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“As a parent of elementary school children, every mass shooting, particularly ones killing school children like in Uvalde, jolts my doing-the-mom-thing-just-keep-busy-can’t-stop denial. On the last day of school before summer vacation, when the bus doors squeaked open, and my kids hopped off, I experienced a momentary sense of relief. They were safe for one more day, at least from school shootings. I hugged my kindergartener and patted the head (that’s all I’m allowed to do) of my fifth grader. Now that a new school year is looming, it’s all I can do not to click on the article about bulletproof backpacks.”
Resources:
AAP policy statement: Firearm-Related Injuries and Deaths in Children and Youth
Lisa Park is a pediatrician.
She shares her story and discusses her KevinMD article, “Bulletproof backpacks: There’s more we can do.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Lisa Park. She’s a pediatrician, and we’re going to talk about her KevinMD article, “Bulletproof backpacks: There’s more we can do.” Lisa, welcome to the show.
Lisa Park: Hi, thanks, Kevin. Thank you so much for the opportunity.
Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.
Lisa Park: OK, so I’m a pediatrician with a subspecialty in adolescent medicine. I really love the adolescent and young adult age group, because they’re in this growth mindset where they’re trying to figure out who they are and what they believe in, and it’s fun and exciting to walk alongside them and give them good medical information so they know how to take care of themselves and advocate for themselves. I have a master’s in public health, so I tend to look at problems systemically, at the bigger picture and other factors that affect our patients’ health.
Most recently, I worked in college health for the last 10 years at a large public university on the East Coast, and I was the director for the last four. During those last 10 years, we all saw, and all of your clinicians know, and actually anybody in the U.S. knows, that mental health has just been an increasing concern among our youth, with increased acuity and complexity. So one thing we did at our clinic that I’m really proud of is that we established a behavioral health clinic embedded in our clinic. Any young adult who walked in the door would be screened for depression and substance abuse, and then if they screened abnormally, they would be hooked up with a mental health clinician right then and there at that visit. So we really reduced the barriers to accessing mental health care. That was my most recent job, and after the last few grueling years as a health care leader during the pandemic, I’ve now turned to writing and continuing to advocate for our adolescents in that way.
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Kevin Pho: So tell me, over the last few years while you were working at this college clinic, and I’m sure you’ve been seeing an increasing frequency of behavioral health issues, what about the toll that it took on clinicians like yourself and other staff members who were working there?
Lisa Park: That’s a great question. As you all know, if you’ve dealt with, and actually all of us have dealt with, mental health patients, it is something that really takes time, and you get really invested in their care, and it’s usually a chronic condition, right? Gone are the days in college health when we had simple problems like just homesickness, right? It’s homesickness plus anxiety, depression, and substance abuse.
So what we realized in primary care and college health was that our patients saw us as a resource, so that was great. They came to us for colds and things like that, but often they wouldn’t bring up these problems. They presented for fatigue, but really underlying that was depression, right? Unless we asked, they didn’t necessarily bring it up, because of a whole host of reasons, stigma, things like that. And so as a primary care team, we really wanted to buttress our knowledge of how to take care of these mental health concerns, because it’s so hard to access mental health as well. So it did take a toll, but I think having the tools in your toolkit on how to deal with those issues really empowers us and helps our patients.
Kevin Pho: So now you’re taking a break from clinical medicine, doing some writing and advocating. Do you see yourself going back?
Lisa Park: Oh, you know, during the pandemic, people always asked me questions, and I said, “I wish I had a crystal ball.” I love seeing patients. I think that somehow a mixture of both would be great for me and for my patients and my family.
Kevin Pho: All right, so let’s talk about the article, about one of the issues that I’m sure you’re advocating about. It’s titled “Bulletproof backpacks: There’s more we can do.” Now, for those who didn’t get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.
Lisa Park: Sure. When the school shooting in Uvalde, Texas, occurred, that was on May 24, and it killed 19 students and two teachers and injured 17 more, I reacted really as a mom, right, with just that shock every time, and sadness, and I just can’t imagine what the parents were going through. The school year hadn’t let out yet, so every day I would drop my kids off at the school bus stop and just pray and hope that I would see them coming off the bus again in the afternoon. I just felt helpless and powerless.
