Darren Taichman, MD, PhD; Sue S. Bornstein, MD; Christine Laine, MD, MPH
Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3207.
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Sarabeth Spitzer, Vishnu Muppala and Abigail Solomon
Stanford School of Medicine, Florida Atlantic University College of Medicine, Tulane University School of Medicine
November 29, 2018
Medical Students Demand Firearm Education
Physicians across the country have responded to the National Rifle Association’s statement that doctors should “stay in their lane” by sharing heart-wrenching stories and images of scrubs soaked with gunshot victims’ blood. In addition, the Annals of Internal Medicine, the American College of Physicians and the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) have responded by announcing a collaboration to increase firearm research[i]. We medical students are grateful for such efforts, but know more must be done. As future physicians, our views span the political spectrum. But, we are unanimous in one belief – we must stop the epidemic of firearm injury and death in the United States. This call does not come from baseless idealists, but rather from impassioned students who understand that firearm violence is a public health crisis that desperately requires intervention. We seek to apply the same approach to firearm safety as the medical community has used to successfully mitigate other public health problems such as motor vehicle accidents and smoking: identifying root causes, conducting population research, and implementing evidence-based changes. As medical students, we rely on our schools’ faculty to prepare us to handle our community’s health challenges. However, although we see victims of firearm violence in emergency rooms, operating rooms and, at worst, the morgue, we are without any formal guidance or training about how to address or prevent this epidemic. In addition to doing research, physicians can counsel their patients directly on the topic of firearm safety and storage. This opportunity uniquely positions doctors to intervene on this tragic public health issue. We come together now to ask the Deans of our medical schools, the developers of our curricula, and all members of our medical community to provide us the education, knowledge and counseling skills regarding firearm safety to properly fulfill our duties as healthcare providers. Immediately, this involves implementing curriculum dedicated to teaching the practical knowledge and patient counseling skills about firearm safety that have shown to be effective in preventing firearm violence.[ii] In the longer term, this requires dedicating appropriate resources to firearm safety research, an area that remains drastically under-studied due to decades of national funding limitations. We call on the medical community now to equip us with the tools we need to live up to the Hippocratic oath we made upon entering this profession. Each of us pledged to “prevent disease whenever I can, as prevention is preferable to cure.” Prevention is not only in our lane- it is our duty.[i] Taichman, Darren, Sue S. Bornstein, and Christine Laine. "Firearm Injury Prevention: AFFIRMing That Doctors Are in Our Lane." Annals of internal medicine (2018).[ii] Wintemute, Garen J. "What you can do to stop firearm violence." Annals of internal medicine 167.12 (2017): 886-887.
R. Chris Jones, M.D.
TriStar Centennial Medical Center
December 11, 2018
Persuasion: Doctors in Their Lane
Persuasion: Doctors in Their LaneThe National Rifle Association (NRA) posted this tweet on November 7, 2018: “Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves.” The post was in response to a position paper from the American College of physicians in the Annals of Internal Medicine regarding reduction in firearm injuries. Not surprisingly, the medical community quickly responded with a flurry of tweets, most of which expressed indignation at being asked to stay out of the gun safety debate. What was surprising, however, was the content and tone of some of the most re-tweeted posts. The following tweet by Judy Melinek M.D. (@drjudymekinek) was either liked or reposted over 700,000 times:“do you have any idea how many bullets I pull out of corpses weekly? This isn't just my lane. It is my [expletive] highway.” The most significant advantage held by physicians in any public policy debate is that we hold the moral high ground. When we employ profanity, exaggeration, or angry tones to make our arguments, we weaken our trust with the citizenry and cede the moral standing granted to us. Our arguments then risk blending with the noise from pundits. Moreover, we need to recognize the power of social media. An angry post by a single physician has the potential to undermine the moral authority for a multitude of our profession. When engaging in policy deliberation, it is paramount that we remember our target audiences. It is easy to direct anger towards a presumed monolithic NRA, but a more effective strategy is to make a case to sympathetic members of the NRA, the public, and policymakers. Gandhi asked his followers to “honor our opponents for the same honesty of purpose and patriotic motive that we claim for ourselves”. Although many physicians are repulsed by the November 7 message from the NRA, the NRA does have physician members. Some of these members may be sympathetic to gun safety initiatives, and could serve as an internal movement to push the NRA towards a different stance. Direct attacks towards the NRA as a whole may only serve to galvanize the organization into further Groupthink mode, and eliminate any chance to obtain internal support. If instead we respond in strong but compassionate terms, we have a chance to find common ground with those with whom we disagree. Despite best efforts, no accord may be possible between gun safety proponents and the NRA. Nevertheless, it is the public and the policy makers that will ultimately effect change in this debate. Both of these groups listen to doctors. We know that people are more likely motivated to action by positive speech than negative. Positive, action-directed messaging by physician groups to these two audience sets may not be as immediately gratifying as an angry tweet, but is much more likely to inspire change of minds, and thus policy. The NRA gave a gift to the physicians who advocate for gun safety. Their inflammatory tweet is a perfect opportunity to educate the public, but to do so using emotion to the advantage of the gun safety position. Physicians are human, and we can be susceptible to anger, but our messaging needs to be smart if we wish to effect societal change.
