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The NRA versus Medical Professionals: Only One is Interested in Saving Lives

Advocating for patients is in a physician’s job description. Sometimes we forget that, and need a reminder. The National Rifle Association, a little itchy with its Twitter finger, needed a reminder.

Gun-related injuries and death are a clear public health problem, inspiring a set of guidelines by the American College of Physicians published recently in Annals of Internal Medicine.

To which @NRA had this to say: “Someone should tell self-important anti-gun doctors to stay in their lane.”

Since that tweet, it’s been a graphic and bloody few days on Twitter, with post-op selfies from surgeons and other clinicians responding not only that #ThisIsMyLane and #ThisIsOurLane, but writing compelling narratives decrying the number of ambulances, hearses and grieving parents families sharing that lane.

Why did the NRA think it could silence doctors? Maybe because it’s worked in the past.

“We have stood by helplessly on firearm safety as politicians and lobbyists blocked us from applying standard scientific approaches to gun violence,” Dr. Esther Choo (@choo_ek) wrote on “We weren’t admonished to stay in our lane, exactly — instead we were told to ignore a health crisis unfolding right in front of us, squarely in our lane. And for the most part, we did.”

So how significant is it that this silence ended? I’d like to think it’s a very big deal.

Americans have major trust issues with institutions, as JAMA acknowledged this week in a Viewpoint, “Addressing health-related misinformation on social media.”

The authors noted that “tangible support for clinicians is necessary as they continue to interact with patients who have been exposed to or have questions about health misinformation from social media. Understanding the underlying causes of patients’ confusion, concern, and mistrust could help clinicians foster patient-centered communication.”

And yet medical professionals are in an especially promising position to cut through that distrust. According to Gallup, nursing is the country’s most trusted profession (82 percent), and doctors aren’t far behind (65 percent).

Which is to say, the NRA has good reason to fear the power of robust gun-control advocacy by physicians, and probably hopes it’s fleeting. Only one side of this argument is about caring for humans and saving lives.

Notably, the reaction to the NRA’s fail as a traffic cop wasn’t the only significant patient advocacy by prominent physicians this week.

For the first time, Planned Parenthood has a physician as president. On her first day in the new role, Leana Wen, previously Baltimore’s commissioner of public health, spoke of “moral imperative” in a Twittter video and, in the journal Health Affairs, of Planned Parenthood’s role as the only source of health care for many women, and the only such care provider in all 50 states.

Seemingly unconcerned with lane violations, Wen discusses how Baltimore has addressed its “health crisis of gun violence.” She notes: ”Three of our four program sites went at least one year without a fatal shooting.”

In Baltimore, Wen’s department was aggressive in calling attention to social conditions related to health, especially among children.

“A patient’s health is not just affected by whether or not they have insurance, or the care they receive from a doctor like me,” Wen says. “Factors like whether or not they have reliable access to food, transportation, housing, and mental health and addiction services, are all critical to identify and improve, if we want to really make a lasting impact on the patients and communities we serve.”

In his latest New Yorker article, Atul Gawande’s advocacy is for patients and their evolving relationship with doctors. I read “Why Doctors Hate Their Computers” as a compelling argument that the doctor-patient relationship is at risk from electronic health records, intended patient-centered efficiencies and the time required for data entry.

Gawande cited a study showing that computers get twice the physician face time that patients receive. That’s hardly the only cause of physician burnout, but it’s a big one. (By coincidence, BMJ this week asked: “Could AI make doctors obsolete?”)

Perhaps that had a role in the physician reaction to the NRA.

Gawande’s Twitter feed called my attention to another physician’s patient/public health advocacy — Scott Gottlieb, who is leading an effort to confront “an epidemic of use of tobacco products by children” at the FDA.

Notably, Gawande ends his New Yorker story by telling about preparing a patient, and his wife, for surgery. It’s not a lane so much as a relationship.

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