Scarcely a day goes by without news of a shooting resulting in serious injury or death in an American city. Mass shootings, defined as involving four or more victims, have also become commonplace–in schools, malls, houses of worship, and restaurants. What is not as widely reported is the ongoing epidemic of suicide by firearm in the United States. In 2022, 48,117 American lives were lost to gun violence, 26,993 of which were from suicide.

We are at risk of becoming desensitized to this terrible reality with the resultant belief that there’s simply nothing we as individuals or organizations can do to stem the tide of this epidemic.

There are many steps we can take as individuals and organizations to prevent these tragedies. First, we must agree that firearm injury is a public health issue. Firearm injuries are also a health equity issue. Firearm homicide rates are highest among teens and young adults 15-34 years of age and among Black or African American, American Indian or Alaska Native, and Hispanic or Latino populations. Black children and teens have a gun homicide rate 20 times higher than their white counterparts. In 2022, for the first time, suicide rates among Black teens and youth surpassed those of their white counterparts.

Physicians have an ethical obligation to promote the well-being of our patients; thus, we have an obligation to take appropriate actions to avert the harm caused by violence and abuse. Questions about firearm injury prevention should become part of routine primary care, like asking about substance use and smoking. Unfortunately, studies show that a very small percentage of patients surveyed report that a physician has ever talked to them about firearms. There are several reasons for this, including time constraints, clinician unfamiliarity with guns, and concern that such discussion might alienate patients. But in surveys of gun owners, 66% say it’s at least sometimes appropriate for a physician to discuss gun safety with them. There’s a clear practice gap that primary care can fill.  First, we must educate ourselves on best practices to have these conversations.

Fortunately, many high-quality resources are available to clinicians who want to become more knowledgeable about how to best discuss firearm safety. The University of California at Davis School of Medicine’s BulletPoints Project offers a free online CME for clinicians to learn the basics of firearms as well as counseling on firearm safety. There’s evidence that clinicians at all levels who are initially uncomfortable with counseling can become more confident and comfortable initiating these discussions with their patients with focused training.

The Texas Primary Care Consortium (TPCC) has engaged a group of community members and leaders with expertise in firearm injury to examine Texas-specific data on firearm injuries and deaths as well as to gain a better understanding of the existing programs and services that focus on prevention of firearm injury. In addition, at the upcoming TPCC Summit, we are featuring a plenary session on firearm injury on Friday, November 3. The panelists are Sandra McKay, MD, FAAP, associate professor of pediatrics at UT McGovern School of Medicine and Ronald Stewart, MD, chair, department of surgery at UT Health San Antonio. The session will focus on evidence-based strategies to reduce firearm injury and the critical role primary care can play.

Together, we can make a difference and keep Texans safer.

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Sue S. Bornstein, MD, MACP

Executive Director, Texas Medical Home Initiative

Co-Lead, Texas Primary Care Consortium