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Protecting our patients: Intervening in the gun debate

Is preventing gun violence really the work of clinicians? Yes, argues first-year Stanford medical student Orly Farber.

Like many, I've been thinking a lot about gun violence. I've been thinking about lives lost and policies never passed, media coverage and copycat acts. I've been thinking about associations with domestic violence and questions of mental health, proposals to ban bump stocks and arm America's teachers.

When I think about these things, my head spins. These issues feel like they're a million miles outside the scope of my work as a medical student. I'm not a politician, I'm not a lobbyist. I don't even have a job. And I wonder, once I do finish school and enter the health care workforce, what role can I even play? Is preventing gun violence really the work of clinicians?

Recently, I resolved for myself, that it is. Even more so, I believe it can be the work of medical students.

Last week I attended one of my favorite classes: The United States of Healthcare. This dinner seminar, organized and taught by second-year students, offers a geographic survey of American health care disparities. We've learned about access to health services for Native Americans in the Bay Area, dug into Medicaid eligibility in Florida, and examined the opioid crisis in Ohio. During last week's class, we heard about gun violence -- across the U.S.

While many people in the medical community readily view gun violence as an epidemic and public health concern, I will admit, I was slow to catch on. The American Medical Association (AMA) began calling it a public health crisis in 2016. But despite my AMA membership, I've struggled with accepting gun violence as a health issue. The connection between guns and health outcomes was clear to me, but the role of the medical community in combating gun violence felt a bit tenuous. I wanted to leave firearm debates to the politicians and lawyers, while I'd pick my battles in more clearly demarcated medical arenas.

But in last week's class, I heard a statistic that changed my perspective: Nearly two-thirds of gun-related deaths are suicides. That means that approximately 21,386 of the 33,000 people who die by gunshot every year in the U.S. do so at their own hands. The vast majority of deaths by firearm are a consequence of a distressed psychiatric state.

If, like me, you're not totally sure how doctors fit into the gun-control debate, then here's an easy starting place: Suicidality is a mental health concern that affects the well-being of our patients. Medical professionals screen for suicidality and are even mandated to report patients who disclose an intent and a plan. Given that the majority of firearm deaths are suicides, then regardless of how you feel about the epidemic framework and regardless of how you feel about the political undercurrents in this debate, gun violence is of concern to clinicians. It is a medical problem.

As a student, I often feel like I'm supposed to be a sponge: I'm here to absorb facts and statistics, to observe a variety of clinical approaches and soak up a range of perspectives. As such, I'm responsible for learning about gun violence alongside anatomy and physiology. Like all medical issues, I have to read about its origins, trace its pathogenesis, and consider interventions. In the future, as a clinician, I'll have to inquire about gun use and counsel my patients on gun safety, just as I will with alcohol or tobacco.

I encourage my classmates and fellow medical and physician assistant students to entertain this framework. As future health care providers, we should all be able to gather in support of preventing the 21,386 lives lost to firearm suicides. Clinicians, working side-by-side with lawmakers, can play a critical role in protecting our patients -- even saving their lives.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Orly Farber is a first-year medical student from Washington D.C. She graduated from UChicago in 2015 and spent the following two years in an allergy lab at the National Institutes of Health. While Orly's heart remains in Chicago, her body is thrilled to be in the Bay Area! She loves running, hiking, rock climbing, baking bread, and tending to her plants -- fully embracing the West Coast lifestyle.

Photo by glukan

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