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Do gun violence prevention programs work? Why is my doctor asking if I own guns? Why are doctors asking about guns? How can doctors help with gun safety?
Our guest Chethan Sathya, MD, director of the Center for Gun Violence Prevention at Northwell Health, joins to discuss the critical issue of gun safety and how hospitals can use a strategic framework that includes community engagement, research, policy development, clinical integration, and medical education. Dr. Sathya emphasizes the importance of screening patients for gun violence risk and how the AMA is advocating for firearm violence prevention to create impactful change. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Chethan Sathya, MD, director of the Center for Gun Violence Prevention, Northwell Health
Transcript
Dr. Sathya: There are evidence-based strategies that are health care-based that can save lives. Safe storage counseling and providing those who have access to a firearm with a gun safety device and some safe storage counseling around keeping firearms safe, which the AMA has done incredible work around.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about strategies to prevent firearm injuries and deaths, and the role that health systems and practices can play.
Our guest today is Dr. Chethan Sathya, a pediatric surgeon, vice president of strategic initiatives, and director of the Center for Gun Violence Prevention at Northwell Health in New York. Dr. Sathya is also the American Pediatric Surgical Association's representative on the AMA Firearm Injury Prevention Task Force. I'm Todd Unger, AMA's chief experience officer, in Chicago. Welcome, Dr. Sathya.
Dr. Sathya: Thanks for having me, Todd.
Unger: I'm excited to talk to you today, as gun violence is such an important issue. And it's one that both you and Northwell are deeply committed to. Let's just start with a basic question about what motivated you to get involved in this work?
Dr. Sathya: Thanks, Todd. You know, I think what motivated me to get involved in gun violence prevention is probably similar to what motivates many frontline health care workers. You know, I actually treated my first child with a gunshot injury in Chicago about five years ago, and it's a case that really does stick with me.
It was a six-month-old infant sitting in the back of a car, shot by a bullet, while sitting in a car seat. And I still remember the horrific expression of the parents when that baby rolled into the trauma bay, my fingers on the bullet wounds and what that experience was like. And that was certainly, unfortunately, not the last, right? We've seen many, many children injured by gunshots in Chicago, and now, here in new York.
And that's certainly what motivates me to say that this is a health care issue. It doesn't matter which side of the political aisle you're on. We have to do something about it, and we know a public health approach can work.
Unger: That is a harrowing story and sadly repeated far too often, and far too many physicians seeing the same thing. I guess the good news is that you're certainly in a great place to make a difference.
Northwell has been a leader on this issue for years. Talk to us a little bit about Northwell's commitment to preventing gun violence.
Dr. Sathya: Yeah. You know, when I started here in 2019, at the end of 2019, I came here as a pediatric surgeon, and you know, came here to be our trauma director at our largest level one pediatric trauma center here in New York, which is part of Northwell Health, which is the largest health system in New York and the largest employer in New York.
I never imagined that our CEO and our C-suite leadership would say, let's prioritize gun violence prevention as a public health issue and as a health care issue at the same level that we want to prioritize tackling cancer, heart disease, maternal mortality, you name it.
So as a frontline worker, I had met dozens and hundreds of my colleagues who were passionate about this, but I didn't realize that there was such a paucity of health care leaders at the health system level that were really engaged on this topic.
You know, when we initially embarked on this journey back in 2019, very few health system leaders wanted to join. They had political concerns. They thought maybe it wasn't worth their time, or they had fiscal concerns.
But now, fast forward four or five years, the coalitions have grown. We have a coalition of 600 hospitals from 38 states that are focused on this topic. We have a new health care CEO council, where 60 of the largest health system CEOs are committing funds to tackle this from a health care lane. So certainly things have changed. And it's been inspirational to be at an organization that has prioritized wanting to tackle this and wanting to change culture across the entire organization.
Unger: It's funny. I guess if you kind of rewind and think about it, it's got to be kind of a hard issue to figure out where to start. There are so many things and got to be, questions about where you can make the biggest difference to prevent gun violence.
