When a gun shot victim comes into the Emergency Room, so much has gone wrong.
An interaction between people has gone awry. Our social fabric that keeps violence at bay, has torn. And of course, our patient’s body is experiencing a cascade of things going seriously wrong.
So as doctors, it’s natural to do everything we can to fix the patient in front of us… but shrug our shoulders at all of the other things that have gone wrong to put that person in that position. Our job, it’s common to believe, starts when the stretcher enters the door. But a new program has me rethinking that — in ways that could save millions of lives.
Massachusetts General Hospital announced the launch of the Mass General Center for Gun Violence Prevention last week. The center was a collaboration of everyone from the Boston Police Department to doctors themselves. And it's envisioned to include programs ranging from providing education for providers on treating gun violence to sponsoring gun buyback programs. The center was founded by the pediatric surgeon Peter Masiakos, who says:
"For as long as our profession has existed, our patients have depended on doctors to be sentinels against hidden societal dangers and advocates for policies that protect us against such dangers. On the front lines of patient care, we are routinely exposed to the faces affected by modern ills such as unemployment, food insecurity, substance use, racism and gun violence. We must stand front and center to better understand the determinants of gun violence and to develop the tools to impact this epidemic that is indiscriminate of race, age, creed, gender and sexual identity.”
The center itself challenges some of our implicit understandings of where healthcare providers start and end. It reminds me of the NRA's plea from last year for providers to "stay in their lane" and the heartfelt rejoinder by an ER doc that guns and violence prevention are very much a doctor's "lane." This initiative goes even farther than advocacy and treatment — it positions doctors and the hospital as responsible for actually "treating" gun violence before it starts, in all of the social, economic, cultural, and educational ways that can happen.
The truth is that when I first read about Mass General's project, it seemed a surprising use of hospital time and resources. But the more I thought about it, the more the initiative made sense to me. This is a collaboration among multiple stakeholders. Just as we need collaboration across the continuum of care within medicine and for any given patient case, we need collaboration across diverse stakeholders outside of medicine to really change results for our patients.
It's one more reminder that, as doctors, we need to keep asking:
- How can we be more collaborative to get better results for our patients?
- Who are the people we need to collaborate with for the best possible care?
Mass General's answers to these questions led them to a comprehensive new program. Your answers might just lead you to chatting with a colleague in the hallway. But all of us can ask the questions.
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