April 19, 2014

Clinicians and Gun Violence: What to know and what to do

Clinicians and Gun Violence: What to know and what to do
By Annie Savarese, MD

On December 14, 2012, twenty children and their teachers were murdered at Sandy Hook Elementary.  In January of this year, there were forty-three fatal shootings in Chicago.  In the United States, gun violence is responsible for over 30,000 deaths and over 70,000 injuries every year.  On average, 282 people are shot daily and 50 of them are children or teenagers.

How have the medical and political communities responded to the issue of gun violence?

On January 8, 2013, the American Medical Association, along with more than fifty other medical societies sent a letter to President Obama offering their collective experience and expertise to help with the epidemic of gun violence.  They proposed the need for stricter gun policy, greater mental health access, and more resources for gun safety preventive measures.

On January 16, 2013, the White House published President Obama’s plan to help reduce gun violence, “Now is the time: The President’s plan to protect our children and our communities by reducing gun violence”.

The four pillars of his proposal include:

  1. Closing background check loopholes to keep guns out of dangerous hands
  2. Banning military-style assault weapons and high-capacity magazines, and taking other common-sense steps to reduce gun violence
  3. Making schools safer
  4. Increasing access to mental health services

Christine S. Moyer’s article, “Obama enlists doctors for gun violence prevention” details the President’s proposals as related specifically to clinicians.  Of special note, the President provided:

  1. Clarification that Affordable Care Act does not prohibit physicians from discussing gun safety with patients
  2. Assurance that physicians can report all credible threats of violence to the police without fear of violating the Health Insurance Portability and Accountability Act Privacy Rule
  3. Authorization for the Centers for Disease Control to resume its previously suspended research on gun violence

What can individual clinicians do to help with the issue of gun violence at the patient-provider level?

  • Use violence screening tools
    • GUNS, a mnemonic developed by The Handgun Epidemic Lowering Plan (HELP) to screen for gun safety
      • Is there a Gun in the household in which the patient lives?
      • Does the patient associate with Users of drugs or alcohol?
      • Does the patient feel the Need to protect him or herself?
      • Do any of these Situations exist: being a witness to violence or being involved in violence?
    • EnLiST, a mnemonic developed by The American Academy of Pediatrics for clinical violence prevention and management
      • early nurturing
      • limit-setting
      • screening for risk and assurance of safety
      • treatment of the physical and psychological consequences of violence
    • Since suicide accounts for more gun-related deaths than homicide, patients need to be screened for the following suicide risk factors
      • mental illness
      • substance abuse
      • domestic violence
  • Counsel at-risk patients
  • Report all credible threats of violence to the police
  • Provide resources to gun violence victims

What can individual clinicians do to help with the issue of gun violence on a larger, public health level?

Comments to: asavarese@gmail.com

Annie Savarese, MD is a National Health Service Corps scholar who is currently a second year family medicine resident in the Georgetown University/Providence Hospital Family Medicine Residency Program.

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