Sound Off: Health Care Providers Have a Role in Reducing Gun Violence

Physician and gun image courtesy Shutterstock.

By Lee C. Rogers, DPM

In the United States, over 30,000 people die every year from a suicide or homicide caused by a gun. That’s nearly as many as die from pancreatic cancer or automobile accidents.

The gun policy debate has been brought to the front of the national discussion since last weekend when a massacre at an elementary school in Connecticut left 26 dead, of which 20 were children aged 6-7 years. The shooter, barely out of his teenage years himself, used a Bushmaster .223 assault rifle with large capacity magazines. The medical examiner reported that all the children were shot more than once, and in one case 11 times.

The American Academy of Pediatrics identified firearm-related injuries in children and adolescents as an ‘epidemic,’ releasing data highlighting it as one of the leading causes of death in that population. The CDC reported that US children under the age of 15 were 12 times more likely to die from a firearm than children in 25 other industrialized countries combined. The United States ranks eighth on a list of homicide rates by country, just behind Mexico.

Recently, an actuary calculated that gun violence collectively reduced the American life expectancy an average of 103.6 days. But that’s not equally distributed among the races or genders. The average life expectancy for African American males is reduced by 361.5 days as a result of gun violence. Additionally, gun violence costs the US about $100 billion annually, which is equates to the same amount of budget cuts that couldn’t be negotiated by the Congressional super-committee.

No one would argue a health provider’s role in rape prevention or domestic violence prevention. On every visit to my hospital, patients are asked if they feel safe at home. Doctors also discuss automobile safety and sports safety with patients as needed. But somehow providers have been sidelined during the debate on gun violence prevention. The National Rifle Association argues that doctors asking about gun ownership violates a patients’ Second Amendment rights. Some states have even passed laws to prevent doctors from asking about guns at home. The 2011 National Defense Authorization Act (NDAA) prevents military commanders from talking to service members about their personal weapons, even if they are suicidal.

Certainly mental illness is a component to mass murders, suicides and homicides. We need an action plan to better diagnose and treat of mental illness. But having policy to reduce access to deadly weapons is prudent, will save lives, and is a public health concern. Providers need to play a central role in preventing gun violence.

What can we do?

First is advocating for gun policy changes just as we have for smoking bans, helmet laws, and sports safety rules. A mass killing of 20 school children has caused enough public outrage to change the dialogue on gun control in the US.

Meaningful reforms start with a ban on assault weapons. No one needs an M-16 for self-protection or hunting. These are instruments of war. Just as we wouldn’t stand for landmines on our streets, we should not allow assault rifles in our neighborhoods. A ban on high capacity magazines will prevent a gunman from shooting 100 bullets without reloading. If we limit magazines to 10 bullets, which should be sufficient to protect yourself against a home invader or hunt a deer, we give people a fighting chance in future episodes of mass shootings.

Require 100% background checks on all gun transfers, commercial or private. This means closing the gun show loophole and requiring private sellers to use a broker or some other method to ensure the buyer can own a gun. As health care providers, we know that the severity of mental illnesses in a patient may wax and wane, but we need to create a federal definition of serious mental illness and exempt HIPAA compliance for reporting these to a national database.

During the treatment of mental illness, providers should ask about firearms in the house. We should counsel families to lock up the gun and trigger. In cases where a patient is at risk of performing self-harm, we should know where they can take the firearm to be deposited while their illness is being treated.

First person shooter video games are violent and desensitize individuals to killing. While a sane person knows fantasy from reality, a person with mental illness or children may not. We should advise caregivers not to allow these individuals to play these games.

I grew up in the Midwest where hunting and gun use was a part of our culture. If you haven’t been exposed to that, go sport shooting at a shooting range with an instructor so you can better understand gun safety and usage. You can place information about gun safety in your waiting room or on the wall in exam rooms.

Also, as a measure of personal safety, your clinic or hospital should have an action plan if faced with an individual with a gun. This is not an uncommon occurrence in hospitals. Assailants may be looking for drugs or to harm a provider or patient. You should have regular drills on what to do.

Health care providers do have a role in preventing gun violence, but it’s up to us if we choose to play that role. I argue that a trauma that cuts short the lives of 30,000 adults and children annually needs urgent action. While critics argue we’ll never be able to prevent all gun-related deaths, that is a poor excuse for not acting to prevent some of them.

Dr. Rogers is a podiatrist and health policy expert. He was a candidate for US Congress in 2012 in California. His SDN username is diabeticfootdr. The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions of The Student Doctor Network or Coastal Research Group.

