What it means for hospitals to address gun violence as a public health issue

Follow this authorLeana S. Wen's opinions

One of Northwell’s innovative efforts is screening all patients who come to the emergency department for their risk of firearm injury. Patients are asked two sets of questions: First, do they have a firearm at home and, if so, it is properly secured? And second, are they at an elevated risk of gun injury? This considers factors such as peer influence and living in an area with a high rate of firearm violence.

It’s crucial that this screening is implemented across the board. Doing so normalizes these questions and makes them part of routine medical care. As Sathya explained, “If we’re asking patients and families about substance use, behavioral health issues, exercise, smoking and wellness, then why aren’t we asking about firearm injury risk?”

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Another important part of Northwell’s approach is its intervention. Someone who keeps firearms at home will receive counseling on safe storage then and there. If they don’t already secure their weapons, the hospital will provide them with a gun lock at the time of counseling.

If hospital staff determines someone to be at risk of becoming involved in a gang, that patient will be referred to community violence intervention programs that help to break the cycle of violence. Northwell even hires “credible messengers” — people from the communities they serve, and those who have been shot themselves — to speak with patients while they are in the hospital. They act as case managers to link patients to community resources and offer additional social assistance, such as housing and employment opportunities.

In 2½ years, Northwell’s clinicians have performed more than 40,000 of these screenings across three hospitals. This is remarkable, considering that asking questions about gun violence is hardly something doctors and nurses learn in our training.

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Sathya admits that it hasn’t been easy to change clinical practice. The biggest issue, he told me, was simply lack of comfort about raising the issue of firearms. “People think it’s polarizing,” he said. “They think it’s........

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