At Northwell, you break down your work into five key areas. I think this framework will be helpful to other folks out there. Can you tell us a little bit about the five areas?
Dr. Sathya: Yeah, absolutely, Todd. So I think you're spot on. I mean, it's difficult at times to conceptualize, how are you going to take on such a big issue? And that in itself can create some inertia.
What I would say, just as a broad kind of context for any folks who are listening, you know, either as health care workers, health care leaders, administrators, is first and foremost understand the communities you serve, and what type of gun violence are you trying to prevent?
We have hospitals across the country who might be in Utah, for example, and their primary driver of gun violence is actually firearm suicide, right? There are others whose primary driver of gun violence in their communities tends to be interpersonal, firearm homicide or violence. Others, it might be unintentional injury or mass shootings.
You really need to get to know the communities you serve. Hear from those communities to understand what your strategy should be first and foremost.
Then, it's a matter of focus. You know, we have divided our center and our strategy across five pillars, as you mentioned. We have over 110 different initiatives trying to tackle all those different aspects of gun violence, because we do serve folks across all of Long Island, the five boroughs, Upstate New York, so we do see the whole gamut of gun violence. And hence, we have protocols that tackle firearm suicide, unintentional injuries and homicide, as I mentioned.
But those five groups are centered around things such as, you know, developing a public health policy framework to tackle this. We know policy is integral to public health. We have a research component where we research new protocols. We have a community engagement arm where we work extensively with gun owners, law enforcement, community violence intervention groups and schools.
And then we have a clinical integration arm, and I definitely want to spend a little bit of time talking about that as well, in a second, because it is pertinent to the screening effort that we've integrated within our health system. But in addition to that, the last arm is really medical education. It is absolutely critical that you educate health care workers, medical students, trainees on what you mean you want to do when it comes to gun violence prevention.
What does that mean? There is a ton of hesitancy and bias as to considering, you know, even among health care workers, should this be prioritized? And we found that, that education was very integral.
Unger: You mentioned a screening program for patients, and how important that is in the scheme of all the different initiatives. Tell us a little bit more about how it works.
Dr. Sathya: Yeah. So, you know, we—one thing that stuck out to us when we initially embarked on this journey was the fact that there are evidence-based strategies that are health care-based that can save lives. Safe storage counseling and providing those who have access to a firearm with a gun safety device and some safe storage counseling around keeping firearms safe, which the AMA has done incredible work around—Meaning having firearms stored securely, locked up without ammunition—that's critical. That can save a life. That can prevent a suicide, a domestic violence incident or a homicide in the household.
We also know that offering patients who are at risk, community violence intervention resources can significantly drop and stop the chance of being in a cycle of violence and getting shot. However, over the last 5 to 10 years, we've seen, though the evidence has supported those efforts, only a minority of physicians or health care workers across the country ever actually talk to their patients about gun injury risk.
Think about it, right? You know, there are pockets of folks, particularly in pediatrics, that do it. But if you look at medical specialists and generalists as a whole, it's very rarely integrated into our usual conversation. So we wanted to change that.
So we took a similar approach to what we did with substance use, where we universally screen all patients, which is a little bit a shift of the paradigm, right? Most gun violence screening happens in a targeted way, with the means to integrate this into usual care.
So what we did is we ask all patients—this is part of our NIH funding that we actually got in 2020—we ask all patients to come to Northwell Emergency Departments questions about gun violence risk. So you come in with belly pain, a headache, urinary tract infection, you're going to get questions about access to a firearm. And we actually ask questions about violence risk, as well. These are different questions that kind of, basically, predict your risk of being shot if you live in a community where a lot of violence is happening. And if you're at risk, we offer resources. Gun lock, safety counseling, violence intervention.
So we now ask these questions at scale, just like we ask questions to patients about drowning avoidance, seat belt wearing, exercise. We now ask these questions as part of usual care. And we've screened nearly 96,000 patients as a result.
Unger: Wow, that's phenomenal. A practical question. When you think about screening people, there's got to be some limitation to the amount of screening questions. How do you prioritize all of the things that you need to know to take care of somebody?
