Firearm violence is a public health crisis. In this April 17, 2023 edition of the Prioritizing Equity series, panelists explore the work of physicians in health systems and beyond in the realms of public health, public safety and firearm violence prevention.
Panel
- Megan Ranney, MD, MPH—emergency physician, deputy dean, Brown University
- Eric Reinhart, MD—political anthropologist of law and public health, a psychoanalyst, second year psychiatry resident, Northwestern Hospital
- Joe Sakran, MD, MPA, MPH—vice chair, clinical operations of surgery, Johns Hopkins Medicine
- Brian Williams, MD—trauma and acute care surgeon in Dallas, Texas
Moderator
- Aletha Maybank, MD, MPH—chief health equity officer, senior vice president, Center for Health Equity, American Medical Association
Transcript
Dr. Maybank: Hello everyone and welcome to Prioritizing Equity. I'm Aletha Maybank and I'm senior vice president and the chief health equity officer at the American Medical Association. Thank you for joining us for a new episode of Prioritizing Equity.
Today, death by firearms is the leading cause of death in children in the United States, and we know in public health that this is preventable and just really should not be. We see more health systems and physicians within them taking action with advocacy in its many forms, as well as doing program development and implementation. Here at AMA, we have strengthened our efforts for preventing gun violence. Specifically, we have committed to form a gun violence prevention task force, as well as adopted over 30 policy recommendations to reduce firearm violence, trauma, injury and death. Some of these policies include AMA supporting gun research, regulating ghost guns and advocating for warning labels on ammunition packages. But today's conversation really builds upon our other sessions related to gun violence as a public health issue, and we'll hear from physicians who are leading narrative change efforts in medicine and across the country really overall that embrace frameworks and methods of public safety and public health as well as leading gun violence prevention within their own institutions.
I'll say on a more personal note, this conversation is near and dear to my heart. I've spent a good part of my career advocating funding and working with neighborhoods in New York City overseeing gun violence prevention programs and implementing them on a place-based level. What's always was clear to me is that the leaders in our neighborhoods, really, they have the brilliant ideas and solutions to making their communities safe places. However, there was and there still is really a resistance to embracing and understanding this other opportunity that frames the context of what they're experiencing into public safety and public health, and then the actions that really take to embody that and that would work to support these leaders at a local level.
In today's session, we're going to hear from four physicians who are working at this intersection of public health, public safety and therefore to meet justice and gun violence. Please join me in welcoming Dr. Megan Ranney, who is emergency physician who is currently the deputy dean at Brown. She is the incoming dean at the Yale School of Public Health and who has been with us before. I really want to thank you for coming and spending some time again. Dr. Eric Reinhart, who is a political anthropologist of law and public health, a psychoanalyst and a second-year psychiatry resident at Northwestern, Dr. Joe Sakran, who is vice chair in clinical operations of surgery at Johns Hopkins Medicine and Dr. Brian Williams, who is a trauma and acute care surgeon in Dallas, Texas. Really honored for all of you to be here, your brilliant minds and all that offers. If you've ever seen these episodes, I really just go around and ask how y'all are doing in general and where are you at this point in time in the country.
I will start, going to start with Megan. Go ahead.
Dr. Ranney: In general, I'm doing well, but on this issue in particular, I think, as has so often happened before over the last decades, we're at yet another inflection point. We're recording this about a week after the Nashville shooting and goodness knows how many other shootings over the last week that got less media publicity. I was really actually looking forward to this podcast as a chance to re-center us around both the urgency of working on this issue, but also the hope. I think it's far too easy to become numb and hopeless in the face of these continued publicized mass shootings. Again, never mind the daily toll that we hear less about in the news, but that we certainly encounter in clinical practice.
Dr. Maybank: Absolutely. Thank you. Joe. How are you? Where are you?
