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When the Patient is Packing

June 30th, 2016 | Posted by in Uncategorized - (0 Comments)

Subject: handguns in the clinical setting

 

As discussed in this morning’s Risk Management presentation following the M and M reports there have been several issues related to patients carrying handguns into the exam rooms during regular doctor/patient visits. The specific case discussed involved a patient who is a federal agent who is fully authorized ( and expected) to carry her weapons at all times and therefore expects to keep them with her during medical visits. A variety of responses to such a scenario were discussed including a reasonable resolution to the initial encounter ( a substitute physician provided care to the patient that day and the clinic manager is looking into providing a lock box for safe storage behind the counter.)

Following today’s meeting I visited the Security office at the UMHS for clarity on policy. I learned the following:

Federal agents are indeed exempt from the restrictions regarding carrying of firearms into the Health System facilities. Traditional law enforcement personnel are expected to report at the front desk that they have weapons and are only allowed to carry if doing so in the performance of security enforcement. Otherwise they check their weapons in a safe location i.e. a lockbox at the hospital.

 

In no case are patients or their visitors/ family members allowed to carry weapons into the UMHS facilities with the exception of federal agents as described above. If you discover such a breach has occurred you are encouraged to alert Security of the presence of a weapon/s in a manner that respectfully informs the carrier of the hospital policy but hopefully does not inflame emotions.

 

A patient such as this federal agent should have anticipated the concern her weapons would cause and explained in advance to the staff and her physician that she can and will carry handguns with her at all times.

 

FYI, in my retirement I have become more active in an organization called Physicians for Prevention of Gun Violence ( PPGV ) which is locally based but whose membership rolls number over 400 physicians across the state.  We have made presentations to various groups of physicians in a Grand Rounds format at over a dozen hospitals and residency programs ( Fam Med, Peds, Int Med) with a focus on recognizing our patients who may be at greatest risk of gun violence. These include CHILDREN, DEPRESSED INDIVIDUALS, PATIENTS EXPOSED TO INTIMATE PARTNER VIOLENCE.

Our message :

  1. Ask about guns in the home and safe storage plans
  2. Provide safe storage info ( UM Injury Center has a great 2-sided handout)
  3. Consider any gun in the home of a depressed patient as dangerous and urge removal.
  4. Be alert to signs of intimate partner abuse (e.g. a set of routine risk questions in our current UMHS health maintenance q’airre) and inform of the greater risk of gun violence in this setting/ direct toward counseling.)
  5. PPGV has decals for your office/home preventing guns. $1.

Thanks, Jim Peggs

www.PPGV.org

Orlando

June 13th, 2016 | Posted by admin in Uncategorized - (0 Comments)

Dear PPGV Members,

As we reflect on the unspeakable events in that occurred in Orlando this past weekend, it is impossible to find words that adequately describe our sadness, anger, and horror. We extend our thoughts and prayers to the victims and their loved ones who must suddenly adjust to circumstances that are beyond comprehension.

One way in which we can be helpful in this time of grief is by encouraging individuals to donate blood to assist survivors who are currently fighting for their lives in Orlando area hospitals. Although the immediate response to calls for blood donations was overwhelming, there will be an ongoing need for blood in the days to come. If you know anyone who lives in or around Orlando, please urge them to contact OneBlood at www.oneblood.org or call 1.888.9Donate to arrange to make a donation.

As we keep the victims and their loved ones in our hearts, let us continue to speak out loudly to our local and national legislators to advocate for sensible gun legislation such as universal and comprehensive background checks and a ban on assault rifles. Let us also use our voices to teach our patients, co-workers, friends, and families about gun safety, safe storage, and prevention of access to individuals who should not have access to firearms including children, cognitively impaired adults, substance abusers, domestic abusers, and anyone in the midst of a mental health crisis.

As medical professionals and as compassionate human beings we must work together to heal our suffering society and to prevent our country from succumbing to the forces of hate, intolerance, fear, and destruction.

Thank you for your support of PPVG and for your commitment to promoting health, safety, and peace through the prevention of senseless gun violence.

Sincerely,

Physicians for Prevention of Gun Violence Executive Committee

MSU Tour Ends, Important New Members

May 27th, 2016 | Posted by admin in Uncategorized - (0 Comments)

Three members of PPGV, Bill Wadland, “Mac” Whitehouse, and Jim Peggs made the PPGV presentation “ Gun Violence and Firearm Safety: The Physician’s Role”  to two separate audiences in Grand Rapids last Tuesday, May 17. The first was at 8 AM Grand Rounds in DeVos Children’s Hospital to the Pediatrics residents and faculty. The second at 10 AM was to the Family Medicine faculty and residents at St. Mary’s Mercy hospital. Both audiences were attentive and receptive to our message about how to intervene in the clinical setting to prevent gun violence and how to join and speak out as a profession to change the grim statistics of gun deaths and injuries.

We enjoyed exceptional hospitality from Dr. Keith English, Chairman, Dept of Pediatrics, MSU. We also were successful in signing up 40 new members to lend their support to PPGV.

