The gloves appear to be coming off when it comes to doctors talking about guns.
Just a few weeks after a social media dust-up in which the National Rifle Association told doctors in a tweet to "stay in their lane" when addressing the politically charged issue of guns, an editorial response in the Annals of Internal Medicine issued a direct challenge back.
In short, it said: "Doctors are in our lane." The editorial also announced a collaboration with the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM) to fund new research supporting new practice recommendations.
The back-and-forth is just the latest example of changing perspectives in the once reluctant medical community to redefine its role in advocating for policies related to public health in the wake of high-profile mass shootings. The editorial was released the same evening a gunman killed three people inside Chicago's Mercy hospital before shooting himself and another man shot multiple people in downtown Denver.
Following the NRA's tweet, a number of doctors and nurses took to social media in numbers, some posting graphic images of bloodied scrubs from responding to gunshot wounds, to declare the subject squarely within their sphere of interest.
Amid the pushback, providers and affiliate organizations have begun to provide both a broader definition of their lane and where gun violence fits within it.
Daniel T. Wu, M.D., associate professor of emergency medicine at Emory University and chief medical information officer for Grady Health System, has been studying violence of all kinds as a public health issue. His team helped chart community hot spots in Georgia where violent crimes slipped under the radar because the vast majority of them never got reported to police.
Dr. Wu’s study places gun violence along a broader continuum of all types of violence, much of which—unlike high-profile incidents involving firearms—occurs invisibly to most of society. He says acting as the only point of contact between many victims and any type of formal social support gives doctors and nurses a unique perspective on both the breadth of the problem and the difficulties involved in coordinating solutions across organizations capable of influencing outcomes.
That imperative to help forces doctors out of roles that used to be much more narrowly defined, Wu said. When it comes to relatively silent, pervasive issues like human trafficking, domestic violence or elder abuse, episodic care of symptoms isn’t enough.
“If you don’t ask the questions, you’re not solving the problem, you’re just treating the outcome,” Wu said.
That means extra work for hospital staff, but when Dr. Wu surveyed his team, he found they bought in readily: Over 90% responded that they saw the extra work as part of their core mission of making their patients safer over the long run, rather than simply patching up their injuries and turning them loose.
“Our patients are presenting to healthcare systems in crisis," said Stephen Hargarten, M.D., director of the Comprehensive Injury Center at the Medical College of Wisconsin. He was speaking at an event hosted by the American Hospital Association and Kaiser Permanente at the National Academy of Science in October to examine how to organize a public health response to the threat of gun violence and firearm injuries. "We need to do a better job as health systems to affect this major problem."
As outrage turns to action, the next step in channeling provider engagement into durable results appears to lie in a spate of new research into various areas of interface between gun violence and public health. Efforts include a new website from the University of Michigan concerning children and firearm safety and Kaiser Permanente’s recent $2 million investment in academic research.