Dr. Sakran: Yeah. Well, look, I'm in Baltimore, Maryland right now. I was on call the past 24 hours, so I guess I'm doing okay. What a great time to have a conversation because post-call, you're a little bit frontal and you're just going to speak your mind, which is what I try to do anyways. Look, I'm really grateful to be part of this incredible panel and I'm glad that the AMA and so many of our medical organizations have really taken this issue front and center. I can't think of a more important group than health care professionals who are, frankly, at the center of this issue, having to talk to families and take care of patients, to be part of this solution in what is perhaps the most important public health problem of modern time. Thank you for doing this and I look forward to the discussion.
Dr. Maybank: Thanks, Joe. Brian?
Dr. Williams: Thank you for inviting me. To be quite honest, I don't know how to describe how I feel right now. The reason is this conversation is timely because my cousin was shot and killed last week. I'm going to the funeral this weekend. I actually almost did not come to the recording today because of that but then I thought, I wanted to bring a voice that is not just a professional endeavor for me to reduce gun violence, but also this is personal. It's infected my family more than just once, but as recently as this last week. The timeliness of it brought me back to this discussion today to talk about the human toll that happens every day that is not making the news, but also that we as health care providers are also humans and this impacts us beyond just a professional endeavor.
Dr. Maybank: Absolutely. Tremendous. Sorry for your loss, Brian, and thank you for making the time to speak with us and very timely. I think you bring up the point that folks don't always get that this work is about us. We're fighting for our own lives and for our own families all the time. We're not disconnected from it at all, so I appreciate you being here. Eric?
Dr. Reinhart: Yeah. Thank you for coming, Brian. I've been working on issues related to this and in communities really affected by gun violence for about 15 years in Chicago. Most of that time, I've not been feeling a lot of hope. Mariame Kaba says that hope is a discipline, and I found it a really, really difficult discipline to maintain over time. But right now, it feels different to me, at least in Chicago, because we just had a big electoral shift with Brandon Johnson coming into office. The big crux of the race here was between a public health model of public safety, which communities have not really had an opportunity to see work. We've not seen investment in it before. Then on the other hand, with Paul Vallas, there was more of an investment in a continuation of the current police model. To see the public health model that all of us here have been working to support for so long finally have a chance to maybe do, to be demonstrated in a place that really, really needs it, has brought me hope. I'm finding hope a lot easier to maintain right now than in under ordinary circumstances.
Dr. Maybank: Thanks, Eric. I appreciate that. It leads me to one of the early questions, and I think there are a lot of assumptions. For somebody, I've spent so much time in public health, that has been most of my career in governmental public health, transitioning over to AMA and the health care side, I fully appreciate the gap in understanding and knowledge about even what is public health and what is public safety as a frame. Eric, you've written several pieces on this, so I'd love if you could start and describe that as a basic, because this is an educational tool for health professionals. If you could just describe those distinctions, it'd be awesome.
Dr. Reinhart: Yeah. Not only is a public health approach to public safety not widely understood right now even among health care professionals, but just public health as a framework is not widely understood. Public health as a field in the U.S. has, over the last at least 50 years, been largely taken over by biomedical frameworks and has abandoned many of its foundational principles, which you find now more in the field of social medicine and within schools of public health, but not always. Often you see there, again, a perpetuation of more biomedical ideas.
You could separate the distinction between these two in this way. The biomedicine is largely organized around treatment. It's largely organized around clinical mentalities, responding to the individual patient in front of you and perhaps some of the marginal social connections that are implicated but it is not generally oriented around root cause analysis, root cause policy responses, political struggle to address the fundamental drivers of poor health, of poor safety in our communities. This is the public health framework. It understands that health is fundamentally political, it's shaped by policy. That's what that means. Even just that term, the idea that something is political is widely misunderstood in the U.S. and that we cannot build health, we cannot build safety to fundamentally intertwine things unless we address root causes and we have to do that through policy action research. Descriptive research is not enough. This would be one of the beginning distinctions to be made.
