Worcester Medicine - Spring 2023

GUN VIOLENCE Approaches to an Endemic Problem in American Society

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Gun Violence: Approaches to an Endemic Problem in American Society

Editorial 4

Michael Hirsh, MD

President’s Message 4

Giles Whalen, MD

It’s the Guns 6

David Hemenway, PhD

Moms Demand Action and the Gun Safety Movement: Momentum is on Our Side 8

Joanna MacGugan, PhD

How to Stop Gun Violence: The Worcester Gun Buyback Plan 10

Michael R. Weisser, PhD

Why Is Worcester’s Gun Violence So Much Lower Than Other New England Cities? 11

Edward J. McGinn, Jr.

This Is Our Lane: Bringing Gun Violence Prevention to Medical Education and Clinical Care 12

Peter T. Masiakos, MD, MS, FACS, FAAP

Two Medical Students’ Perspectives: Utilizing Research as a Means of Advocating for Firearm Safety 14

Christopher Zaro, BA and Symren Dhaliwal, BS

A Medical Student’s Perspective on Gun Violence as a Public Health Emergency 16

Eugenia Asipenko

Health Matters 18

Society Snippets 19

In Memoriam

Robert B. McGan, MD 20

Rudolf Jakob Utzschneider, MD 21

Willard G. Rice, Jr., MD 22

Calendar of Events 23

published by Worcester District Medical Society

321 Main Street, Worcester, MA 01608 wdms.org | mwright@wdms.org | 508-753-1579

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President Giles Whalen, MD

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Lisa Beittel, MBA

Sonia Chimenti, MD

Anthony L. Esposito, MD

Larry Garber, MD

Rebecca Kowaloff, DO

Susan Krantz, MD

Julianne Lauring, MD

Anna Morin, PharmD

Nancy Morris, PhD, NP

Thoru Pederson, PhD

Joel Popkin, MD

Alwyn Rapose, MD

Parul Sarwal, MD

Akil Sherif, MD, SVH, Cardiology Fellow

Robert Sorrenti, MD

Martha Wright, MBA

Peter Zacharia, MD

Alex Newbury, MD, UMass, Radiology Resident

Arunava Saha, MD, SVH, Medicine Resident

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Michael P. Hirsh, MD,FACS, FAAP

It is with mixed emotions that I have the honor of serving as the guest Editor of this edition of Worcester Medicine about Gun Violence in America. That’s because after more than 40 years working in the gun violence prevention field, our country has been marching backward with rising levels of gun violence each year. In 2021 alone there were 49,000 gun fatalities (63% of which were suicides), with more than twice that many injured. And as we are increasingly recognizing that witnessing or living in fear of gun violence has its own effects that can lead to mental illness, depression or parasuicidal behavior. Still, there is a major division in our country regarding how gun ownership affects these horrible stats -- with some Southern and Western states making it easier than ever to buy, carry, and even open carry firearms while the North and West Coast generally do a better job of regulating gun ownership. Middle ground has been hard to come by.

I came to be involved in this area of injury prevention when one of my fellow surgical co-residents was gunned down at Columbia Presbyterian Medical Center on November 2, 1981. Just as I have done with all my work in this field--including the Worcester Goods for Guns Gun Buyback Program, which has collected over 4000 weapons from the streets of Worcester County--I dedicate this edition of Worcester Medicine Magazine to the memory of John Chase Wood, II, MD.

In this edition, we are featuring a wide breadth of opinions and programs to highlight the issues and controversies that cause this public health crisis to seemingly be an insoluble problem. I thank all the contributors for sharing their approaches and expertise. +

Michael P. Hirsh, MD, FACS, FAAP is Professor of Surgery and Pediatrics at UMass Chan Medical School, Director of Pediatric Injury Prevention, founder of Worcester Good for Guns Gun Buyback Program, and Medical Director for the Worcester Division of Public Health.

President’s Message

Giles Whalen, MD

Dear Worcester Medicine Readers,

As we settle in to 2023, I hope your year is off to a good start. Despite the ongoing COVID-19 pandemic, Worcester District Medical Society continues to remain active and starting this year, we have begun to hold our events in person again.

I want to thank Dr. Michael Hirsch for guest editing this issue on gun violence -- a problem which he has worked tirelessly to mitigate throughout the course of his long and distinguished surgical career. Thank you also to Dr. Anne Larkin, our 227th Orator, who spoke to a room full of colleagues and medical students about what our future physicians need to know to thrive and do well for their patients.

Upcoming events include the Massachusetts Medical Society House of Delegate proceedings. The first session will be virtual, and the second session will be in person at the Westin Hotel in Waltham. Please consider becoming a member of our delegation. It is an excellent way to meet new colleagues, learn about healthcare policy with issues facing medicine, and better understand the legislative process. As an individual or as a collective group, you can make a difference. If you are interested in learning more about this opportunity, please contact our Executive Director, Martha Wright at mwright@wdms.org or 508-753-1579.

The WDMS Annual Business Meeting will take place on April 11 at the Beechwood Hotel. Please join us as we congratulate our 2023 Community Clinician of the Year, Dr. Manjul Shukla for her tireless volunteer efforts, particularly with local COVID-19 vaccination clinics.

The Women’s Caucus is planning a wonderful lecture on May 3 at Mechanics Hall. Our speakers will be Drs. Michelle Dalal and Harikirin Khalsa, and they will discuss The Power of Food, The Power of the Pause: How Lifestyle Medicine, Plant-Based Nutrition, and Biological Self-Awareness Build Stronger Selves, and Help Us Empower Our Patients.