1. http://pediatrics.aappublications.or…105/4/888.full
2. http://www.cdc.gov/MMWR/preview/mmwrhtml/00046149.htm
3. http://www.nationmaster.com/graph/cr…er-100-000-pop
4. http://knowledge.wharton.upenn.edu/a…articleid=1214

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26 Responses to “Sound Off: Health Care Providers Have a Role in Reducing Gun Violence”

  1. Reason says:

    You argue here for the position that civilians should not have access to M-16s, a fully automatic select-fire assault rifle which has to my knowledge been only used in 2 cases of murder ever and one was by a police officer. An M-16 was not used in this case, an AR-15 was, and they are very different guns. Many Americans believe that the second amendment gives citizens the right to purchase and own some types of military weaponry to protect from a tyrannical government or a police state. It’s what the amendment is designed to do.

    What we can do is focus on providing better mental health care as physicians and including discussion about firearm safety, becoming a society where mental health is not stigmatized, and making sure that we all have the right to defend ourselves. My clinic has an action plan to deal with facing an individual with a gun – we’re armed.

  2. Physician/Gun Owner says:

    I completely agree with Reason above. We as physicians, with high education levels need to resist the urge for knee-jerk gun-control policies. As is the case with the vast majority of gun crimes, this individual did not acquire his weapons legally, he murdered his mother to acquire them. I truly believe that such a terrorist (notice that I didn’t say sick or mentally-ill which portrays him as a victim or a patient when he is in reality no different than other terrorists) would have inflicted just as much damage and killing even if there wasn’t a single firearm in the US. He likely would have devised a bomb or hijacked a plane or some other means of inflicting his terror. Thats what terrorists have done for years. Please do not demonize individuals with manageable mental health issues by labeling this terrorist as one of them. Also please resist the urge to do the same for gun owners, many of whom do feel that it is appropriate for citizens to own AR-15 rifles for legitimate uses, one of which is to protect you and your family should such a situation arise. Not to mention that this right is guaranteed to us by the second amendment. As was said above, arming yourself in your clinic as well as arming responsible teachers, principles or school guards, just as we arm pilots is a more reasonable response to such a terrorist attack.

  3. Randall Sexton says:

    I keep hearing the media refer to “Assualt rifles” as poster above says. An assualt rife was not used in the CT school shooting. Hell, you’d think the media would look up what an assualt rifle is. I have a .22 cal rifle and 7 magazines with 25 round capacity. It’s a lot easier to target shoot due to my finger injuries rather than reloading a 10 round mag every few seconds.

  4. Lee Rogers says:

    The M-16 is an AR-15, yes it is a select fire weapon, but it is in the same class ( http://en.wikipedia.org/wiki/AR-15 ). It doesn’t matter what your definition of an assault weapon is or what mine is. Any federal law will be specific and it should be expected that the Bushmaster .223 would be included.

    What I find surprising is that all of you above are posting more from the perspective of an NRA attorney, than a physician. This is an object that kills 30,000 people every year. Any object that leads to that many deaths needs to be address. So yes, that’s cars, that’s smoking, that’s asbestos, and it’s guns.

    In District of Columbia vs. Heller, when the SCOTUS overturned the handgun ban in DC, Conservative Supreme Court Justice Antonin Scalia wrote the opinion for the majority. In that opinion he said the rights under the Second Amendment are not unlimited. He wrote that the government has the power to set conditions and qualifications on the manufacture and sale of firearms and prohibit dangerous and unusual weapons.

  5. Johndr says:

    My office asks all new patients if they have unsecured guns in the home. It’s just another social health question like bike helmets or domestic safety. My office also has an action plan: it’s a .380 pistol lawfully concealed beneath my jacket.

  6. Tony B says:

    The argument for or against specific weapons is moot. With the number of available weapons on the legal and black market, no gun control law is going to put the assault rifle or automatic weapon genie back in the bottle. It’s naive and an exercise in frustration to continue to consider it.

    Second, concealed or open carry should be available to all responsible citizens. (Criminals are already carrying.) Further, preventing concealed carry on school grounds, military bases, etc makes those locations soft-targets for people bent on mass violence (reference Fort Hood, any number of school attacks).

    Where should this argument be focused? On proper funding of mental health services and reducing our societal addiction to violence.

    We can look north for a good example. Canadian citizens enjoy their guns as much as Americans. They can own all sorts of weapons (including assault rifles) yet have nowhere near the weapon violence. Why? First, they treat and monitor their mentally ill thanks to national healthcare programs. Second, their local and national media don’t make every murder and crime a top local-news story — because it isn’t. It makes for easy and sensational reporting, but it’s not news that some gang member shot another guy in the ghetto. News is something that is noteworthy, it potentially affects many people — one gang member shooting another is neither a surprise nor should be be considered news.