Then with public safety and public health, what you've had in the U.S. is a field of public safety that's really been dominated by criminological metrics and criminological terms. The field of criminology, a branch of sociology, has developed in very, very close association with police departments and policing systems in general for about a hundred years. What that has resulted in is a way of measuring safety that is fixated on only one part of safety, which is crime rates. That is the generally accepted metric upon which we evaluate public safety in our communities. What's left out then are eviction rates, maternal mortality rates, overdose rates, poverty rates, access to health care and mental health care. All of these things that, I think, it's quite clear statistically, are the much bigger drivers of the lack of safety in our communities. Public health as it approaches public safety, I think the task is to reclaim not just the interventions, but also the way that we measure, the way that we conceptualize safety to approach it with a much more holistic root cause-oriented framework.
Dr. Maybank: Thank you. I appreciate that very much. Very good and very clear. Megan, building off of that then, what's the frame in and how do you bring in gun violence to that context? Especially now you're headed to a public health school and one of the leading ones in the country. Congratulations on that. What does that mean in terms of the context of gun violence and gun violence prevention?
Dr. Ranney: Absolutely. Thank you for having us on. Eric, thanks for that framing. I think about public health in ways that are similar to Eric's, but slightly different. To me, the public health framework really is this four-step approach that we take to any health problem, which is about collecting data, looking at risk and preventive factors. There are a bunch of different models that we can use for looking at risk and preventive factors, one of which is this kind of root cause analysis. There's the social ecological model that goes from individual out to society. Then within the world of injury prevention, we talk about there being different types of risk and prevention frameworks as well.
The third step in the public health model is looking at what can we do to change it? Again, that's going to be interventions or programs that could range from something on the individual level. We can talk as we go on in the podcast about some hospital-based programs that many of us are involved in, up through the neighborhood or community, up through society. Those can range from policies and legislation to culture change or environmental change and investment, shifts in the educational system. There's a wide variety of types of interventions that are part of the public health framework.
Then that last step is we put in place what works. All of us as physicians have been part of shifts in evidence in our clinical practice and we've seen the same thing in public health, where it is critically important for us to evaluate whether or not a strategy actually works to decrease the burden of injury, the burden of disease, writ large, rather than just putting in place what we think might work based off of an emotional gut reaction.
To me, that's where we, straddling medicine and public health, both have the capacity to raise awareness to those very real health effects of firearm injury, calling out that this is a health problem and to go off of what Eric said, this is not simply a criminological or political or policy problem. It is something that affects people's physical and emotional health, their sense of safety, their sense of wellbeing, their ability to go out on the streets, to go to school, to go to work and then use that four-part strategy to develop a wide spectrum of interventions because there is no public health problem in history that has been solved through a single strategy. To me, the advantage of bringing it into that health sphere is that it gives us a whole new language and a whole new suite of potential interventions that we can bring to bear, again, rather than being hopeless and helpless.
Dr. Maybank: Thanks, Megan. Joe, do you have any further reflection on the context of—
Dr. Sakran: Yeah, listen. I'm not going to repeat ...
Dr. Maybank: ... public health and gun violence?
Dr. Sakran: I'm not going to repeat. That was an incredible framing of what a public health problem is. In my mind, I try to think about it in a very simple way, which is our goal is to improve the health and wellbeing of the population as a whole rather than just treating the individual patients. When I think about other public health problems that we have faced, we have to recognize that there is no one solution. This requires a multifaceted approach that cuts across different disciplines.
The one thing that I'll just I'll say is, we have to move away from simply trying to focus on human behavior, which we know in and of itself is not cost-effective, and really developing a system that allows us to ensure that we can make communities safer. That's what we've been trying to do. We have seen a cultural transformation over the past decade because of the work that's being done at the local and the state level that has allowed us to come to the point where people, even outside of health care, are now talking about this issue as a public health problem and not simply from the vantage point of a criminal justice issue. I think that's so critical.
Dr. Maybank: Thanks Joe. And Brian?
