Curbing Firearm Violence: Vital Signs Talks with Michael Hirsh, M.D.

BY ROBYN ALIE
MMS PUBLIC HEALTH MANAGER

In 2002, Michael Hirsh, M.D., began the “Goods for Guns” weapons exchange program in Worcester, which is now held annually on the anniversary of the Newtown school shooting. The program has seen roughly 2,600 firearms turned in, three-fourths of which are handguns. Dr. Hirsh, the director of trauma services at the Trauma Center and Pediatric Intensive Care Unit of the UMass Memorial Children’s Medical Center, puts the total cost for collecting 2,600 firearms at less than the cost of caring for four patients who might have been injured by those weapons.

While at Columbia Presbyterian in 1981, a fellow resident went home to bring crackers to his pregnant wife and was shot in the chest by a 15-year-old boy, beginning Dr. Hirsh’s interest in preventing firearm violence. He met Sarah Brady, the wife of secret service agent Jim Brady, who had just started up a center to end handgun violence. “She got it way back then, that there are conditions — poverty, racism, food insecurity — that contribute to violence. But the only thing that elevated violent acts into lethal acts was the handgun,” he said.

VS: What is the role of physicians in addressing this issue?

Dr. Hirsh: This has become critical. It’s very important for doctors to ask their patients about the status of gun ownership and how guns are stored. We know that the gun in the home increases the risk of femicide by five times, suicide by five times, and homicide by eight times. These are not insignificant. You may be taking care of your own house fine. Are you sure that your kids are going to be OK? Seventy percent of kids know where the weapons are.

With the opioid epidemic, we’ve seen an uptick in break-ins. Stealing a gun is a way of getting cash. Up to 35 percent of gun violence in Central Massachusetts is done with stolen weapons.

VS: What is the response of patients when you broach the subject of gun ownership?

Dr. Hirsh: You have to be forthright and say that the American Academy of Pediatrics says the three most important safety questions I can ask a parent are about child restraint, smoke alarms in the home, and guns in the home. In the south, you add in pool safety. I try to ask all those questions, so I’m not just focused on the gun. I tell them that kids are very inquisitive. We just want to make sure they’re safe.

With your adult patients, ask if there are children going through your home — nephews, nieces, grandchildren. Patients have the right to refuse to discuss this — I don’t mind. In 30 years, one patient questioned why I was asking, and no one refused to answer.

This doesn’t have to be a 12-minute interview. Questionnaires are important — add guns to it.

VS: Beyond the practice, is there a greater role for physicians or the MMS?

Dr. Hirsh: The state of Florida passed a law in 2011 (banning physicians from asking about gun ownership). This law is First Amendment rights being trumped by Second Amendment rights. Florida has ruled that the interview is conduct not speech; therefore, it can be regulated.

It’s bad for gun violence for sure. And it’s the establishment of the precedent of the slippery slope that would enable a legislature to decide what topics are taboo — maybe it’s sexual reproduction, maybe it’s drug use. If we allow this kind of intrusion into the doctor-patient relationship, we’ve given up one of our strongest weapons. Organized medicine is our best help. The MMS this past year reaffirmed the sanctity of the doctor patient relationship, which should be inviolate.

Motor vehicle fatalities this year are going to be fewer than firearm fatalities. In the 1950s, there was the same attitude to the car as there is now to guns: it wasn’t the car killing people — it was the driver. There has been a multipronged approach to the car. We now have airbags, seatbelts, crumple zones, rumble strips, and worked to change the social norm that it’s not funny anymore to drive drunk.

There are analogous things we can do with the gun: on the research side, the gun technology side, and the liability side. This is where we have to go with the gun now. It’s the unsecured weapon that is a public health problem.

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