The MSU Tour lasted almost 1 year. Grand rounds were given at  MSU sites from Flint, Marquette, Traverse City, Midland, Alma (remotely), Grand Rapids and, of course, Lansing. Thanks to Dr. William Wadland for the MSU Tour- a great success for PPGV!

James Peggs

St. Joseph Mercy Hospital, Ann Arbor is on its way to becoming perhaps the first Michigan hospital physician council to commit to gun violence reduction with the latest leaders joining PPGV.  Drs. David Steinberg, Chief of Staff, and Bryan Popp, Department Head of OB-Gyn have joined us.  St. Joe now has more leaders than the UM where a similar campaign to align with medical chiefs is in progress. It’s a “race” to see which hospital will be first.

Jerry Walden

National Medical Council on Gun Violence Presentation Summary

May 10th, 2016 | Posted by admin in Uncategorized - (0 Comments)

Dear PPGV Members,

Last month Andrew Zweifler and I were pleased to participate in the National Medical Council on Gun Violence conference in Chicago.  This was a CME conference devoted to exploring how the medical community can make a meaningful impact in addressing the epidemic of gun violence in America.  Our talk, titled “Let’s Talk About Guns: Strategies for Successful Clinical Conversations” was well received and generated lively discussion.  In our presentation, we examined the many barriers that complicate physicians’ ability to talk with patients about guns, ranging from legal barriers such as “gag laws”  (otherwise known as the “Docs vs. Glocks” law in Florida) to general mistrust and fear that can directly impact the doctor/patient relationship.  Using the example of a “well child” visit as the context for illustrating successful strategies for discussing this topic, we emphasized the importance of building warm, genuine relationships with patients and also highlighted the physician’s role as an educator in providing common sense anticipatory guidance. Just as physicians routinely advise patients about the necessity of bicycle helmets, car seats, and smoke alarms, so must we educate our patients about the importance of safe gun storage and restricting access to people who should not have them such as children, substance abusers, domestic abusers, cognitively impaired adults, and anyone in the midst of a mental health crisis.

There were many incredible and nationally known speakers at this conference including Deb Azrael from the Harvard School of Public Health, Injury Control Research Center who spoke about the epidemiology of gun violence; Liza Gold – forensic psychiatrist from the Georgetown University School of Medicine and editor of the recently published book, Gun Violence and Mental Illness; surgeon Michael Hirsch of the University of Massachusetts Memorial Medical Center who spoke about an exciting and successful gun buyback program that he has developed in his community, and psychiatrist Elspeth Ritchie, professor of psychiatry at the Uniformed Services University of the Health Sciences who spoke about the unique difficulties related to gun violence with military service men and women. All of the presentations were outstanding. I am hopeful that the entirety of the conference will be made available online so that everyone can learn from the material that was presented. Here is a link to the conference brochure that lists all of the speakers.  We are especially grateful to Mike Weisser for organizing this event and gathering together this passionate and determined group of clinicians, researchers, and advocates.

One of the most exciting outcomes of the conference was a common desire amongst participants to incorporate gun violence prevention into medical training. Dr. Zweifler and I have joined a work group that is collaborating to put together educational materials geared for medical students, resident physicians, and physicians in practice. This is an exciting opportunity, and we welcome the involvement of anyone who is interested in collaborating. Please contact Dr. Zweifler (zweifler@umich.edu) or myself if you would like more information. We are only getting started now, but hope that we will be able to harness the momentum and passion generated in Chicago to make an important and necessary impact in the world of medical education.

It was an honor and a pleasure representing PPGV at this conference, and we look forward to continuing our work together to reduce preventable injuries and deaths due to gun violence in our communities.

 

Sincerely,

Sonya Lewis, MD, MPH

Andrew Zweifler, MD

 

Ken Silk Remembrance

May 8th, 2016 | Posted by in Uncategorized - (0 Comments)

Doctors- Kenneth Silk’s Memorial Service was held yesterday May 7 at the League on the UM campus. It was a wonderful tribute to a superb man. So many stories about Ken’s generous spirit and gifted life were shared by the many attending. There will be a Kenneth R. Silk, MD Lectureship in Psychiatry. To contribute to that on line go to victors.us/kensilk or write the UMHS office of Development. I have sent the following tribute to his family.

Kenneth R. Silk, MD                                                      Spring, 2016

Physicians for the Prevention of Gun Violence (PPGV) lost a strong partner in the fight to prevent gun violence with the recent passing of Kenneth R. Silk. Ken was a psychiatrist known and beloved in many circles – the Michigan gun violence circle is rather new and small. Ken joined us in the last 2 years and became important at once. His assets were a good sense of himself and his worth, a wonderful sense of humor, a keen intelligence and thoughtfulness. He was an academic, an administrator, a good writer and an editor. His career focused on borderline personality disorder, an entity thought untreatable for many years- a tribute to his willingness to work on a very tough problem.  He helped PPGV with our planning, thinking, and writing. With Ken we were working on a new gun violence curriculum for the University of Michigan. Gun violence is another tough problem and Ken was vital to PPGV.