    The US should consider returning serious funding for mental health services and reopen institutions for those who cannot be rehabilitated. With the amount of oversight independent NGOs and others would put on institutions, it would be unlikely there would be abuses or wards reminiscent of “One Flew Over the Cuckoos Nest.”

    Last, I do want to make sure people don’t gloss-over facts — the AR15, XM15, M4 and M16 are all assault rifles. The M16 is an infantry rifle based on the AR15 design. XM15 and M4 carbines are very similar in operation and effectiveness. To an unfamiliar shooter, they can look exactly the same. The M4 has minor modifications to make it an infantry weapon (do a Google search). To say the shooter in CT didn’t use an assault rifle is obscuring facts and doesn’t help the argument. He used an XM15 to kill most if not all of the victims.

    To argue the ‘legitimate use’ of the XM15 for self-defense is silly and weakens any rebuttal or argument for assault rifles. Except in extreme cases (think Zombie apocalypse) you’re better off with a handgun or shotgun for home or personal defense. Let’s be straight-up — an XM15 or M4 is fun to shoot. Just like it’s fun to own a sports car — it’s not practical or necessary — but it’s a lot of fun.

    • Randall Sexton says:

      In my opinion an assault rifle is fully automatic, at least it was when I was firing one. An M-16 geared down to one shot per trigger pull is not an assault rifle, at least not one I’d want. Hell, you can get almost any caliber, including .22 cal, that looks like an assault rifle.

      • Tony B says:

        The M16 and M4 have a 3-round burst mode, but no full-auto (eg: hold the trigger and empty the magazine). The burst mode is rarely used in combat. Best to stick with common definition of an assault rifle which can be found using Google or Wikipedia.

    • Randall Sexton says:

      Negative. I’ve emptied many an M-16 mag on fully automatic. Never used an M14 but the M14A1 is also fully automatic. I’ll double check to see if anything has changed when I go back to work Monday since I’m a military contractor.

    • John Smith says:

      No. AR-15 are not fully-automatic assault rifles. Semantics matter here and the strict use of the words “assault rife” in the law is to mean more than one round is fired with each trigger pull. Just because they look like M16 and M4 does not make them as capable as the latter two.

  7. Think Foryourself says:

    Dr. Rogers undoubtedly went through years of primary school, middle school, high school, undergrad, and doctoral education. I would like to assume that during this education he learned that is unwise to regurgitate information, both at a personal level an public level, without first confirming that said information was factual. As stated above, M-16 rifles have only been used in two murders in this country, one by an officer. While looks are similar, function is not.

    Additionally, I would like to enquires how the arbitrary number of a 10 round maximum capacity magazine was chosen. Has there been any research that shows this is the top end of shots fired in self defense situations? Has there been any reduction of gun crime in states that taken it upon themselves to limit their very own citizens?

    Dr Rogers, I would furthermore like to ask how your extensive education failed you on your very narrow interpretation of the 2nd Amendment.

    Maybe instead of lecturing, hope back in the student seat.

  8. LiberalNonsense says:

    Do some research instead of regurgitation liberal media spin. Gun bans have failed everywhere they have been implemented. All they do is take guns out of law abiding citizens hands and give criminals who will always be able to get their weapons on the black market carte blance to terrorize the rest of the population. In the first years after the UK gun ban in 1996 gun-related violence almost doubled and is only increasing. Are the citizens of the UK any safer from gun crimes? Nope. Our forefathers fought against TYRANNY with GUNS to liberate and establish this country. Remember that before you spout off about the 2nd amendment about hunting and home defense.

  9. Croooz says:

    Why not title it, “Doctors have a role in reducing the number of individuals who use guns to terrorize and kill”? Well because then it would be clear from the title that that role belongs to police officers not physicians. It is just empty rhetoric to point to the object as the problem and not the individual and then assume that physicians have some role. The only role I see is for the physician to be armed to protect themselves and their patients.

  10. Wesley Buckle says:

    The second amendment was written during a time when muskets with single shots and gun powder were the available guns of choice. Not high-velocity assault rivals and pistols with extremely high rates of fire. I think if the founders saw what civilians were able to get their hands on today due to our loose interpretations of their amendmant (which was intended for militias, not civilians) they would be mortified.

    We need to stop being afraid of adapting our “laws of the land” to the changing times. The second amendment, constitution, and the bill of rights are no different. It’s 2012.. not 1791.

    And I don’t know about you, but I do not want to be living in a real-world video game for the rest of my life. It is rediculous to say that physicians or teachers should be armed while on the job. More guns = more murder. Look at every other modernized nation in the world for evidence.

