Can health professionals help their patients deal with guns?
Brown University
 |
| Lotsa luck with this guy |
Health care professionals could help reduce the toll, but only about 20% receive any education on their role in firearm injury prevention.
With a goal of changing that, a consortium of scientists, physicians and educators from across the country—a significant number of whom are firearm owners—established new guidelines on educational priorities regarding firearm injury prevention training for health care professionals.
The guidelines were
published this month in the journal Academic Medicine.
“Our job as clinicians is to help patients stay healthy,” said Dr. Megan Ranney, a Brown University professor of emergency medicine who was the senior author on the study and served as a mentor and advisor on the project.
“We ask and
counsel about a lot of things ranging from diet to smoking to seat belts to
pool safety. Yet study after study has shown that we do not do that for firearm
injury.”
When providers have thoughtful, culturally competent conversations with patients and families about firearms, Ranney said, they can change behavior to increase safety.
Research shows that after a conversation with a pediatrician about
firearm injury prevention, parents are more likely to store guns safely, for
example; another study showed that violence intervention programs can help
reduce injuries among young trauma patients admitted to hospital after
shootings or stabbings.
The
problem is that these conversations aren’t happening, the researchers say.
“In many cases, physicians haven’t felt comfortable talking about firearms with patients because it’s been viewed as a divisive subject,” said Katherine Hoops, a study author and assistant professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine.
“We set out to change
that by being the first to create standards for undergraduate, graduate and
continuing medical education, so clinicians and educators have a foundation
from which they can develop educational programming for their learners.”
In
April 2019, Hoops and Jahan Fahimi, associate professor of emergency medicine
at the University of California San Francisco, with guidance from Ranney,
convened a diverse group of 33 experts in medicine, nursing and public health from
academic institutions across the country to create a comprehensive and
adaptable framework for firearm injury education. The group included firearm
owners as well as former members of the military, Ranney said.
The
group outlined seven categories previously identified in medical research as
priorities, including a general category with priorities applicable to all
types of gun-related injuries, and six specific categories focused on intimate
partner violence, peer violence, mass violence, suicide and unintentional
injury.
As
examples, according to the researchers, clinicians should know the frequency,
patterns and risk factors for fatal and non-fatal firearm injury, including
suicide and suicide attempts; understand firearm access, possession, ownership,
transfer and use; and be familiar with basic types of firearms and ammunition.
They also should be able to provide counseling about firearm injury prevention
— such as safe gun storage — to their patients and understand how to escalate
concerns for patients who may be at risk.
This
isn’t an anti-firearms set of objectives, Ranney said, but a harm-reduction set
of objectives. While the vast majority of firearm ownership is tied to beliefs
and practices around gun safety, she added, there are certain situations,
practices and societal factors that elevate risk.
“These
guidelines are about teaching medical professionals how to identify those
gradations of risk and how to act appropriately to lower them,” Ranney said.
“The conversation around gun safety is similar to how I talk to patients about
car seats. I counsel them on how to safely put their child in the seat, but I
don’t tell them how to drive.”
Fahimi
said the authors hope that the educational framework will fundamentally change
how physicians talk about violence in their practices: “It’s engaging with
patients, talking about their experiences, helping them understand the risk of
injury, and ultimately preventing injuries and saving lives.”
The
study was funded by AFFIRM,
a non-partisan nonprofit co-founded by Ranney and dedicated to creating a
public health approach to firearm injury prevention.
