Physiatry Forward: Our Lane
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Our Lane

Author: R. Sterling Haring, DO, MPH
Resident Physician at Vanderbilt University Medical Center, Doctor of Public Health Candidate at Johns Hopkins University, and AAMC Representative on the AAP's Resident/ Fellow Council

Few would argue that two of the nation’s top public health crises are firearm violence and opioid-related injury. For the first time in over two decades, the number of firearm-related deaths has surpassed that of motor vehicle crashes. In late 2018, the National Rifle Association published a tweet rebuffing evidence in the Annals of Internal Medicine supporting stricter regulation of firearms, in accordance with established research and overwhelming public opinion. In the tweet, the group instructed physicians to “stay in [their] lane,” arguing that firearm policy is, and should be, beyond the scope of the medical profession. The tweet incited an immediate and powerful backlash among the online medical community. Hundreds of physicians posted graphic images of trauma room floors or stories detailing the care they have provided for victims of gun violence. The deafening response was unmistakably clear: “This is our lane.” Physiatrists were among that response: An estimated 15%1 of spinal cord injury patients are victims of gun violence and in some cities, like Baltimore, the leading cause of spinal cord injury leading to paralysis is violence.2 Likewise, firearm-related injury is a major contributor to TBI-related deaths, accounting for nearly all such deaths by suicide.3

In addition to firearm violence, twenty-first century medicine faces other new and intimidating crises. Overdose is the single most common cause of injury-related death in the United States. An estimated 70,000 Americans died of overdose in 2018—enough to fill the NBA’s largest arena nearly four times over. Physiatrists are among the top prescribers of opioid analgesics, after primary care and orthopedic providers.4

Physiatry is an injury-oriented specialty. Just as pediatricians seek to optimize child health by offering vaccinations (primary prevention) and well-child checkups (secondary prevention), physiatrists can and must work to identify and, where possible, prevent injuries of all types. Unfortunately, there are no options as simple as immunization against motor vehicle crashes, falls, traumatic brain injuries, gun violence, or opioid overdose. But that doesn’t mean we lack tools. Injury prevention requires the implementation of evidence-based practices and policies, changing popular attitudes and opinions, and encouraging widespread behavior change. It means educating patients and caregivers at the bedside, but it also means educating lawmakers and journalists in committee hearings and media interviews.

Patient outcomes are directly and inextricably tied to political will. The integration of seat belts into modern vehicles is credited with saving nearly 15,000 American lives annually. Yet, like airbags, childproof pill bottles, helmets, and lead-free paint, even this standard faced substantial political and public pushback when first proposed. Today, despite widespread support by policy experts, battles rage on over evidence-based policies such as “red flag” firearm laws that allow police to temporarily remove firearms from individuals who make credible threats, or securable pill vials that facilitate the storage of controlled substances in lockable containers. We physiatrists must step up and carry the torch passed to us. We must seek every opportunity to speak, write, testify, and change the minds of lawmakers, colleagues, insurers, and the general public to ensure that these and other effective policies are enacted and enabled to prevent further harm to our patients.

The National Center for Injury Prevention and Control at the CDC lists five topics as their priorities: overdose, falls, TBI, MVCs, and violence. The list may as well read “physiatry, physiatry, physiatry, physiatry, and physiatry.” Engagement, activism, and prevention are our duty. These are our patients, and this is our lane.

References

  1. Jain NB, Ayers GD, Peterson EN, et al. Traumatic Spinal Cord Injury in the United States, 1993-2012. JAMA. 2015;313(22):2236. doi:10.1001/jama.2015.6250
  2. Robinson L. Gun violence often leads to spinal cord injuries in Baltimore. WBAL-TV. www.wbaltv.com/article/gun-violence-often-leads-to-spinal-cord-injuries-in-baltimore/7096840. Published October 30, 2015.
  3. Daugherty J, Waltzman D, Sarmiento K, Xu L. Traumatic Brain Injury–Related Deaths by Race/Ethnicity, Sex, Intent, and Mechanism of Injury — United States, 2000–2017. MMWR Morb Mortal Wkly Rep. 2019;68(46):1050-1056. doi:10.15585/mmwr.mm6846a2
  4. Chen JH, Humphreys K, Shah NH, Lembke A. Distribution of Opioids by Different Types of Medicare Prescribers. JAMA Intern Med. 2016;176(2):259. doi:10.1001/jamainternmed.2015.6662