Dr. Williams: I love hearing Eric talk. We talked about this before and the way he approaches this is very inspiring, but when he talked about the root causes and addressing those to reduce the human toll of gun violence, that is something I think is very important in speaking specifically to the medical students and trainees who maybe were watching this. The first time I heard about public health, I was midway through my residency. We're having a discussion and I said, "What is public health?" And that's absurd that I've got that far in my medical education without really focusing on what public health meant. I think that's changed now for the newer generation, but I think that will make the profession and this upcoming generation of health care professionals much more effective at eradicating root causes of these huge problems that seem insurmountable. I like that we're having a discussion about public health and actually bridging it and making it in more interlocked with traditional medical training. I think it'll go far towards reducing the human toll of gun violence.
Dr. Maybank: Absolutely. Again, I opened the floor up always for you all to ask questions and to chime in so don't mind me. I'm just here for the flow. Thanks for that. Actually, Brian, just to go to you and just speak specifically connecting those dots practically in the spaces that you have been. You were in Chicago and now you're in Dallas. Can you talk about how you have worked to support building in that public health frame in the efforts that you're doing within the context of the institution around gun violence prevention for the residents, students or even faculty and staff? We're educating everyone a lot of times in the context of the institutions that we're working in.
Dr. Williams: Sure. This is the great thing about academia is that we are constant learners. I remember my first gun violence victim when I was a medical student down in Tampa, then more gun violence in Boston as a resident, then in Atlanta as a fellow. Dallas, Chicago, now back to Dallas. What I've seen over the time period from me, my personal evolution, is I had to look beyond just the one-on-one interaction with these victims that were coming in because there was something more profound happening outside of the hospital that was putting them at risk and how do I connect those dots so that those of us that are caring for these patients, the doctors and the nurses and the techs, can be more effective at influencing action outside of the hospital.
I think you touched upon this. It's very important. You mentioned that the community leaders have really good solutions and often the people closest to the problem have the best solutions so we, within the hospital, caring for these patients and taking care of their families, need to do a better job of connecting with those closest to the problem. You see that happening a lot more at institutions across the country so my part has been is how do I educate my residents and students and fellows. I say my—they don't belong to me, but I feel very protective of them as a faculty member. How do we infuse that experience, that lens, so they look at this beyond just a gunshot victim. They are a human being, an entire story that impacts their lives. How can we affect that to make their lives better?
Dr. Sakran: Dr. Maybank, if I can just build off of that real quick.
Dr. Maybank: Yeah.
Dr. Sakran: I think what my man Brian is saying here is so critical and this often gets lost. Whether it's an incredible medical organization like AMA or me sitting here at Johns Hopkins, we often forget the fact that the community, those that are closest to the struggle, understand what the solutions are. We have to really, and I think we've started to do this, shift our strategy and approach from simply trying to come up with solutions and say, "Hey, this is what you should implement," and actually engaging the community, those that are living this every day, to be true partners in the process of developing these very critical processes that are going to allow us to make community safer. It's very easy to forget that. We've really been very deliberate about making sure that the right people are at the table.
Then the last just piece of this is when you think about health care professionals, it's not natural in traditional training for us to think about our impact beyond the bedside. What I would say is when you look at the social issues that we are facing in America today, whether it is gun violence or COVID or climate change, immigration, racism, health inequities, they're so interconnected to health. We have both the opportunity and the responsibility to help drive that change, but that's not traditionally taught. That's why right now we're seeing health systems really think about how do we empower our health care workers, our professionals, to be able to be part of that community as trusted public messengers and that's so important.
Dr. Ranney: Joe, if I can go off of that to go back to something that Eric said at the beginning, which is to also avoid medicalizing this. That although yes, physicians and nurses have a critical voice in the fight against firearm injury, whether it's homicide, suicide, unintentional injury, we cannot center this fight around ourselves. I think that there is a special power that comes when we come to the table, when we wear our white coats, when we tell the stories, either personal or HIPPA-appropriate stories of patient care. We saw that with This Is Our Lane campaign a few years back in 2018.
