'We have a moral imperative to speak out': 10 questions with the physician leading #ThisIsOurLane

Shot in the throat when he was 17, trauma surgeon Joseph Sakran, MD, has a message for the National Rifle Association: Of course healthcare providers have a role in the discussion around gun control, and they have a responsibility to speak up. 

Dr. Sakran created the #ThisIsOurLane movement on Twitter as a response to a Nov. 7 tweet from the NRA stating, "Someone should tell self-important anti-gun doctors to stay in their lane." As the director of emergency general surgery and assistant professor of surgery at Baltimore-based Johns Hopkins Medicine, Dr. Sakran sees victims of gun violence every day. 

"This public health epidemic can strike anywhere at any time, and last night's shooting at Chicago's Mercy Hospital made perfectly clear that, no matter what anyone says, #ThisIsOurLane," he said in a statement. "We have a moral imperative to speak out, to do all we can to help members of our communities avoid ever becoming our patients." 

Becker's spoke with Dr. Sakran, who also serves on the board for the Brady Campaign to Prevent Gun Violence, about U.S. gun violence and what providers can do to help address the epidemic. 

Note: Responses have been edited lightly for length and clarity. 

Question: To start off, can you tell me a little bit about your background with gun violence?

Dr. Joseph Sakran: When I was 17, I was nearly killed after being shot in the throat with a 30-caliber bullet. Most 17 year olds don't know what they want to do with the rest their life; they don't appreciate the people in their life; and frankly, they don't realize that they're mortal. When that happened, it really inspired me to go into medicine, become a trauma surgeon and figure out how do we work at the intersection of medicine, public health and public policy. 

Q: What is the message behind the #ThisIsOurLane movement?

JS: I want to be clear: There's a false narrative spreading that we are anti-gun. That couldn't be further from the truth. We are about responsible gun ownership. That's our goal.

When we saw that rhetoric from the NRA, it was a clear demonstration to me, the medical community and frankly to Americans that [the NRA is] really not serious about moving the needle forward on this issue. That rhetoric united the healthcare community. 

The other aspect of the NRA's communication I thought was inaccurate was the claim that the medical community has done this without really collaborating or discussing with other individuals. [The NRA tweet claims "the medical community seems to have consulted NO ONE but themselves” for the gun safety policies they promote.] What’s interesting is, for example, the American College of Surgeons met with NRA leadership in January 2017 to figure out ways they could collaborate to reduce firearm injury and death in this country. 

Q: Beyond the NRA, where are you finding the most opposition to this idea that gun violence is a public health issue?   

JS: Over the past week, I've found both non-gun owners and gun owners from a healthcare professional perspective have come together and agree we have a role in this. A lot of the opposition I've seen has not been from individuals who have personally talked to me, at least not at this time. Most of what I've seen is on social media, and who knows who is making those comments and what the intention actually is. When I talk to most people, there is a significant amount we agree upon. 

Q: Do you think that area of agreement is a new?

JS: I don't think it's necessarily new. I've talked to hundreds, if not thousands, of gun owners. When you sit across the table, have a cup of coffee and discuss these issues, I have found there is a significant amount we have in common. Part of the problem is it appears we are on polar opposite sides because these false narratives that exist in the "Twittersphere" and other social media venues. 

I think there is a disparity between leadership of the gun lobby and the membership. When you talk to responsible gun owners, they agree about expanding universal background checks. They agree about safely storing firearms. These things are not controversial. They are made out to be controversial, but when you sit down one-on-one to talk to folks, there is a lot of agreement. Part of our role is ensuring we approach this in an engaging way, in a way that's professional, collegial and involves all stakeholders, and that includes the medical community. 

Q: What do you think is the biggest misconception about gun violence? 

JS: We see all these mass shootings that happen, and mass shootings are less than 2 percent of the entire epidemic. The reality is we have young black men killed in our inner cities on a daily basis in places like Baltimore, Chicago and St. Louis, and their stories often go untold. So this is not a once-in-awhile thing, this is an everyday thing. We have an obligation to ensure that those stories are shared with the public so they understand the problem we are dealing with. 

Q: On Monday, four people were killed in a shooting at Chicago's Mercy Hospital. What do you think hospital leadership needs to take away from this horrific event? 

JS: It's just heart-wrenching to hear that news as it broke overnight. It tells me a couple things. Not only are we taking care of these patients, but there are times when we become the patients. Monday was an example. 

From a security perspective, we have to start thinking about who is entering the hospital and what type of screening folks are undergoing.

From what I understand, there might be an intimate partner violence piece to this. We know that abusers who have firearms result in an increased risk of death to those being abused. In fact, 25 percent of women face domestic abuse throughout their lifetime. 

Q: You hear a lot at the national level about improving mental health resources as solution to address the problem. What's your take on that? 

JS: Only 4 percent of violent acts are committed by folks who have some sort of mental health diagnosis — bipolar disorder, schizophrenia, major depression. In fact, often these individuals can be victims, not the ones committing the crimes. It's what I call the myth of mental health. There is a role for mental health when you talk about suicide, because there is an association between suicide and firearms, but when you are talking about these violent acts, data would suggest it's only a minority of the cases. 

Q: What's your advice to physicians and nurses? What can they do? 

JS: We rarely think one person can make a difference. That's why our voter turnout rate is so low. It's important to understand that each of us as clinicians has a story, and it's important that our story is heard. We have both the possibility and responsibility to ensure our voice is heard in the discussion to develop a data-driven approach and solutions to reduce firearm injury and death in this country. 

Q: What do you see as the most important piece to the solution on a national level? 

JS: A couple things. One is expanding universal background checks. Currently 1 in 5 gun sales happen with no questions asked, which means thousands of firearms get into the hands of people who are felons or have committed domestic violence acts, and so forth. 

Another thing is safe storage. There are 4.6 million children who live in homes with unlocked and loaded weapons. Most responsible gun owners would tell you we should always store our weapons and firearms safely. 

The other thing is federal funding and ensuring federal dollars flow to the CDC so we can actually research the etiology of gun violence and solutions that can be tailored to the community as is appropriate. The solutions for inner cities may be different than for people who are committing suicide, but we really need better and more robust data to be able to come up with a clear, evidence-based pathway. 

Q: Is there anything else you think our readers should know? 

JS: Hospitals and academic medical centers need to start thinking about creative ways to fund this research. Maybe that involves public-private partnerships to ensure we are allowing our researchers and scientists to come up with the appropriate data that's needed. Laura and John Arnold [a former hedge fund manager and his wife, who together run the Laura and John Arnold Foundation], for example, they've committed $50 million, and they've teamed up with RAND to do this. Kaiser Permanente has committed $2 million. There's all these private groups coming out in support of this, and I think we need to [strike more of these partnerships] that and not just wait for someone to fund us. 

 

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