Over the course of the summer, I thought, “I can do more than this.” As physicians, or any health care providers, we like to solve problems, right? There has to be something we can do. So I drew upon my clinical experience with mental health patients and suicidal patients, looked at the evidence, and drew upon my experience as a mom, right, talking to other parents who felt similar distress. You had that med student who was great on your podcast, who talked about being in the ER. She was on a rotation. There was an infant with respiratory distress, and all the mom wanted to talk about was this recent school shooting. That’s me, and that’s us, right, when we hear these awful stories in the news. So the article really progressed and evolved from one of just raw emotion and powerlessness to, “Hey, we aren’t powerless. We can do things at every level to reverse this trend.”
Kevin Pho: So talk about some of the things that you do, not only in the exam room, but, like you said, as you step up and take a more macro view of it. But let’s start in the exam room. What are some things that you as a pediatrician can do?
Lisa Park: Yeah, and not just as a pediatrician, but really any of us in the health care field can do this. I think one thing is just realizing that firearms are here to stay. They’re common, and they’re lethal, right? Just to share some stats, there are 254 million firearms in the U.S., and an estimated 54 percent of households that have firearms don’t lock their guns, meaning their firearms are not stored unloaded, with the ammunition separate from the firearm. An estimated 4.6 million children live in households with unsecured firearms. So it’s common. Chances are, if you’re seeing any kind of patient, pediatric or any kind of patient, some of your patients have firearms, so we should get used to talking about it.
Kevin Pho: So take us into one of those conversations. Let’s say, take us into the exam room. Let’s say you were talking to a family whose firearms are not locked or not secured. Tell me how that conversation goes. What kind of questions do you ask them?
Lisa Park: Yeah, so the first thing is framing it as just something normal that I talk about: “Hey, we talk about not texting when driving, and seatbelts. So another thing that I want to make sure you’re safe about with your kids is firearms. Do you have firearms in the home? And then, if so, how do you store them?” We all think that we’re really great at hiding things from our kids, but we are not, right? They know where the best candy is. They know how to find all the dangerous things. So really, this is an anticipatory guidance type of conversation. Let’s talk about it before it becomes a problem and before it becomes deadly.
Kevin Pho: We live in a polarized society. Obviously, everything is politicized, especially guns. Do you ever get pushback when you bring up this conversation in the exam room?
Lisa Park: Actually, I haven’t, if I approach it in that way, like, “Hey, I talk to all my patients about this.” It’s kind of like any other sensitive topic, right? I talk about sexual health a lot in adolescent medicine, but just having the questions and practicing that language helps me just say it in a normal review-of-systems way, right? Like, “OK, well, let’s just go through this and talk about it, and how can we be safer about it?” And you’re right, it has become polarized, but I think that now it’s become a safety issue, right? I don’t think anyone would disagree that they want to keep their kids and their loved ones and friends safe, right? So we can all agree on that baseline, and then, how do we do that?
Kevin Pho: All right, so let’s move outside the exam room. What are some other things that we can do?
Lisa Park: Oh, well, one more thing, and I wanted to say this: They’re lethal, of course, right? And that’s inside and outside the exam room. The sad statistic is that 90 percent of suicide attempts that involve a gun result in death, versus 4 percent of suicide attempts that don’t involve guns, say, drug overdose, are lethal. So it’s a 90 percent lethality rate. If we had any other condition that had a 90 percent fatality rate, we would be talking about it and doing something about it, right? You don’t avoid that subject, and talking about it with patients makes a lot of sense.
And then you said outside of the exam room. Sure. So, yeah, the AAP is about to release a policy statement on November 1, just re-updating their policy on firearm violence and reducing it in kids, because it’s now the leading cause of childhood death from zero to 24, actually. They take a harm reduction approach, which is similar to what I’m advocating for, right, just talking about it and reducing the risk. But they said it’s really a multi-pronged approach: As a clinician, you can deal with it, and we talked about how we talk about that with patients. As a parent, you can talk about it with other parents before playdates, before a kid sleeps over at another kid’s house, just asking about firearms, just like we talk about allergies, right, or pets in the home. And then there’s getting involved as a community, so advocating and voting. Those are really powerful things that we can do as clinicians, but even just as citizens of the U.S. I talked about in my article how the Bipartisan Safer Communities Act passed this summer, and that was the first major gun safety legislation in 26 years. So it is a long game, but it does matter, right, who we elect to office and what kind of policies they pass. So really just getting informed about what candidates will protect your community through gun safety legislation is really powerful and important.