But, and, to never forget that a true public health solution and really the way that we are going to fix this issue cannot be centered on us and what we encounter in the hospital. By the time someone comes to us, we have missed so many opportunities for upstream prevention. Yes, it's about separating someone from the potential to access a firearm at that moment of desperation, anger, impulsivity, hopelessness. It is also though about changing all of those steps that puts someone in harm's way up until that final moment of being ready to pull the trigger. I think that we just miss the forest for the trees when we only focus on what happens after someone has been shot.
Dr. Maybank: Absolutely. Eric. I'm coming to you, Eric. I am right now. You're next. Thank you. I want you to build on that, but I also want you to talk from the perspective of being a current resident, but also Eric and I have had a lot of conversations and I know a lot of how Eric is rooted and it's very aligned with me. Just speaking to that role of the physician and the ideas of what is needed, and we talk a lot about revolutionary medicine and things of that nature, so I want you to speak to that of what is really needed in order to drive this change of how we think and operate. Not the literal operate, but maybe the literal operate, I don't know. I'm not a surgeon, but how we function as medicine.
Dr. Reinhart: Yeah. Everything that each person has said so far, I'm very enthusiastic about hearing this. Everyone here, I look up to enormously and you're each far more advanced professionally than I am. Your question, Aletha, I think is quite useful to think about from a training perspective.
From an institutional perspective, when you are looking to climb a hierarchy, most of the people with whom I train, they're planning to get jobs afterwards. They're hoping, some of them, at least that they're academic jobs. And in order to get those jobs, you have to abide by certain norms. You have to meet certain expectations. Nobody that I work with says, "We're going to go medicalize political problems," and end up causing unintended harm. Nobody is setting out to do that, but there are institutional structures that reproduce that harm and that medicalizing tendency time and time again.
I used to teach a course with Paul Farmer, an acclaimed anthropologist. We would focus, one of our main frameworks, we think about global public health, is thinking about the unintended consequences of purposive social action. We set out to do good and we end up abetting the perpetuation of the status quo, the deepening of inequalities and the medical apparatus in the U.S. has done this so many times. It's not through lack of good intent. It's in part because of the institutional normativities that are pressed upon us, and we absorb without recognizing it. I think going through training within a medical apparatus ... I realizing I'm using this term. This is in part from Foucault. He has this term, dispose of teeth, this idea of a social apparatus that embeds all of these norms inside us and we end up reproducing without recognizing it. This is, for Foucault, power.
Power is not acted upon us; it's acted through us and this is absolutely true of medical training. I think it's really important to ground oneself in communities, in ways of thinking, in mentalities, epistemic structures, ways of knowing, that are outside of these powerful medical institutions which are oriented around research grants, so NIH metrics and values, the bottom lines of the institutions for which we work, tenure lines and all the politics that go into that. These are not things that serve our communities. They may be hurdles that we have to get over it in order to be in positions to leverage institutional power for some other purpose, but that is a very difficult process and most people are absorbed into the norms of these institutions which are not aligned with the goals of the communities that we say we serve.
I think this is a very difficult problem to confront as a trainee. How do you ground yourself in ways of knowing the world, of valuing things that are not the cost benefit analysis of economists, but the cost benefit analysis of people who are living through the everyday texture of violence and loss and grief, and that's not easily put into a number and spit out in a paper for JAMA, but that's where we need to ground ourselves if we're to be faithful to the ideals with which we enter. That was maybe a very abstract response to your question, Aletha, but I think it's a huge question.
Dr. Maybank: Everybody showed up as their true selves, that's what I want. No, it's a beautiful response to the question. I appreciate it.
I'm not going to completely switch because I'm hoping we provided those who are listening in, again, the concepts, definitions, ways of thinking, narrative change, our role as physicians, so I want to speak to now the context of policy and advocacy because I think we all are very clear that that's really important within our institutions and then also big P outside.
Joe, you've led lots of advocacy and I would love for you to just speak to what that looks like at this point in time within your institution, but also how have you been operating externally with partners and what's really needed at this time from physicians and other health professionals as well?