Dr. Sathya: Yeah. It's a great question, and it's only getting more and more complex. You know, when it comes to social determinants of health, gun violence screening, mental health screening, substance use screening, and a whole host of other things, there are only more and more questions that are coming out every day.
So one key factor for us has been a team-based approach, right? We don't rely on just a physician, a nurse, a social worker to do this type of program. It's very much a team-approach.
Nurses do the pre-screen. Physicians come in for more of the screening. Social workers or dedicated health coaches or violence interrupters that we have employed in the hospital, then do the intervention. So it's very much a shared accountability, which does help.
But at its core, technological integration is really, really helped with this. Integrating these questions into our EMR. Allowing for novel development of apps, for example, that are just patient-facing that really, at some level, take the health care worker out of the equation, and only offer the health care worker for the intervention is another strategy that we've been exploring and using that has been particularly helpful.
So I would say technology has really been a key, and will continue to be a key if we are going to, as providers, actually screen for all these different things, considering how many patients we need to see, and, you know, throughput is incredibly important.
Unger: So this is a big program. It's a lot to take on. Are you seeing the results that you hoped from doing this?
Dr. Sathya: Yes. You know, when it comes to screening—so as part of the center, of course, our coalition efforts have been really eye-opening. You know, just even the collaborative that I mentioned, we launched a learning collaborative in 2020 to bring hospitals together to talk about this topic and to implement best practices, that has led to a 50%, 52% increase in the number of those 600 hospitals actually implementing gun violence programs for the first time.
So we're definitely seeing that type of implementation. Learning collaborative is actually moving the needle. People are starting to implement these programs at scale.
When it comes to our screening effort, yes. I mean, we went from not doing any screens, to now doing these 96,000 screens. We're expanding the screening program to ambulatory centers, to other service lines within our system, and to other hospitals across the state and the country.
There are dozens of hospitals that are now integrating this type of screening effort, as we develop this blueprint of how to successfully implement that work. This has resulted in thousands of life-saving interventions to patients that we, honestly, every day find out, we would have never known were at risk, whether it be related to access to a firearm or violence risk.
And it's switching the dialogue to not only making this a public health issue, but really taking a primary prevention approach, where we don't need to wait till someone's shot to try to do secondary prevention. We're trying to integrate this stuff as part of usual care right away, to have that primary prevention. So we're certainly seeing that change.
And one other thing, Todd, is, I mean—we're an organization of 100,000 people. We now have tens of thousands of our employees who are excited about this topic. Every Friday, they wear orange.
At the start, there was a ton of hesitancy among health care workers, but that culture was able to shift. And with this ongoing epidemic, guns being the leading cause of death among kids, most Northwell folks are very, very proud that we're trying to do something about it.
Unger: Gosh, I love that example, too. To see a program drive culture is just so very important, and I also am so impressed by how something that you start at your system can then move across the nation in terms of getting other organizations on board.
If physicians want to get their organization to get more involved, what kind of business case do they have to present to their leadership to convince them?
Dr. Sathya: You know, that is another exceptional question, and I think one that we have not spent traditionally enough time talking about, right? I think when we discuss things like return on investment or, you know, what considerations does a system have to take to make those investments, this is an important question.
So I would say that this extends beyond gun violence, right? I think that this really extends to a number of different social determinants of health.
At its core, though, remember gun violence injuries are extremely expensive to treat, right? We know that they're much more costly to treat than other types of trauma, blunt trauma included, speaking to the complexity of these wounds. And the majority of those patients are on Medicaid, right? We know that from the studies.
So there is an argument to be made at the administrator level as well, that these are not patients, you know, given the differential reimbursement rates that you get from the state versus what a health system actually pays in cost, you know, this is a big hit to health system finances. So the more prevention that can be instituted, the less that you're going to have that incremental deficit, as a result of what I just talked about.
And I do think that there is something to be said about also wrapping this into many health system's value-based care models, as primary prevention. As they're looking to be more efficient with cost, that's generally how we've been framing it successfully. Yeah.