Michael U. Antonucci, M.D.
Department of Radiology and Radiological Science, Medical University of South Carolina
December 19, 2018
The View from My Lane
With the recent mass-shootings in Thousand Oaks and at the Pittsburgh Tree of Life Synagogue adding to the increasing number of gun-related deaths in the United States, physicians promoting guidelines to reduce firearm-related violence1 have been instructed by the National Rifle Association to “stay in their lane.” This subsequent editorial2 reflects a powerful refusal to be silenced and counters the NRA’s tweet with both strong evidence and common sense. Data released since its publication reveals that 2018 saw a record number of school shootings,3 further clarifying the urgency of the issue. Against this backdrop, and contrary to its initial goal, the NRA’s suggestion has motivated physicians across specialties to examine “their lane” and identify ways to combat escalating gun violence.
As a neuroradiologist, “my lane” traverses behind the scenes. I am spatially removed from patients and indirectly evaluate them through images. While clinical colleagues (directly interacting with patients) typically have a more complete overview of a specific issue, the extent of damage from a bullet is a notable exception. Though I am spared emotional tasks like conveying prognostic information to victims’ families, I have a more vivid first look at the pathology along ballistic trajectories. On clinical exam, superficial skin laceration and hematoma around a scalp entry (and, if present, exit) wound belie the more significant intracranial findings seen on medical imaging. This can include skull and metallic fragments within brain tissue, resultant hemorrhage in and damage to eloquent cortex and white matter tracts, edema, and herniation.
In my lane, the prevalence of gun violence is alarmingly apparent. For example, over a particularly taxing call weekend, with gunshot victims treated by multiple clinical teams, the neuroradiologist interprets imaging of every head, face, and spine impacted by a firearm. Individually, these are not pretty pictures; the collective catalog is devastating.
I do not envy my clinical colleagues who deal with this directly—whose literal blood-soaked hands invoke the ire of the NRA. Nonetheless, my lane affords me with an opportunity and responsibility to share what I see. The accompanying figure (http://annals.org/ImageLibrary/the-view-from-my-lane.jpg) includes imaging from three victims of gun violence. These are only a fraction of the many now indelible in my memory and stored in our imaging archive. They are an objective, unfiltered look at the reality of gun violence in modern medicine and underscore our frustration as we attempt to bandage the wounds of the unfortunate victims who enter our lane.
1. Butkus R, Doherty R, Bornstein SS, for the Health and Public Policy Committee of the American College of Physicians. Reducing Firearm Injuries and Deaths in the United States: A Position Paper From the American College of Physicians. Ann Intern Med. 2018; 169(10):704-707.
2. Taichman D, Bornstein SS, Laine C. Firearm Injury Prevention: AFFIRMing That Doctors Are in Our Lane. Ann Intern Med. [Epub ahead of print] doi: 10.7326/M18-3207.
3. Riedman D, O’Neill D. “CHDS – K-12 School Shooting Database.” Center for Homeland Defense and Security. www.chds.us/ssdb. Accessed December 16, 2018.
January 12, 2019
Ruthless Business people
NRA comment is outrageous.Unfortunately, in USA some businesses have to strong lobbying powers(case of Big Tobacco). We should not cease our efforts to get guns out of homes.
Taichman D, Bornstein SS, Laine C. Firearm Injury Prevention: AFFIRMing That Doctors Are in Our Lane. Ann Intern Med. [Epub ahead of print 20 November 2018]169:885–886. doi: 10.7326/M18-3207
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Published: Ann Intern Med. 2018;169(12):885-886.
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