Dr. Sakran: Yeah. I think health professionals have such an important role to play in advocating for gun violence prevention. When I look at this, really I'm blessed to be at an institution that really is supportive of the work that I'm doing both locally and across the country. As we heard earlier, that's not always the case. I think there's several things that health professionals can really do to really think about this both within the system and beyond. The first is within the health system, I think as health professionals we can raise awareness of the impact of gun violence on public health, which we've talked about. Educating our colleagues, patients and the community members about the risks associated with firearms and the importance of gun safety.
I think health professionals can also advocate for data-driven policy changes that can reduce gun violence. We've talked about this in so many different forums. Most recently, as you know Dr. Maybank, the American College of Surgeons with a number of other organizations, including the AMA, came together and brought together 46 different medical organizations across the country to really be able to look at this issue as the House of Medicine, which is tremendous. For the first time, we are hearing health professionals talk about supporting data-driven policy measures, which I can tell you when you look back a couple of years ago when we had the first summit as Dr. Ranney will remember, no one wanted to talk about policy at the time. There's really a transformation happening.
Outside of our health system, I think that health professors can engage in community-based advocacy efforts. There are many organizations. In full disclosure, I'm a board member of Brady United, and I work a lot with Brady United, but also other organizations that are working in the space because what has happened is we have seen these silos that exist across cities and states, which has really been detrimental to moving the needle forward. One of the things that we're trying to do is really break down those silos so we can work hand to hand in parallel.
Then the last thing that I'll say is I think health professionals, like so many people on this call, have engaged in research to better understand the causes and consequences of gun violence in America. This includes conducting studies on effectiveness of different prevention strategies as well as identifying risk factors for gun violence. Overall, we have a critical role to play.
Dr. Maybank: Thank you. Megan, as you start to think about your role, what's your vision on educating? Clearly, they're going to be public health students. Some may not be physicians, which is fine, clearly, but we want more physicians to have public health degrees, of course, or to have that context. What's your vision of how to educate the public health student of the future and what's the process that you'll go through to figure out what is best? You heard from a trainee here, Eric provided some context. I think that that's important to centering the voices of those who are experiencing training now and getting their ideas, but I would just love to hear from you how you plan to lead.
Dr. Ranney: Around this issue.
Dr. Maybank: Yeah.
Dr. Ranney: I think the most important thing and the grounding of public health, as the other three have already outlined, is really that basis in the public and in the community. If as I'm thinking about doing work around firearm injury prevention within the Yale School of Public Health, in conjunction with the Law School and the School of Medicine and the School of Architecture. There's absolutely an element of the built environment and of housing. The foundation of all of that is grounding it in the community experience.
The next step is understanding theory and you do have to understand theories of behavior change, whether it's on an individual level or on a societal level. There's no need to recreate the wheel when there are strategies that have already worked for similar problems in the past.
Then the third part is working in partnership to apply it and giving folks the actual opportunity to make that difference, to create change and to see the positive effects of the process. I'll say in my work with trainees—and I've been quite fortunate to have a number of both residents, fellows, master students, doctoral students—we have a current brand new faculty member who used to be a police chief and is now a faculty focusing on substance use disorder and the overlap with the justice system just published a marvelous paper in JAMA of all places showing that the amount of violence that youth are exposed to in urban neighborhoods far outstrips the amount of violence that people are exposed to in the military. Providing those opportunities where trainees have a chance to say, "This is an issue that matters. I'm going to get to know the community. I'm going to develop a skillset to be able to adequately describe and analyze it as," Joe outlined, "and then I'm going to do something. I'm going to use my own personal experience as well as my passion to help make a difference."
There are a thousand ways that we need to do that work to make a difference and I'm looking forward to bringing it to Yale, but it's also about the bigger picture. It's not about one institution. It's about us working with Southern Connecticut University and working in Hartford and in Bridgeport as well. There's a much bigger picture than any one institution.