Unger: That is a great example. And thinking about your personal impact, not only the work that you're doing at Northwell, you're also a leader within the AMA Firearm Injury Prevention Task Force. I'd love to hear a little bit more about your work on the task force, and how you hope to make a difference more broadly across medicine.
Dr. Sathya: Yeah. You know, the AMA has done an exceptional job taking a leadership role on this topic. And I think there's just such tremendous potential there, given the AMA's reach, impact, and just ability to really shape the narrative. So I've been very inspired to see the AMA take that stand.
As part of the task force, you know, there's a variety of different things being developed.
Toolkits for positions. You know, how can you actually operationalize what we're talking about on this segment today into a manual to really allow folks to take that first step? You know, what can you do to combat gun violence in your community?
Everybody can do something. It doesn't matter if you're, you know, a nurse, a social worker, a clinician, a health care leader, an administrator, there's always something to be done. So articulating that has been a big focus of the task force.
One thing I'll call out in specific as well is that we have been embarking through our CEO health system coalition and the task force at the AMA on an Ad Council public awareness campaign that is, pretty much, you know, mostly funded by health systems. This actually bore out of that health system coalition I was talking about, where those CEOs are now stepping in, but the AMA has been an integral, integral, part of that.
And that is going to be the first Ad Council-focused campaign on guns being the leading cause of death among kids in history. And it is now, you know, in its early stages of inception.
For those of you who aren't aware, the Ad Council is, you know, one of the largest ad agencies in the entire country. They did Smokey the Bear and a number of other impactful public health campaigns. So this is a really unique opportunity to help health care voices inform a public awareness campaign so as to depolarize this issue, bring folks together, understand what they can do when it comes to primary prevention. Safe storage counseling, violence intervention.
And, you know, really find that common ground, because I'll tell you, Todd, in having this conversation with tens of thousands of families, every year, I have yet to find one American family on any side of the political aisle that doesn't want safety of their families, safer communities, less violence and no mass shootings. I have not found one family. And there's far more common ground than we think, so public awareness, public education is a big part.
Unger: I really appreciate that focus on common ground and common sense solutions to the gun violence issue.
Not surprisingly, with all the work that you're doing, in this arena, you become very sought after as an advocate on the issue. You spoke at the AMA Annual Meeting, South by Southwest. You've even been in a Netflix documentary.
What impact do you think that all of your advocacy has had, and why is it so important to have a physician front and center on this issue?
Dr. Sathya: You know, it's—well, first and foremost, of course, you know, this is a collective effort. There are so many incredible physician leaders who have really led the way on this, researchers who have paved the path for folks even like myself to get engaged on this.
So, you know, very much, such a coalition effort. I think, again, that's one of the great things that the AMA has done, is bringing a lot of those folks together, provided us a platform to talk with one another.
And you know, I will say, almost all the strategies we have that I'm talking about were informed by incredible work that was done in other hospitals. You know, whether it be Hopkins, University of Chicago, a lot of our partners, so a big shout out to all those folks.
I do think the collective effort has really been able to, in the last three or four years, push this topic much more into the public health and health care space. Again, if you see the momentum shift from the number of health system CEOs, large health system CEOs, starting to take this on, it's been huge.
Kaiser, just recently started a center. There's a number of other hospitals that are starting centers.
We're seeing more congressional folks wanting to engage in this conversation, even on the Republican side, as it relates to public safety.
We are seeing state offices of gun violence prevention collaborating with hospitals in almost every state.
And as you know, the recent Office for Gun Violence Prevention at the White House was very much born out of that collective advocacy and from a ton of doctors, you know, different advocates, outspoken critics kind of advocating for more need to focus on this.
So I would say there's been a direct correlation with more investment, change in policy. We saw the bipartisan Safer Communities Act come out, which was the first bipartisan legislation on this topic in 30 years, and just general movement across health systems, which we haven't seen ever before.
Unger: Dr. Sathya, thank you for everything that you're doing at Northwell, the AMA and beyond. We really appreciate you joining us today and sharing your perspective and advice.
If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join.
That wraps up today's episode. We'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
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.
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