Physicians Need To Be Engaged In Preventing Gun Violence Right From The Start.

In 1969 I was a caseworker for the Cook County Welfare Department, working out of the West Madison office near Garfield Park in Chicago’s West Side.  The neighborhood, then and now, was considered one of the city’s more troubled areas characterized by high levels of crime and low levels of economic opportunity; not quite as bad as some other Chicago neighborhoods but not a place where I would ever feel comfortable or at home.  And when I recently looked at the Chicago Tribune’s crime map, it hardly came as a surprise that East Garfield was still a place where getting shot or shot at is a regular feature of life in that part of town.

Actually, Chicago is right now enjoying a slight respite from the gun violence of the past few years with 2015 shootings running about 20% lower than in 2014.  I’m not sure, however, that the word ‘enjoying’ actually fits what happened this past weekend because so far during the holiday there have been 9 killed and 32 others wounded by gunfire and Memorial Day celebration still has one more day to go. Is it actually possible that a city of 2.7 million could end up with 50 shooting victims in just 3 days?  Last year, New York with twice as many people experienced 10 shootings over the holiday weekend and the media called it a “shooting spree.”  When it comes to gun violence, Chicago is hardly the “Second City,” that’s for sure.

conference program pic                 Of course the crime numbers on Chicago’s West Side are appreciably different from where Barack and Michelle live in the South Side neighborhood known as Hyde Park.  This area surrounding the University of Chicago and counting about the same number of residents as east Garfield recorded only 6 violent crimes in the past month.  I suspect that crime in Hyde Park will drop even further in 2017 when the President comes home to live full-time surrounded by a phalanx of Secret Service agents complete with dogs, anti-crime patrols, choppers, the whole Presidential security bit.

In addition to the Obamas, Hyde Park is also home to the Chicago Crime Lab, a research and think-tank at the University supported by a who’s who of America’s glitterati foundations and various government funding sources.  The Lab has published significant research on gun violence, much of the work conducted by Philip Cook and Jens Ludwig and one of their reports, Gun Violence Among School-Age Youth in Chicago, stands out as a model for public health research of this kind. The report deserves to be read in its entirety, but my self-imposed space limitation requires me to focus on only one major theme, namely, the fact that youth who engage in gun violence can usually be spotted at a very young age.

The report argues that children start to exhibit behavior that pushed them to get their hands on guns by the time they reach middle school years; i.e., the eighth grade.  This report was published in 2009 but America’s foremost criminologist, Marvin Wolfgang, basically made the same argument in his remarkable book, Delinquency in a Birth Cohort, published in 1972. Wolfgang didn’t tie delinquency to gun violence per se, but you don’t have to be a rocket scientist to assume the connection between repeated delinquency, serial criminality and access to guns.

If, as Cook and Ludwig argue, behavior predictive of gun violence begins to appear at a young age, their call for interventions by school authorities and community programs lacks one vital piece.  Every young child in cities like Chicago is examined by a physician at least once each year.  And who better than physicians are trained to diagnose youth behavior that might create risk? When it comes to children’s health, we need to think of gun violence not just as a socio-economic phenomenon, but as a medical condition whose diagnosis and treatment should be handled by the same medical professionals who make sure that kids are immunized against measles, mumps and the flu.



1 thought on “Physicians Need To Be Engaged In Preventing Gun Violence Right From The Start.

  1. Again with this BS about involving doctors in the gun debate. Look they have a hard enough time doing their job as it is, they don’t need to add more confusion to what is already there.

    Deaths by medical mistakes hit records
    Tejal Gandhi, MD, president, National Patient Safety Foundation
    Tejal Gandhi, MD, president of the National Patient Safety Foundation and associate professor of medicine, Harvard Medical School, spoke at the hearing.
    The way IT is designed remains part of the problem
    WASHINGTON | July 18, 2014

    It’s a chilling reality – one often overlooked in annual mortality statistics: Preventable medical errors persist as the No. 3 killer in the U.S. – third only to heart disease and cancer – claiming the lives of some 400,000 people each year. At a Senate hearing Thursday, patient safety officials put their best ideas forward on how to solve the crisis, with IT often at the center of discussions.

    Hearing members, who spoke before the Subcommittee on Primary Health and Aging, not only underscored the devastating loss of human life – more than 1,000 people each day – but also called attention to the fact that these medical errors cost the nation a colossal $1 trillion each year.