Dr. Maybank: Absolutely. I also appreciate that and the context of a political education also oftentimes gets missed, and even a public health education. We have a fellowship, and I usually don't do this in this conversation, but I'm going to do it in this one. We have a medical justice advocacy fellowship where we have 12 mid-to-early-career physicians who spend a year with us. They say the most impactful part has been them actually going to the Hill and learning firsthand what it means to actually speak to a politician. Then it gets them a better sense of how they have to show up and what's important and relevant, but also how to tell the story that's relevant.
I think oftentimes, and I think Joe, you've said this. Eric, you're kind of saying that. You all have said this. We have to know how to show up in those spaces too in order to be effective as physicians and advocates. I think the more that we have that kind of education, the more helpful it is for us as individuals, but also as the collective. We start to have an analysis that is shared in common and I feel that it feels more healing.
As I talk about healing, Dr. Williams, Brian. You have a new book, “The Bodies Keep Coming: Dispatches From a Black Trauma Surgeon on Racism, Violence, and How We Heal.” Congratulations on that. Can you tell us a little bit about why you wrote this and then I'm going to ask the question of you about how do we heal? I want everyone to then answer that as well.
Dr. Williams: Sure. I wrote this book because I wanted to be part of the solution to all the social injustices that I think we witness, particularly in trauma and emergency medicine throughout health care, and move beyond the hospital and expand the group of people involved in the solutions, not just those that work within in health care. The goal was to reframe the narrative about structural racism and health care inequity and what it makes means to create justice today, not just talk about it or write about it or go to conferences. What work do we need to do to make that happen today?
I began this book, and the entry point is basically me as a trauma surgeon, but I wanted to explore the bigger issues that we're dealing with nowadays: structural racism, economic disenfranchisement, education issues. How those all come together. Because as Joe said earlier, these are all interconnected to health. These all cross our paths and impact our jobs and our roles. I felt, okay, let me bring you into this world that I'm in. How can I pull you in and show you the world through my eyes and then go on this journey and say, "Here's what's happening here in the hospital. Here's what's happening outside the hospital where you are. Now, how do we come together to create justice and move towards healing?" Because in the end, the most important part of this book, I feel, is it is hopeful. It's not an easy read, but in the end, it's meant to be hopeful and to show how we can come together to create a better future.
Dr. Maybank: Thank you. I'm just asking another question. Do you feel you changed in the process of writing this book? How are you after writing this, because I think that I speak to the power of us as physicians, and the possibility really for us to put our voices in places such as books and publications, I think is tremendous. All of you engage in writing, and I think from my experience, I've recognized there's a change in me after every time I write something because you go through a process. I'm just curious about did you change in any way? Did you learn anything about yourself as you went through the process?
Dr. Williams: I'll say the answer to both of those questions is YES, in all caps. They say that writing a book may not change your life, but it'll certainly change you. That's true for this. It's a memoir, so I'm telling personal stories. It's rooted in personal narrative. To share those things with strangers, that will change you, to think about what you're going to share. Recognizing that you were putting yourself out there for praise, but also critique, you have to prepare for that.
But in the end, it was very, very useful and important for me to do that because in doing so, it really forced me to think about the world around me and the role I wanted to play in making the world a better place. I could be a great clinician, an educator or research, do all those things, but really what is it that I can do to make the world around me on a large population level of a better place? Writing the book kind of forced me to articulate that and internalize that going forward so yes. I'm different than I was when you first asked me to do this podcast. I've changed that much.
Dr. Maybank: Yeah. The others, how do we heal? What do we have to do to heal as I think individuals and communities, society? I'll go with Joe. Joe, we'll go with you first. We'll start there.
Dr. Sakran: Yeah. Here's what I'll say is I don't think there is any one right answer. When you think about healing and you think about grief, I think each and every one of us, we deal with it in very different ways. I come to this conversation not just as a trauma surgeon, but as a survivor of gun violence. I think about my ability to do my job today and how am I able to do that, but I think part of it was, it's been quite a while. I was 17 when I was shot in the throat to getting to this point where there was enough time where I was able to process the trauma that happened.
