The American College of Physicians has just released a survey covering attitudes of its members towards gun violence. This was the second survey conducted by the ACP on medical attitudes towards guns, the previous having been published in 1998. In the earlier survey, while 90% of the respondents believed gun violence to be a public health issue, less than 20% stated that they engaged in prevention counseling with patients. The feedback from the most recent survey was similar; most physicians consider gun violence an even bigger medical problem than they did previously, but a majority still do not consider themselves willing or able to intervene with patients who present evidence of being at risk for violent behavior with guns. In fact, three-quarters of the respondents said there was a need for more education of physicians to help them counsel patients in firearm injury prevention.
The survey results reported by the ACP are similar to feedback from other medical specialists. In 2013 The American College of Emergency Physicians also published a survey on how emergency physicians felt about gun violence patients and, like the ACP, found that the vast majority of emergency physicians had never been formally trained regarding firearm safety counseling and did not believe that patients would see them as credible sources for gun counseling.
Gun violence appears to be the one public health issue for which physicians have not developed very clear guidelines for counseling and/or treatment. In fact, there is no medical agency or association that has even issued a protocol for identifying patients who might be at risk for gun violence, either as perpetrators or victims. While we know everything about gun violence victims after they are shot, physicians do not have the knowledge to appropriately intervene before the violence takes place. Lacking the kinds of treatment guidelines that exist for other public health issues like obesity, smoking or substance abuse, physicians are forced to pretend that gun violence as a clinical issue doesn’t exist.
The ACP survey was followed by a Policy Position Paper in which the organization listed nine recommendations to help prevent gun violence and only the first two recommendations covered practice and counseling methods for physicians to follow in treating patients. The other seven recommendations covered the usual legal/legislative solutions that have been advanced by every advocacy group that promotes policy initiatives to reduce gun violence.
Everyone should debate and support common-sense legal and legislative solutions to the problem of gun violence, but you don’t need four years of medical school followed by an internship and a residency to figure out how to advocate against guns. What physicians should and must bring to the debate is exactly what they are not doing now, namely, using their unique skills and their equally-unique relationships with patients to deal with gun violence as a medical issue for which interventional counseling might yield significant results.
In a paper published last year, Shannon Fratteroli and colleagues pointed out that the greatest value of joining advocacy to medical treatment in discussions about gun violence is the fact that physicians are trained to communicate with patients about fear, they are “accustomed to helping people manage their fear of disease and death.” As so much of the current gun debate is generated by fear – fear of crime, fear of violence, fear of government – physicians should bring their clinical experiences in managing fear to this debate and thus provide patients with sound and effective alternatives to using a gun.