On March 24, 2018, Dr. Ed Kraemer, a family physician and professor at University of Missouri-Kansas City’s School of Medicine, stood on the steps of city hall in Lee’s Summit.
Dozens of residents had gathered for one of the hundreds of March for Our Lives rallies that took place across the United States that day.
As he prepared to speak to the crowd, he held a letter from the now-former president of the American Medical Association, David Barbe, that he and many other doctors had received the day after a shooting at a Parkland, Florida, high school killed 17 students and teachers.
“It was saying that we just can't tolerate this anymore,” said Kraemer. “As physicians, as communities, as organizations, we need to start taking more action.”
It asked them to lend their voice to the demand that lawmakers examine gun violence through federally funded research and take appropriate steps to address it.
Kraemer says the letter also pushed him to look at ways local physicians were addressing the problem.
“Any physician who's interested in what goes on outside of their own little office or exam rooms or department — which should be all of us — should be interested in this problem,” Kraemer said.
‘The conversation has become difficult’
In the wake of the 2016 Pulse nightclub shooting, the American Medical Association, a nationwide organization of physicians and medical students, declared gun violence a public health crisis.
The previous year, more than 36,000 people had been killed by gun-related injuries in the U.S. According to data collected by the Centers for Disease Control, that number has steadily risen each year.
The most recently available data shows that nearly 49,000 people were killed by gun-related injuries in 2021. Of those deaths, 43% were listed as homicides and 54% were listed as suicide.
“It's so startling to me how recent the conversation has become difficult regarding gun violence,” said Dr. Stefanie Ellison, an associate dean at UMKC’s School of Medicine and an emergency physician at University Health.
It’s become more challenging to study gun violence as a public health crisis, even as many in the medical community agree it is one.
Rules such as the Dickey Amendment make it difficult for physicians to study methods to lower gun violence rates by creating informal restrictions on what federally funded research can examine.
Ellison believes the government should remove both formal and informal restrictions on potential research.
“The time is right for us to have the conversation and really start to push back so that we can use money to study this,” said Ellison. “The first step is having a conversation about the problem, understanding the problem. That’s doing the work it takes to prevent gun violence.”
Many physicians must also battle misinformation about the gun violence epidemic.
Dr. Alie Scholes, an emergency physician at St. Luke’s Hospital and professor with UMKC’s School of Medicine, believes that physicians have now been forced onto the front lines of a conflict over reality.
“I think (physicians) need to be beating the drum for the truth about what's really happening,” said Scholes. “If you have a gun in your house, it does not make you safer. It increases the likelihood that somebody in that house is going to harm themselves or someone else.”
‘You don't know how to do it until you have to’
Many physicians working to educate young medical professionals are now adapting their curriculum to better prepare their students to treat people affected by gun violence.
They’re emphasizing that medical students should talk to their future patients about their relationship with firearms.
“Our professionals are being trained to see patients in the clinic and establish their relationship with gun violence, or at least seeing if there’s a gun in the home,” said Ellison. “That needs to be part of the conversation.”
Education on safe storage and potential mental health risks are often the most effective ways to prevent the most common cause of death by firearms: suicide.
“The way this is portrayed in our media is that we have a mental health crisis,” Scholes said. “But the facts are that we don't have more depressed people in the United States. We just have a much more lethal and readily available means for which people can die by suicide.”
According to a study conducted by Harvard University’s School of Public Health, suicide attempts with firearms end in death 85% of the time, compared to the most common method of suicide, drug overdose, which has a less than 3% rate of completion.
Medical instructors are also expanding lectures on firearms themselves.
“I do a lecture every year on guns, just guns. Some people, like me, grew up in a home where there was never a gun,” said Scholes. “We have no idea the difference between a handgun and a rifle, so I do a sort of didactic lecture.”
Scholes believes this sort of information can help students better understand and examine the scope of the gun violence problem.
Students also go through training periods known as clerkships, where they accompany different physicians during their on-call hours.
Scholes often has students accompany her during her shifts as an emergency physician at St. Luke’s. Many of those who work with her are first- and second-year medical students, some no older than 20.
Scholes ensures they experience all aspects of her work, even the heartbreaking duty of speaking with families who lose loved ones.
“Those are hard things to learn when you're 18. It's emotionally sort of at an adult level and they're coming in as teenagers,” Scholes explained. “You don't know how to do it until you have to, so it's good to have a little bit of training.”
‘Just patching people up doesn’t solve problems’
UMKC’s School of Medicine is starting to focus more on prevention and emotional well-being for gunshot victims.
“There is more education on trauma-informed care,” said Ellison. “Our trauma services are educating students on how to ask about violence in the person's life and what sort of trauma they've had from that violence. Because we know that if we address that and we change that cycle, they're going to have better health.”
Dr. Michael Moncure, a trauma surgeon with University Health and Vice Chair of Surgery at UMKC’s School of Medicine, is one of the physicians championing this type of care.
As he sees it, when a gunshot victim comes into his hospital they’re often further traumatized by staff acting quickly in a hectic environment.
“You're encountering someone who's on their worst day of their life,” said Moncure. “We're cutting people's clothes off and we're telling them to stay still, being stern with them. We’re never giving them any choices.”
Moncure hopes that by teaching medical students to mitigate this initial potential for further trauma, they can improve medical care while also making patients more receptive to post-care prevention efforts.
“Just patching people up and putting them back out is not going to solve any problems,” Moncure explained. “It's not going to do anything for our country or community. It's just going to scar this next generation.”
Moncure is trying to expand his students’ education on resources outside the operating room by exposing them to anti-violence groups like Kansas City’s Aim4Peace.
So far, he’s been impressed with the next generation of physicians’ efforts to work toward solutions. Many students in the med school’s program are already engaged in student-led gun violence prevention groups like Students Demand Action.
“They want to seek out that information,” Moncure said. “They really wanna learn how to make their society safer.”