Many of us in the medical community flinched when we first heard his diagnosis. His bone marrow disorder called for a complex response. Ken seemed centered. His family found him grateful and happy with the life he had led. He pushed on. He received a bone marrow transplant. The subsequent marrow failure dealt another blow and our fear returned. But, Ken seemingly had all he needed. He made plans. He volunteered for a PPGV medical talk in June.

His obituary mentions his mischievous streak as well as his ethical pursuits. We came to love these two parts of Ken. He was fun loving and he was serious about making the world a better place. He showed us how to live and then he showed us how to die. We are better for knowing him and will celebrate him and grieve his death. Thank-you Kenneth R. Silk!

 

Hospital Leaders Join

April 28th, 2016 | Posted by in Uncategorized - (0 Comments)
New Leaders Join PPGV
We want to introduce some new leaders to the group- we are very happy to welcome them and to have their help.
From the University of Michigan
1. Valerie Opipari, MD, Chairman, Department of Pediatrics and Communicable Diseases.
2. Max Wicha, MD, Founding Director Emeritus of the UM Comprehensive Cancer Center and Director of the Wicha Labratory.
From St. Joseph Mercy Hospital
1. David Fugenschuh, MD, Director of Radiology
2. Jeffrey Sanfield, MD, Chairman, Department of Internal Medicine
From Beaumont Hospital.
Samuel Bauer, MD, Medical Director, Outpatient Perinatal Clinical Services, Department of Obstetrics.
From Sparrow Hospital -Lansing
Gabriel Elia, MD, Nephrology
From Tulane University in New Orleans
Jane Andrews, MD,  Internist and Coordinator of Advocacy Program
Welcome to all of you! Thanks to Drs. J.Tulin-Silver, K. Orringer, B. Lozoff, W. Whitehouse, and T. Johnson who extended invitations this special group of new members! Our hope is that hospital-wide efforts to curtail gun violence may net new and better results!

Going to Chicago- National Medical Conference on GV

April 16th, 2016 | Posted by in Uncategorized - (0 Comments)

I am excited to tell you that Dr. Andrew Zweifler and I will be presenting a talk tomorrow at the National Medical Conference on Gun Violence held in Chicago. Our talk is titled, “Let’s Talk About Guns: Strategies for Successful Clinical Conversations”.  In our presentation, we will examine the challenges involved in discussing gun safety with patients, and we will offer ideas about how medical professionals can overcome these challenges in a clinical setting. The link below is to the program.

http://NMCGV%20Program%20-%20April,%202016.pdf

Over 100 Medical Groups-including PPGV Call for Gun Research

April 10th, 2016 | Posted by in Uncategorized - (0 Comments)

141 Medical Groups Urge Congress to Restore Funding for Gun Violence Research

Doctors call on lawmakers to “end the dramatic chilling effect” of a law seen as curbing almost all CDC firearm studies.

Dr. Ken Silk Refutes Michigan Gun Owners

February 28th, 2016 | Posted by admin in Uncategorized - (0 Comments)

The Discussion On Gun Control Continues After Kalamazoo Shootings

FEB 23, 2016

CREDIT WIKICOMMONS

Some groups are calling for gun control measures after shootings in the Kalamazoo area left six people dead, but not everybody agrees.

The Michigan Gun Owners organization say the core issue is not being discussed.  The group’s attorney, James Makowski, says it’s not a gun control issue, but rather a mental health one and that should be addressed.

However, those who would like to see more regulations, such as the Physicians for Prevention of Gun Violence group in Washtenaw County, say that’s not accurate.  Psychiatrist Dr. Kenneth Silk says most of the gun deaths in this country don’t occur in mass murders, but they occur because of impulsive actions people take.

There are about 500,000 licensed concealed pistol holders in Michigan.

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— Jorge Avellan is the Ann Arbor beat reporter and anchor for 89.1 WEMU News.  Contact him at 734.487.3363 or email him javellan@emich.edu

The Guardian gives PPGV an Op Ed

February 23rd, 2016 | Posted by in Uncategorized - (0 Comments)

When I attended a national meeting that focuses on gun violence, the National Physicians Alliance (npalliance.org) meeting last year I paid attention to 2 discussions, one led by a medical journalist and one by a union organizer. The journalist taught us to use the media as a friend, the unionist to tryto find out what your target wants.Both were very professional!

Yesterday’s Op Ed in the Guardian was both of these. My coleader, Andy Zweifler and I had spoken to HB 4795 in Lansing.  I sent a copy of my remarks to the Guardian. HB 4795 is the Preemptive Punishment Bill that would stifle dissent like the Ann Arbor School Board outlawing “Open Carry” in schools by charging court costs and fines to the dissenting party. And while in Lansing I looked for a newspaper writer, but found none. Then on Sunday I saw the invitation to write an Op Ed column and away we go! (I had mailed several pieces to other papers in vain before.) Give them what they want.
So here is the link again or you can google the Guardian and my name. Our legislature wants guns everywhere- we at PPGV and NPA don’t- it’s killing us!