Kevin Pho: So one of the things that I always talk about on my site and on this podcast is that we physicians need to advocate more, not just for guns but for a variety of issues. Give us an example of your advocacy in the past. It could be writing or speaking or connecting with politicians. Give me an example of how that has moved the needle for you.
Lisa Park: Yeah, I wholeheartedly agree. I think that as physicians, we have this social capital, right? People see us as experts, because we trained in this field, and we advocate for the safety of our patients every single day in whatever way that looks like. So what I did was, and I talked about the evolution of this article, I got involved with Moms Demand Action, which is a nationwide organization that advocates for gun safety, and they do the whole range, right? They do canvassing, especially before Election Day, talking to legislatures, state and federal, and then op-eds, and I had the opportunity to publish it on your blog, and doing things like going to community organizations, like churches and PTAs, and talking to parents about, “Hey, this is how you store guns safely if you do have them.” So really, there’s a place for all of us. You don’t have to be marching in the streets, but you can if you’re really good at that, and you’re extroverted, and that floats your boat. But there’s also room for the quieter advocacy, one-on-one with a patient, one-on-one with a parent, and just talking about it in that way, too. I think we can all do our part.
Kevin Pho: There’s a substantial proportion of the population who sees the issue not so much as gun safety or gun control, but more as a behavioral health issue. So how do you respond to someone who has that perspective?
Lisa Park: I did talk about that in my article, that it’s really an “and,” right? You need to have both of those conversations, and both of those are large, complex problems that we need to attack. With mental health issues, of course, suicide is one of the major causes of death from firearms, as well as homicide. So we need to be addressing suicide prevention and asking about depression and suicide, and we also need to be talking about firearms, because it may not come up. If you wait to talk about mental health, and wait until there’s a crisis in mental health before you talk about firearms, you may have missed your opportunity for the firearm to be locked up and safely secured.
With suicide attempts, depression can be long-standing, but the thought of attempting suicide often is very impulsive, and often for individuals who want to carry out a suicide, it will happen within an hour of when they have that thought. So it’s a very important intervention that you could have done a few months ago, to talk about securely storing a firearm, that can save someone’s life in that moment. So we really need to be having both conversations and advocating for both important issues.
Kevin Pho: We’re talking to Lisa Park. She’s a pediatrician, and her KevinMD article is titled “Bulletproof backpacks: There’s more we can do.” Lisa, what are some pieces of advice that you could give to my clinician audience? It could be either inside the exam room or even outside, doing some advocacy work. What kind of actionable advice can you give to advance this issue?
Lisa Park: Well, I think that the first thing to do is get comfortable talking about it. Like I said, it can become part of your guidance about safety if you’re a pediatrician, but really anybody can have that conversation, because if you’re an adult internal medicine doctor, you might have a parent sitting across the room from you with a kid, and they may have firearms. So it’s worth talking about, and screening for mental health as well.
The other thing that a lot of people don’t realize is that there’s this continuum. Of course, not having the firearm in the home is probably the safest way to reduce lethal suicide attempts, but if there is a firearm in the home, you go from the basics, which is safe storage, the gun and the ammunition separately, locked and unloaded. The next step is, if you know that a loved one has had depression or has had suicide attempts, taking the keys when they’re in a moment of crisis. Think about how we envision drunk driving. Everybody knows: Take the keys. It doesn’t solve the alcoholism, but you’re removing, in that moment of potential crisis, injury, or death, the lethal means. So, giving the keys or changing the combination to the lock safe that the gun is kept in. The next step is out-of-home storage. Many states have ways that you can temporarily give your gun to a gun store or to law enforcement, things like that, so it’s creating that time and space between the individual and the firearm. And then it goes all the way to extreme risk protection orders, which are red flag laws, where law enforcement or family can petition a court to temporarily remove access to firearms. So we have all these things in our toolkit, and it’s worth researching them so that you can talk to your patients who have had mental health issues, or even ones who have firearms and no mental health issues, right, so they know what the options are for everyone to stay safe.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Lisa Park: My take-home message would be that we are not powerless. Unfortunately, every week there is another shooting, which is just awful and shocking, but we can move from that and do something about it at any level. Clinicians, talk to your patients. Parents, talk to other parents. Vote, and look up those candidates that vote for gun safety legislation, and get involved. There are so many things we can do, and every step is necessary. So don’t feel powerless. We can do something about this.
Kevin Pho: Lisa, thank you so much for sharing your time and insight. Thanks again for being on the show.
Lisa Park: Thank you.
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