patients about matters affecting their health and safety," said Wintemute, who wrote a commentary published Monday in the Annals of Internal Medicine. In it, he calls for physicians to take an online pledge to discuss firearm safety with their at-risk patients.
"As with any other complex problem the answers won't come if each of us waits for somebody else to take the initiative," Wintemute said, adding that he believes interest has grown within the medical community to find solutions to a problem that has steadily grown in recent years.
Wintemute said there was a time when panel discussions on gun violence as a public health issue would draw audiences so small that a five-person panel would outnumber the audience. "These days those rooms are full," he said. That's not surprising given the rising human toll.
About 25 out of every 100,000 patients visiting ERs between 2006 and 2014 were there for firearm-related injuries, according to a study published this month in Health Affairs. That resulted in more than 700,000 visits during that time period. Those patients cost $2.9 billion in ED charges and $22 billion for inpatient care.
Still, providers have more questions than answers when it comes to how they can help curb the problem. Wintemute said physicians must identify their patients' risk factors and intervene when it's obvious patients could be either victims or perpetrators of gun violence.
While mass shootings receive lots of attention, providers could have a greater impact preventing suicides. An estimated 45% of patients who commit suicide see their primary-care provider within a month of their death.
"The bottom of the iceberg is what's happening with people using guns on themselves or their loved ones," said Dr. Jay Shannon, CEO of the Cook County Health & Hospitals System in Chicago.
Shannon said patient screening can effectively identify substance abuse, a history of violence or poor management of a mental health disorder and how it makes patients prone to gun violence. While he admits that routine screening for these issues currently is not conducted on all patients visiting Cook County health facilities, trauma and behavioral health patients are.
Many physicians are reluctant to discuss gun safety, Wintemute said. One barrier remains the lack of evidence on what intervention strategies are most effective.
The other involves issues of sensitivity and privacy. Earlier this year, a federal appeals court in Florida struck down a state law that barred providers from talking to patients about gun safety. The Republican-controlled state Legislature in Florida and the National Rifle Association said doctors were pushing an anti-gun, anti-Second Amendment agenda. The court ruled that doctors have a constitutional right to have the conversations and that those discussions did not trespass on patients' Second Amendment rights to own guns.
Yet another issue is that many physicians feel they don't know enough about firearms to speak about them intelligently. Wintemute urged doctors to take it upon themselves to learn more, but also advocated for medical specialty organizations and hospitals to develop continuing education programs on gun safety.
"If somebody comes into the emergency department because they've been shot, in addition to addressing the immediate clinical need, a hospital can take on the large question of what they can do to prevent this from happening again," Wintemute said.
Several online resources are available to help start the conversations. The state of Massachusetts, for one, last year posted information on gun-licensing laws and reporting obligations and clinical scenarios to consider. A pamphlet distributed to providers in the state encourages them to talk about gun safety just as they would any other potentially dangerous risk such as alcohol and cigarettes or prescription medications.
An edited version of this story can also be found in Modern Healthcare's Oct. 23 print edition.
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