I think a lot of times when you think about what we do as those of us that care for injured patients where we're making one methodical decision after the other, and we've often forgotten the mental and emotional impact that has on us as a team. Right now, we are starting to peel back those layers. Some people on our team, the way they heal is they talk about it, but some people, they need time before they can get it out. There's all sorts of different ways that I think have to be tailored to the individual. I don't think there's any necessarily one right answer, if that makes sense.
Dr. Maybank: Oh, absolutely. There's definitely not one right answer. Thank you. Megan?
Dr. Ranney: I believe that we heal but also create hope by doing the work to change the structures that got us into this place. At the end of the day, that is what creates hope. It's that sense of community and purpose and a sense of—honestly—control and action. I think that the biggest thing that any of us on this podcast, anyone listening to it, can do is to commit to being part of the change.
I couldn't agree more with Joe's statement about each of us is going to find that path in a different way. For some, it may be through our faith community. For some, it may be through a sporting community or through a cultural group, or through a specialty society or through an organization like the AMA. But finding those groups of people, and I will say some of the folks on this podcast have been part of that hope and healing for me, having that ability to lift each other up as we go forwards and make clear that there is a path is truly the only way.
Dr. Maybank: Thanks, Megan. Eric?
Dr. Reinhart: Yeah. Brian said as he was describing his book that one of the motivating questions is how do we come together to heal? For me, this is absolutely central. Care, in my view, healing, they're fundamentally participatory. They're collective activities. We have this imagination all for ourselves as clinicians, as people who go and care for other people. This is a pervasive idea of what caring is, a kind of unidirectional relationship, a kind of charitable humanitarian enterprise. This I think is really corrosive to the possibility of truly effective care within society where I care for somebody else, and they are simultaneously caring for me and caring for others.
I think one of the most important parts of healing is finding a way, being given a way, a role, a valued dignified role to care for others, to be part of a collective process in which the whole of society, the whole of a population is working upon itself and everybody has a role. What I've been formulating in my head is an idea of disability collectivity, that everybody has some kind of disability or another. That doesn't mean they're the same. We are in very different positions from which to act, but with every disability also comes a kind of corresponding insight and ability, a way to relate to people in a different kind of way. What would a society look like that's organized not around caring charitably for those who are disabled, who are sick, but for finding out and maximizing the potential of each person to participate in a process of collective care with one another.
To me, this is healing. This is not just an abstract ethical idea. This is very much a political idea. This is a policy question. How do we build health systems, not necessarily health care systems, but health systems that are grounded in the search for producing the community structures that are well funded. Not just saying, "I value year lived experience," but backing that with material investment and employment to participate in this kind of a care structure. For me, healing is about this kind of political work to produce the possibility of collective healing and participatory care.
Dr. Maybank: Thanks, Eric. We're towards the end. I could really continue on because I really have a lot of other questions for y'all but we're at 45 minutes. I really want to thank all of you. I see you; I follow you. Again, thank you for the leadership that you have shown this country and our profession and yourselves, really. You can see towards the end of the show and where I am and how I've evolved over my career is I can talk about the technicalities of all out of this work for sure, but I don't feel that that's where the human spirit is moved to do differently and to be better. It happens at the intersection of hearing each other's stories, being able to show up as our full selves so that we can connect with one another and as Eric said, value the dignity in each of us. Thank you for allowing the space to get to that point and I really appreciate you all for that. Thank you all for listening in for today and the panelists.
In closing, I do want to just acknowledge and highlight, we have an initiative called Rise to Health, which is a national coalition for equity and health care. Again, kind of building on the same principles that we're talking about today, about what does it really mean to have collective care and to be in coalition with one another. For more information, you can go to www.risetohealth.org and also, we launched National Health Equity Ground Rounds. We had a sighting session, the first one. The next one is on May 9 called, “Follow the Money: Understanding the Structural Incentives for Inequity in Health Care and Beyond.” I don't think we've announced who's going to be on that conversation, but it's kind of good so I hope you all are going to be able to tune into that. Thanks again and take care everyone.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