    “The tragedy that we’re talking about here (is) deaths taking place that should not be taking place,” said subcommittee Chair Sen. Bernie Sanders, I-Vt., in his opening remarks.

    [See also: EHR adverse events data cause for alarm.]

    Among those speaking was Ashish Jha, MD, professor of health policy and management at Harvard School of Public Health, who referenced the Institute of Medicine’s 1999 report To Err is Human, which estimated some 100,000 Americans die each year from preventable adverse events.

    “When they first came out with that number, it was so staggeringly large, that most people were wondering, ‘could that possibly be right?'” said Jha.

    Some 15 years later, the evidence is glaring. “The IOM probably got it wrong,” he said. “It was clearly an underestimate of the toll of human suffering that goes on from preventable medical errors.”

    It’s not just the 1,000 deaths per day that should be huge cause for alarm, noted Joanne Disch, RN, clinical professor at the University of Minnesota School of Nursing, who also spoke before Congress. There’s also the 10,000 serious complications cases resulting from medical errors that occur each day.

    Disch cited the case of a Minnesota patient who underwent a bilateral mastectomy for cancer, only to find out post surgery a mix-up with the biopsy reports had occurred, and she had not actually had cancer.
    “Medicine today invests heavily in information technology, yet the promised
    improvement in patient safety and productivity frankly have not been realized.”
    – Peter Pronovost, MD
    In terms of how to address this crisis, the recommendations put forth were diverse – including boosting the number of registered nurses, supporting AHRQ, CDC and establishing incentives. There did, however, exist common agreement with one thing: information technology is falling short in many arenas.

    “Medicine today invests heavily in information technology, yet the promised improvement in patient safety and productivity frankly have not been realized,” said Peter Pronovost, MD, senior vice president for Patient Safety and Quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins.

    Peter Pronovost, MD

    Jha agreed. There’s been so much hype around electronic health records, with the industry showing “phenomenal progress” with adoption and use. “But the potential is not going to be realized unless those tools are really focused on improving patient safety,” he said. “The tools themselves won’t automatically do it.”

    Tejal Gandhi, MD, president of the National Patient Safety Foundation, added: The IT needs to be improved. “We need better systems to minimize cognitive errors…such as computerized algorithms,” she said, speaking on behalf of ambulatory patient safety.

    One of the more significant issues relating to ambulatory medical errors involves missed and delayed diagnoses, she pointed out, for instance failing to order appropriate tests or initiate follow up. The IT systems, she continued, need to be designed to better manage test results.

    And other key recommendations?

    [See also: CDC on EHR errors: Enough’s enough.]

    Jha pointed out: Data and metrics are key.

    “If you don’t have data and metrics, you don’t know how you’re doing; you don’t know how you compare to anyone else, and you have no way to judge whether your efforts are making a difference or not,” he said.

    Jha advocated on behalf of giving the Centers for Disease Control and Prevention the job of collecting and monitoring this data.

    Pronovost agreed, as currently, there exists no “guarantee that the measures that we’re reporting are accurate,” he said.
    “What these numbers say is that every day, a 747, two of them are crashing.”
    For instance, he referenced the time when Johns Hopkins was both congratulated and criticized for its performance on blood stream infections, pertaining to the same measures and the same time period. “The one we’re paid on using administrative data, got it right 13 percent of the time,” he said.

    “Why is it when a death happens one at time, silently, it warrants less attention than when deaths happen in groups of five or 10?” he asked. “What these numbers say is that every day, a 747, two of them are crashing. Every two months, 9-11 is occurring…we would not tolerate that degree of preventable harm in any other forum.”

    In the hearing’s closing questions, when Sanders inquired as to why this crisis was not constantly splashed across front page news, he was met with this: “When people go to the hospital, they are sick. It is very easy to confuse the fact that somebody might have died because of a fatal consequence of their disease, versus they died from a complication from a medical error,” Jha said. “It has taken a lot to prove to all of us that many of these deaths are not a natural consequence of the underlying disease. They are purely failures of the system.”
    Topics: Clinical, Policy and Legislation, Quality and Safety, Adverse event, Institute of Medicine (IOM), Agency for Healthcare Research and Quality (AHRQ), Electronic Health Record (EHR), Centers for Disease Control and Prevention (CDC), Johns Hopkins University

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