The Challenge of Screening for Gun Violence

Written by Sarah Kimball, MD, NPA Gun Violence Prevention Taskforce Co-Chair
My final patient of the day fit a disturbingly common mold in my primary care practice in a safety-net clinic in Boston. An otherwise healthy twenty-six year old woman, there would have been a small number of preventive care and screening issues to address, but for her looming concern. She struggles daily with chronic upper back pain, in large part due to a gunshot wound injury that she sustained seven years ago. It has made work difficult, as most of the jobs available to her involve long hours of standing. That one night, when she was a victim and bystander, has made every day since measurably harder.
Weekly, almost daily, these patients come into my clinic and doggedly I ask the common screening question. Is there a gun in your home? Writing this today, I struggle to think of a single case when the answer was yes. I’m left uneasy, with a screening test that doesn’t seem to be capturing the major risk factors that place my patients at risk. Should I be asking about certain neighborhoods? Particular bars? Social contacts? What is the risk factor that could be intervened on to keep my patients from becoming victims or participants in gun violence? Fundamentally, we need more research to help develop and hone screening tools meant for an adult context, ones that can identify high-risk patients who are more likely to suffer from community-based gun violence
Epidemiologic principles dictate that when I screen my patients for a disease, I should have an intervention for those who screen positive. Yet for my patients, the interventions that research recommends (keeping weapons stored unloaded and locked in a drawer or cabinet, separately from ammunition and out of the reach of children) won’t help prevent exposure to gun violence that happens outside of the home. For a screening test to be effective, we need evidence-based interventions that could reduce risk before patients suffer the effects of gun violence.
As physicians we have the opportunity to impact the lives of our individual patients and also to come together to impact our state and federal policies that protect and serve our patients and communities. I joined NPA’s new Gun Violence Prevention Task Force to unite with other physicians to find ways to effectively raise our voices to demand common sense gun policies in our states and nation. As co-chairs of the task force, Tobie Smith and I are looking forward to expanding our work to address gun violence as a public health issue. We are establishing task force work groups that will explore ways to effectively engage physician colleagues, policymakers, the public and media, as well as our patients.
We invite you to join our new 4th Wednesday Gun Violence & Public Health Webinar Series that will be held monthly at 9pm (E). We are designing this webinar series to inform and connect physicians and medical students to useful, effective resources and allies. This month’s topic is, “Who is Dangerous? Gun Laws & Mental Health, Suicides, & Restraining Orders.” On April 22, we will address child access and safe storage and provide concrete resources for physicians to share with patients, communities, and colleagues.

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