Reminiscing on the Etta James hit “At Last,” that’s exactly how I felt when Steven J. Stack, MD, president of the American Medical Association, addressed the epidemic of gun violence in our nation. Finally he hit the nail on the head, and called the situation what it really was: a public health crisis.
I have long pondered and wrestled with what the medical community is doing about this evil that has befallen our era. Moving to Chicago ten months ago, my family’s biggest concern was the weather, which I quickly rebuffed; a trip down to North Face would settle that. My mind was fixed on starting my clinical rotations, after laboring to get the USMLE Step 1 out of the way. One thing Mike and Molly failed to point out was the gun-craze of the city — that, I had to find out on my own, watching numerous patients roll into the ED, not by sitting behind five seasons of a TV comedy.
In my quest for an answer, I attended a Black Nurses town hall session on gun violence, with the hope of finding an answer on how the medical community is addressing the situation. Multiple active and retired nurses came up and spoke, but none gave me what I wanted. Then a rehab physician came up, and although she didn’t quite answer my question, she pointed me in the right direction. She echoed the same words the AMA president said, “…the United States faces a public health crisis of gun violence.” That phrase rang bells and alarms in my head, public health, where have I heard that? HIV, TB, STI, bacterial meningitis, Ebola, Zika, that’s it! And what do they all have in common? Screening. We screen, screen and then quarantine.
Another phrase I picked up from the meeting was “If it takes a village to raise a child, then it also takes a village to stop gun violence.” Big kudos to the Democrats of the Senate, taking a stand or better still a “sit-in” on the matter and contravening the rules, just to make sure their sons, daughters, relatives and friends don’t become part of the mounting statistic. They are fighting the way they know how to, using the weapons in their arsenal. Everyone has to battle with their individual weapons of choice, mothers with words, pastors with their pulpits, law enforcement with the penitentiary –– everyone has a role to play.
So, my question to the medical community is, what weapons are we going to use to screen? We have taken an oath to heal, provide succor to our society, so what are we drawing from the armory? I’m sure if Dr. Stack could reply, he would say the same thing that I propose: history taking and physical exam. History taking as we were taught in medical school gives the majority of the diagnosis before doing any imaging studies or lab tests.
I believe as health care professionals, in addition to other training we receive, we should also be briefed on how to spot a patient with possible gang related activity, or those with potential of carrying out hate crimes, homicides in society. Yes, this sounds vague at first, but I believe there’s a pattern or some similarity within this sect of patients. A retrospective study should be carried out to study the behavioral tendencies of these patients, their responses, demeanor, appearance, judgment and insight. I have been told that this translates to profiling of the patient which is not ethical, but then my question is, “What is profiling?” and when have we not carried it out? We are taught to notice when our patients are avoiding eye contact, or have unexplained marks, scalds, burns and bruises. Beyond the physical, we learn how to decipher if our patient is a victim of emotional or psychological abuse, so why can’t we apply the same approach to this gun-violence epidemic befalling our nation?
I see no reason why questions like, “Oh, I see you have a mole on your lower back, has it always been there or is this new? Is it getting bigger or is it the same size? How about this tattoo? I didn’t see it the last time, when did you get it? Where? What does it mean? Any life changes since your last visit? Any stress at home or work? What has been your response? How do you protect yourself in times of danger?” can’t be part of our routine doctor-patient office encounter. If we are so comfortable asking patients about their sexual practices, why can’t we ask about their associations, companions and opinions?
Like the CAGE questionnaire for alcoholism, Dr. Stack, we need an outline that helps us determine if a patient has a gang association, we need to be trained on gang signs, their tattoos, colors, mementos and tokens. Now, the next question, what do we do with such information? Over the past years, medical practice has had a blooming partnership with the National Association of Social Workers (NASW), and I believe this is another way to exploit such a partnership. You see the issue of violence is not a 21st century development, or a 16th century one for that matter. Violence has its origin from the biblical days of Cain and Abel. Our focus should not be solely helping victims of violence, but stopping it in the first place. Together with social workers, let’s help unlearn violence, let’s teach peaceful conflict resolution and behavioral appropriateness, as part of a care team. This I believe is a move the medical community can make to show the world, as we are in this battle together.
If we can’t stop guns from reaching the wrong hands, at least we can affect the way and manner with which they use them. We can’t turn a blind eye to this epidemic and just do our jobs, get our paychecks, and believe it doesn’t affect us. What happens if the grandma we left on the front porch in the morning is being rolled in on a gurney hours later? If only Peter Parker was more mature and wise, Uncle Ben might still be alive today.
“With great power there must also come — great responsibility.”