    This logic is no different than what is happening on many college campuses (and our society in general) today when we teach people how NOT to be raped as opposed to teaching people not to rape. It doesn’t address the root problem and will therefore continue to happen.

    • Jack says:

      What about Canada? They’ve got assault rifles.

      • John Smith says:

        So does the U.S. In either case, fully automatic rifles are outrageously expensive, costing over $20,000.

      • Wesley Buckle says:

        And they have FAR fewer assault rifles floating around simply because the process to obtain one is extremely arduous. It is easier to get a gun in this country than a drivers license (!!!). Our laws and policies lack any sort of consistency, especially those related to civilian gun acquisition. I have lived in several countries in Scandinavia where it is nearly impossible for ordinary citizens to get a hold of the weapons Americans are able to and as a result, their country and people are much safer for it. Every time a massacre would happen in the States while I was abroad, my Scandinavian friends would be appalled at how preventable incidents like those were. Of course, there needs to be a significant increase in mental health funding in this country and a large cultural shift in attitudes towards mental illness as well to supplement. But even when our country is at its best in terms of trying to crack down on these massacres, it is still mute in comparison to the steps other industrialized nations take to reduce the chances of incidences like Sandy Hook from happening again (and they rarely do). The world is appalled at our nations inability to tackle problems such as this and it is a slap in the face to those of repeatedly become victims of this type of carnage. Our country has become to desensitized to violence and gun violence specifically. Believe me. I’ve lived in New Orleans where this happens DAILY and no one even bats an eye simply because it is so common.

    • Think Foryourself says:

      What, pray tell, was the reason behind the 2nd Amendment again? And why do you think that concept outdated?

    • John Smith says:

      Not true. Germany has fairly lax laws as well but their gun-related crime rate is pretty low from what I know. Gun sales have been increasing inversely with crime rate in the US. Obviously, you cannot prove there to a causal relationship but it does disagree with you said about there being fewer incidence of violet crimes if there were fewer guns.

    • Michael W. says:

      I feel the reality is quite the opposite. Our founding fathers saw firearms ownership as a defense against tyrannical governments. By virtue of the fact that our “potential” oppressors have updated their weaponry, in order to maintain a formidable force, the citizenry must do the same.
      The framers of The Constitution were a lot smarter than most give them credit for. There is a reason that they use the term “arms” and not muskets, muzzle loaders, or single shot rifles. Their wording intentionally allows for technological advancements.

  11. John Smith says:

    If we’re going to have handguns and rifles be as available and accessible as they are now, I’d prefer more randomnized people start owning and carrying guns. Hopefully, we can assume that most people are good people and that this hypothetical population of responsible gun owners would create a form of herd immunity that protects and buffers the rest of the population against the few violent instigators. However, if the restrictions are this lax without a large population of participants, you could never achieve the sense of security offered by the second amendment against domestic violence.

  12. Michael W. says:

    Advocating for the reduction of gun violence does not necessarily mean gun control. There are many more significant underlying issues at work here. Crying for gun control is an easy way out for a group that doesn’t want to deal with the more complex issues.
    To see what I mean, one has to look no further than US child abuse statistics. Per UNICEF, we abuse and neglect our children to their deaths at a rate of twice or more higher than our civilized European counterparts. This suggests that maybe our penchant for violence is caused by something other than an availability of firearms.

    Furthermore, and most importantly, our right to ride helmet free, hit a defenseless receivers and smoke are not explicitly protected by the Bill of Rights.

  13. adam says:

    Exactly what we needed….another clueless person writing an article straight out of their rear end.

    The problem with the assault weapons ban of the 90s is that it is actually very difficult to define an “assault rifle” and that ban had ridiculously arbitrary language. You also have to realize that these “assault weapons” represent a tiny fraction of all homicides.

    First person shooters have also been a popular political target by clueless politicians. The evidence is just not there. Do some research PLEASE.

  14. Bill says:

    Articles like this are just what the idiot media spews. It is puzzling why someone with so much education wouldn’t have researched the topic better or consulted an expert.

    Why ban the scary semi-automatic assault weapons but still allow semi-automatic handguns (aka 90+% of handguns)? They both do the same damage at close range. While the ‘assault’ weapon is likely a rifle and is more accurate at a greater distance they are both very lethal at close distance.

    If you are going to ban semi-automatic weapons, then about 200 million guns need to be turned in.

  15. Lee Rogers says:

    Follow up: The New England Journal of Medicine published a Perspective this week on “Preventing gun deaths in children” and emphasize many of these common-sense reforms. http://www.nejm.org/doi/full/10.1056/NEJMp1215606?query=featured_home