Trauma surgeons see horrific injuries everyday. But wounds caused by gunshots can affect some doctors, nurses and other health care professionals in a profound and unique way.
Dr. Stephanie Bonne, a trauma surgeon at University Hospital in Newark and an associate professor at Rutgers New Jersey Medical School, said the difference between gunshot wounds and other traumatic injuries is that gunshots are intentional.
Bonne is an advocate for community-based intervention programs that address mental health issues and gun violence as a public health crisis.
“We see a lot of unintentional injuries – motor vehicle accidents, falls. With gun violence it is intentional. Somebody wants to hurt somebody else, you know that it’s preventable, a lot of other types of injuries are preventable too, and it just feels more preventable.”
Bonne said that even among other intentional injuries, wounds due to gun violence are particularly dramatic.
“It’s so easy to kill somebody with a gun, it’s hard to kill somebody with a knife or with your fists. You don’t have to get close to them: you don’t have to look them in the eye. The lethality of the means is so great.”
Several studies have revealed that posttraumatic stress disorder (PTSD) among trauma surgeons is associated with gun violence along with physician burnout, depression and suicide.
“Trauma surgeons have PTSD rates similar to combat veterans,” said Bonne.
“We have not had a discussion about what is the connection with survival burden, survivor guilt and PTSD of what we see in the ER that certainly transcends gun violence,” said Bonne.
Why is this happening to doctors? Bonne said that it is an area that hasn’t really been addressed.
“Maybe it’s not burnout but the moral injury that comes with treating problems that seem insurmountable. Problems that just keep coming, the patients just keep coming.”
Bonne said that the moral injury part has more to do with violence and it leads health care professionals to ask questions like who are we as a society that people want so badly to hurt other people.
“I really want to understand why this problem is happening and how we can fix it. There’s a science to that, there’s a science to the public health approach, there’s a science to the medical approach. That’s really a better way to describe it.”
Bonne acknowledged that the pushback from pro-gun lobby is strong but said that she is not antigun, but rather “anti-bullet hole.”
“I’m talking about what I see and drawing attention to the fact that this is a problem. We’re not trying to go after anybody’s guns; we are interested in the root causes of violence and mental health.”
Last year doctors clashed with the National Rifle Association when a physicians group published a paper on reducing firearm injuries. The NRA responded with a tweet criticizing the doctors saying: “Someone should tell self-important anti-gun doctors to stay in their lane.”
Bonne said that the public health approach recognizes that while it is a root cause issue, it is also an access issue and that having access to weapons certainly exacerbates the problem.
“You can’t unmarry that from the problem,” Bonne said.
Bonne said that she would like to see more attention paid to preventing children’s access to guns including teaching families about safe storage of weapons so children don’t have access to them.
“I would like to see more research on violence, why it’s happening, how we can provide the resources to prevent the problem that ultimately is made worse by putting a gun in the room,” said Bonne.
Dr. Nicole Fox, a trauma surgeon at Cooper University Health Care in Camden said whenever doctors see a person intentionally harm another individual it is disturbing.
“To see people injured and dying on a daily basis is a very stressful thing. This is a high acuity field of medicine and the stakes are tremendous. To see injured patients every day, whether it’s related to gunshot wounds, stabbings, motor vehicle accidents or falls, this can certainly contribute to PTSD.”
Fox said everyone has a different mechanism of dealing with the stress of the job.
She noted that time outside of work is important including time to process everything that you do on a daily basis.
“Most of us have hobbies. We spend time with our families and we find a way to decompress outside of work where we can focus on something that is not related to what we do every day.”
Fox cited data indicating that one physician dies every day by suicide. She said among the contributing factors to PTSD according to a recent study in the Journal of Trauma and Acute Care Surgery are a high operative caseload, a high number of calls per month, and having less than four hours of relaxation per day.
“Once you recognize PTSD in one of your colleagues, one of the questions is what do you do? Once you have seen it and you know it is there, how do you help them address it, treat it, and deal with it? That must be the next step.”
In another national survey published in the Journal of Trauma & Acute Care Surgery that explored unveiling posttraumatic stress disorder in trauma surgeons revealed that, both symptoms and the diagnosis of posttraumatic stress disorder (PTSD) are common among trauma surgeons.
Survey data suggested that defining the factors that predispose trauma surgeons to PTSD might be of benefit to the patients and the profession. Researchers determined that information from the survey would be useful to major national trauma surgery associations for developing targeted interventions.
An article published in The Journal of Medical Practice Management noted that PTSD is under-recognized in physicians. The article is based on a study, stated that five types of physicians appear to be particularly prone to developing PTSD: emergency physicians; physicians practicing in underserved and remote areas; physicians in training; physicians involved in malpractice litigation; and physicians who are “second victims” in the sense that they are indirectly exposed to trauma.
In addition to experiencing trauma, the cumulative stress of practice may cause PTSD, the study concluded.
And an article in the Annals of Emergency Medicine reported that the dangers of untreated PTSD affect physicians personally, with significantly higher rates of suicide, depression, anxiety, and burnout, and professionally, with increased errors and inefficiency.