Physi­cians are as­sess­ing their role in curb­ing gun vi­o­lence

Modern Healthcare - - NEWS - By Steven Ross John­son

The preva­lence of firearm in­juries that plague the na­tion has spurred some physi­cians to call on their col­leagues to be­come louder ad­vo­cates for gun safety.

In a com­men­tary in last week’s An­nals of In­ter­nal Medicine, Dr. Garen Win­te­mute, an emer­gency depart­ment physi­cian at UC Davis Health in Sacra­mento, Calif., said physi­cians need to coun­sel pa­tients about firearm be­hav­iors and take ac­tion to try and re­duce the risk of in­jury. That could mean re­quir­ing physi­cians to learn more about firearms or hav­ing hos­pi­tals and spe­cialty or­ga­ni­za­tions de­velop con­tin­u­ing ed­u­ca­tion pro­grams on gun safety.

“Doc­tors have a unique role to play be­cause we are in a po­si­tion to talk to pa­tients about mat­ters af­fect­ing their health and safety,” Win­te­mute said. His com­men­tary called for physi­cians to take an on­line pledge to dis­cuss firearms 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,” he said, adding that he be­lieves in­ter­est has grown in the med­i­cal com­mu­nity to find so­lu­tions to a prob­lem that has grown steadily 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 emer­gency depart­ment vis­its—roughly 700,000 pa­tients—be­tween 2006 and 2014 were for firearm-re­lated in­juries, ac­cord­ing to a study pub­lished ear­lier this month in Health Af­fairs. 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 like the one this month at a Las Vegas mu­sic fes­ti­val where nearly 60 peo­ple died and more than 500 oth­ers were in­jured gar­ner the most 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, the as­sess­ments are done for trauma and be­hav­ioral health pa­tients.

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 Florida Leg­is­la­ture 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 be­lieve 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 around the state to providers en­cour­ages them to talk about gun safety just as they would any other po­ten­tially dan­ger­ous risk such as al­co­hol, cig­a­rettes or pre­scrip­tion med­i­ca­tions.

“Doc­tors have a unique role to play be­cause we are in a po­si­tion to talk to pa­tients about mat­ters af­fect­ing their health and safety.” Dr. Garen Win­te­mute ED physi­cian UC Davis Health

UC DAVIS HEALTH

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