The Medical Spotlight on Guns

Last week, Dr. Benjamin Mauck, a 43-year-old orthopedic surgeon, was murdered in his Tennessee office. An irate patient decided to forgo an online screed and instead picked up a gun. When the media reported the killing, they also recounted a list of recent healthcare shootings. I’m an orthopedic surgeon, and I’ve had my share of irate patients. In a country awash in guns, should I be worried?

The question itself is a three-level gut punch. First: how can I be an effective physician if I fear the people I serve? Second: bullets have found their way into our schools, houses of worship, and even our beds; what right do I have to assume my office offers sanctuary? And last: As a doctor of thirty-five years who’s waited until now to speak out, am I partially responsible for this ever-growing list of shootings?

Soon after Dr. Mauck’s murder, the president of the American Academy of Orthopedic Surgeons sent a message to our 39,000 members. He expressed his heartfelt condolences to Dr. Mauck’s family, friends, and patients. A good start. He went on to discuss the mounting threat of violence in healthcare settings and the need to promote workplace safety. Not just “thoughts and prayers” but a call to action. Excellent. He concluded by lauding our group’s advocacy efforts in support of the federal “SAVE” Act. “Safety from Violence for—Healthcare Employees.”

Swing and a miss.

Healthcare employees, why us and not all? Why not support a “Safety from Violence in the Produce Aisle Act?” Or a “For God’s Sake Don’t Shoot in Church Act?” How about the “We Expect Our Kids to Come Home from School Act!?”

Since the formation of the American Medical Association (AMA) in 1847, we’ve learned to advocate, but primarily for ourselves.

To be fair, my internet search turned up public statements from various medical societies. The AMA’s website states they’ve advocated for gun safety measures since the 1980s. And after the Pulse Nightclub massacre in 2016, the AMA declared gun violence a “public health crisis.” In 2018, the American College of Surgeons published its firearm safety task force (FAST) recommendations. A committee of eighteen gun-owning surgeons—whose gun-owning status, somehow, imparted a level of gun violence expertise—suggested universal background checks, “responsible” gun ownership, and innovative firearm technology might mitigate harm—a less than earth-shaking conclusion.

Until I penned this piece, I knew nothing about these workgroups and statements. If a doctor has to search for this information, how much of our message reaches the public? It took a barrage of sustained public service campaigns to get us to click seatbelts, don bicycle helmets, and cut down on tobacco. Shouldn’t our medical groups candidly weigh in on the wisdom of open carry in movie theaters? Where was our public outcry when politicians un-ironically suggested we place loaded weapons next to whiteboard erasers in school teachers’ desks? We need to reach people where they live. Sending position and policy statements to a visibly fractured Congress is not working.

The Biden administration managed to pass a watered-down gun bill last year. It will expand background checks for those under 21 and then sunset in ten years, just like the ‘90s assault weapons ban. That law reduced deaths and injuries—for ten years. Left out of the current bill was a federal red flag law for mentally unstable gun owners. Instead, they’ll send money to the states to use as they see fit. Perhaps, states with stricter gun laws could fund state border crossings to check for unhinged weapon owners.

Our medical groups champion mental health issues, yet we failed to define the impotent regulation of 400,000,000 weapons as lunacy. Per capita, there are 1.2 firearms for every man, woman, and baby, the de facto members of our “well-regulated” militia. Despite our lobbying efforts and position statements, politicians, judges, and justices sent this unsupervised mob, armed with Glocks and AR-15s, to our societal backyard and said, “Play nice.”

Yes, a small number of doctors joined the ranks of the 45,000 firearm fatalities in 2022, and that’s shocking. But they also joined the ranks of the 300 - 400 physicians who, annually, complete suicide. Studies show that one in ten doctors have contemplated or attempted suicide. The burnout rate has never been higher. Why?

In their book “If I Betray These Words,” Drs. Wendy Dean and Simon Talbot borrow the battlefield term “moral injury,” originally used to describe the trauma incurred by soldiers who passively or actively participate in morally dubious acts. The authors apply this language to the soul-crushing effects on doctors who passively comply with for-profit Medicine. The stress of misaligned financial incentives—to sell medical care rather than provide healthcare—often contributes to burnout and, for some, signs of PTSD. Does our relative silence on gun violence add to this moral injury?

While we’ve advocated for healthcare worker safety,175,000 gunshot wound victims rolled through the E.D. doors last year. These wounded people are not news to us; we literally slip in their blood.

Years ago, Congress cut funding for gun-related injury and fatality studies. The implicit and explicit message was “stay in your lane.” Exam room conversations about guns in the home became uncomfortable, almost taboo. But the numbers of wounded and dead kept rising. And as their numbers grew, so too the pain born from silence.

U.S. gun violence shocks the world. Why should doctors be shocked when the “public health crisis” we confronted with jargon-laden policy statements comes knocking at our door? We should pool our PAC money and speak out, not to an ineffectual Congress, but directly to those we serve.

My sincere condolences to Dr. Mauck’s family, friends, and patients. And to all the victims of senseless gun violence. From where I’ve stood—in my kids’ schools, in grocery stores, and in the blood of my patients—guns offer a false sense of safety over family-shattering risks and serve only to stoke our fears.