When firearms violence hit the internal medicine practice of AMA member Douglas DeLong, MD, the patient who died was not the victim of a mass shooting or a homicide. Dr. DeLong’s patient, an otherwise healthy 80-year-old man who never hinted at feeling depressed, shot himself with a pistol.
Dr. DeLong still recalls clearly the day decades ago when a patient’s wife walked into the office with the tragic news, went into detail about what she found and—although she didn’t say so—Dr. DeLong got the message that she blamed him for not recognizing that her husband was struggling. Feeling that he would be unwelcome at the funeral, Dr. DeLong chose not to attend. He also never saw the woman again as a patient.
“How can you not blame yourself? Every physician has moments like this. There’s no doubt about it,” said Dr. DeLong, an internal medicine physician in Cooperstown, New York, and alternate delegate for the AMA Senior Physicians Section. “Everyone is acutely and painfully aware of what an issue gun violence is. We see it on the television on a daily basis, but it's not well enough appreciated that the majority of gun violence—greater than 90%—are not mass shootings.”
In fact, “60% of deaths due to gun violence are due to suicide. And the majority of those—if you were going to stereotype people—could be somebody like me: an older, rural, white gunowner. Those are the people who are most at risk,” he explained. “Further, we know from other studies that physicians are just not comfortable talking to their patients about guns and clearly this is something that is ‘in our lane.’”
“If you can make that intervention in something that's a transient phenomenon prevented from happening, that's a great thing,” Dr. DeLong said. “And you won't be shocked like I was when someone's wife walks into your office one day and says their husband killed themselves.”
From creation to adoption, Dr. DeLong shared the process of moving his resolution that addresses firearm violence and suicide among older adults to policy during the 2022 AMA Interim Meeting in Honolulu.
“Writing a resolution, first of all, comes with an idea, but the fact is it's really hard to come up with a new idea that some smart person hasn't already thought about,” said Dr. DeLong. “That's why you have to go to the policy.”
“There've been thousands of really smart physicians that have preceded me, and the AMA does have a fair amount of policy on guns, but it doesn't really highlight suicide in seniors by guns. I'm trying to be laser-focused—it's trying to be simple,” he explained, noting “writing it is the hard part. Then keeping it simple, keeping it germane. And then going through our [Senior Physicians] section was relatively simple.”
“I’m asking the AMA to do a couple of things. No. 1 is an educational piece to help physicians be more comfortable, to be able to efficiently and effectively screen those folks who are at highest risk without any more burden to the already burdened primary care physician, which is something I did for 45 years,” Dr. DeLong said. “We can't add more clicks to the EMR, but there are ways of doing it quickly and efficiently.”
Specifically, in adopting the resolution that Dr. DeLong advanced, delegates directed the AMA to “develop and disseminate a formal educational program to enable clinicians to effectively and efficiently address suicides with an emphasis on seniors and other high-risk populations.”
“And further, we now also have—in most states—these Extreme Risk Protection Orders, which are always known as red flag laws, but they differ from state to state,” he said. “I would almost guarantee you that very, very few physicians are really comfortable or knowledgeable about what is allowed or not allowed in their particular state. So, I'm asking our AMA to come up with a toolkit to tailor information for physicians.”
“The third piece of it is, I want to publicize and shine a bright light on the fact that most gun violence is suicide and I'd like to partner with other organizations to publicize that because it's critical,” said Dr. DeLong. “There are more than 40,000 deaths due to gun violence annually and if 60% of that is suicide that's potentially a lot of lives that we could save if we could identify those people.”
Specifically, delegates directed the AMA to “partner with other groups interested in firearm safety to raise public awareness of the magnitude of suicide in seniors and other high-risk populations, and interventions available for suicide prevention.”
From giving grand rounds and writing policy papers and editorials to recording a story slam video and being a guest on an episode of “Annals Consult Guys” from the Annals of Internal Medicine, Dr. DeLong has had a fair amount of experience discussing resolutions with others to gain traction in the AMA House of Delegates.
“It’s important to be articulate when you’re testifying or having a debate,” said Dr. DeLong. That means “just sticking to the facts and not being confrontational. ... People will do the right thing if given the right information.”
“No one wants to write a resolution, get it passed and then just have it in some sort of compendium booklet and do nothing at all,” said Dr. DeLong. That’s why “you really want to have specific asks in your resolution.”
For example, in the resolution on addressing firearm violence and suicide among older adults, Dr. DeLong asked to develop an educational project and toolkit while partnering with other organizations to educate physicians.
“The best resolution is a simple resolution,” he said. Firearms violence is “a significant public health issue. It’s amenable to preventive care.”
In addition to better training, physicians “also need the help of the public,” Dr. DeLong said, so that there’s greater awareness that the toll of firearms violence is not restricted headline-grabbing mass shootings.
“It’s this day in, day out tragedy of suicide by guns in older men in rural areas. That was just completely under the radar, and I’m trying to shine a bright light on that,” he added.