Gun violence is focus of Stanford Medicine teach-in

Medical schools are uniquely positioned to teach current and future physicians about the health risks posed by guns, and to study how to reduce gun violence, said Daniel Bernstein, MD, associate dean for education at the School of Medicine, in his opening remarks at a March 14 teach-in on campus addressing gun violence.

“One of the other missions of a medical school is to encourage and foster dialogue,” he said. “There’s no way to move forward on an issue as politically charged as this one without learning how to talk with our colleagues and friends about it.”

The forum included presentations on the epidemiology of gun violence, the financial cost of gun violence, the laws and regulations governing gun ownership in the United States, a trauma surgeon’s perspective on gun injuries, and a pediatrician’s call to action on the issue. Among the highlights:

• Understanding the national gun-violence epidemic requires delving into specifics, said Jahan Fahimi, MD, PhD, assistant clinical professor of emergency medicine at the University of California-San Francisco. “Are we talking injury or death? Homicides or suicides? Black or white? These three [categories], at the very minimum, are needed to get us to a place of understanding the scope of the problem in a more nuanced way,” he said. He showed data indicating that gun deaths among African-Americans are primarily homicides. However, most gun deaths, and the majority of those among white Americans, are suicides.

There are few injuries as violent as those from firearms.

• Stanford trauma surgeon Lisa Knowlton, MD, assistant professor of surgery, spoke about her experiences caring for gunshot victims. “As trauma surgeons, we like to think we are prepared for anything, but there are few injuries as violent as those from firearms,” she said. Knowlton took the audience through the process of assessing and caring for a gunshot victim, enumerating the difficulties of stabilizing these patients and the priorities in trauma surgery for treating gunshot wounds. Patients who survive the initial surgery face “multiple surgeries, prolonged stays in the hospital, complications, loss of work, depression, mental health issues, PTSD; the impact can really be very devastating even if they do manage to leave the hospital alive,” Knowlton said.

• The financial cost of gun injuries can be measured many different ways, with the annual total cost across the country estimated at $174-$229 billion, Stanford medical student Sarabeth Spitzer told the audience. Last year, Spitzer was the lead author of a study of the costs of initial hospitalizations for gun injuries, which totaled $734.6 million per year nationwide. Other costs, such as lost wages or the toll on quality of life following a gunshot injury, are harder to measure, she said. We also need clearer information on who bears the costs, which now typically land on gunshot victims, insurance companies and taxpayers. “The more reliable and transparent the data, the more informed public health decisions can be,” Spitzer said.

Guns don't make families safer

• The United States has an array of gun laws that are not easy to explain or navigate, David Studdert, LLB, ScD, MPH, professor of medicine and of law, told the audience. “Most of these laws do not exist at a federal level,” he said. “A state like California is a national leader in implementing and formulating such laws, while others such as Virginia and Wyoming have virtually none.” He also described 2017 Pew Survey data that show widespread agreement between gun owners and nonowners on several proposed gun control measures, such as expanding background checks to include private gun sales and banning people from carrying concealed guns without a license.

• Pediatrician Michelle Sandberg, MD, of Santa Clara Valley Medical Center, explained how physicians can advocate for gun safety with their patients. Doctors should broach the subject of gun safety from a health perspective, Sandberg said. “Firearm counseling should be nonambiguous and nonjudgmental, like counseling about medication safety or storing poisons,” she said. She also encouraged physicians to promote the ASK campaign, in which parents ask anyone who might be supervising their children, “Is there an unlocked gun where my child plays?”

At the end of the forum, several audience members asked questions about specific measures to reduce gun deaths in the United States. In response, Studdert emphasized the need to change prevailing ideas about firearms. Those with guns in the home are 22 times more likely to injure themselves or a family member than to use it in self-defense. And yet, he said, average gun owners typically have purchased a firearm because they think it keeps their families safer. “The evidence shows that no, it doesn’t, and the best thing we could do would be to convince them otherwise,” Studdert said. “Clinicians clearly have a role to play in that changing of hearts and minds.”