And for our last event for the 2022-2023 calendar, we are welcoming back our Meet the Author Series on May 24 at the Albert Sherman Center Auditorium. This year’s author is Dr. Mark Vonnegut who will talk about this latest book, The Heart of Caring: A Life in Pediatrics.

Finally, please consider joining our group on a Medical Humanities tour of England June 6–15 . For questions, please call the WDMS office at 508-753-1579. +

Giles Whalen, MD President, WDMS

Gun Violence

It’s the Guns

David Hemenway, PhD

Compared to the more than 30 other high-income countries (e.g., Australia, Canada, Germany, Japan, South Korea, the United Kingdom), the United States is an outlier in terms of firearm homicide, overall homicide, firearm suicide, and unintentional firearm deaths. For example, compared to children (aged 5-14) in the other high-income countries, a child in the United States is more than 25 times more likely than a child in these other countries to be a victim of gun homicide. When it comes to suicide, American children are almost ten times more likely to find a gun and kill themselves (Table 1).

What can explain such enormous differences?

The U.S. is similar to these countries in terms of rates of non-gun crime, like assault, burglary, robbery, and motor vehicle theft (1). Evidence indicates that American children are similar to children in these other countries in terms of aggression and depression. What makes us different from the other high-income countries is that we have so many more guns—particularly handguns and military weapons—in private hands. In addition, we have the weakest gun laws.

In the U.S., many studies show that a gun in the home increases the risk of violent death in the home and that more guns in the community increases the risk of violent death in the community (2). For example, many studies have explained the large differences across the 50 states in their rates of homicides, suicides, and unintentional firearm death. The major explanation is not state levels of mental illness, crime, poverty, or alcohol consumption. It is the level of household gun ownership and the strength of each state’s gun laws.

Table 2 does not show the results of an actual study that includes all 50 states as well as many other possible risk factors. It simply illustrates the main findings of such studies by comparing the group of states with the highest and lowest levels of household gun ownership. The two groups of states are matched so that they have comparable populations, to allow for looking at numerators— the actual number of people dying. The lowest gun states, mostly from the Northeast, not only have relatively few guns, but also strong gun laws. The

highest gun states, mostly Southern and mountain states, have many guns and weak gun laws.

In the most recent decade for which there are data (2011-2020), 127 children in the high-gun states died from an accidental shooting compared to five in the low-gun states. Overall, children in the low gun states were 6.1 times more likely to die from guns--9.9 times more likely to die from gun suicide and 3.4 times more likely to die in a gun homicide. They were 2.4 times more likely to die in a suicide or a homicide from all means combined.

Massachusetts is a low-gun state, with relatively strong gun laws. That is the key reason we have relatively low rates of suicide—and, for an urban state, low rates of homicide. It is why we have relatively low rates both of police being shot and killed and police killing civilians (3). It is why we have relatively low rates of mass murder. We would do

table 1: violent deaths among 5-14-year-olds United States vs. the Other High-Income Countries

Ratio

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What makes us different from the other highincome countries is that we have so many more guns in private hands. In addition, we have the weakest gun laws.

table 2: violent deaths, 2011-2020 United States Children Aged 5-14

High-Gun States* Low-Gun States* (High-Gun/Low-Gun)

* Gun ownership levels based on Shell 2020 [5]. The 14 states with the highest levels of household gun ownership were MT, WY, AK, ID, WV, AR, MS, AL, SD, OK, KY, LA, TN. The 6 states with the lowest average gun levels were MA, NJ, RI, HI, NY, CT.

Source: CDC WONDER data.

even better in terms of gun homicides if neighboring states had fewer guns and stronger gun laws. Most crime guns in states with few guns and strong laws are trafficked from states with many guns and weak gun laws (4). While Massachusetts does better than most other U.S. states in terms of firearm deaths, we do much worse than the other high-income countries—which have even fewer guns (particularly handguns) and stronger gun laws.

What can you do to help reduce the rate of gun death in the U.S.? At the local level, you can promote local gun buybacks, attend gun-related hearings, and support groups advocating stronger gun laws like those in all other high-income countries.

But since crime guns easily move across state borders, working solely at the local level may not be enough. Federal action is needed. Yet for many decades, even though most Americans, including most gun owners, have wanted more reasonable gun laws, we have not been able to get them. This is largely because one of America’s two major political parties has become allied with the gun industry and have made gun issues part of their strategic platforms. The best thing that Americans can do is to give their time and money to help elect a Congress and executive branch that is more responsive to the needs of the average American than it is to the desires of the gun industry and gun lobby. +

David Hemenway, PhD is Professor of Health Policy at the Harvard TH Chan School of Public Health.

References:

1. Hemenway D. Private Guns Public Health. Ann Arbor: University of Michigan Press, 2017.

2. Stroebe W. Firearm possession and violent death: a critical review. Aggression and Violent Behavior. 2013; 18:709-721.

3. Hemenway D. Azrael D, Conner A, Miller M. Variation in rates of fatal police shootings across US states: the role of firearm availability. Journal of Urban Health. 2019; 96:63-73.

4. Collins T, Greenberg R, Siegel M, Xuan Z, Rothman EF, Cronin SW, Hemenway D. State firearm laws and interstate transfer of guns in the United States, 2006-16. Journal of Urban Health. 2018. 95:322-36.

5. Schell TL, Peterson S, Vegetabile BG, Scherling A, Smart R, Morral AR, State-level estimates of household firearm ownership. Santa Monica, CA: RAND Corporation, 2020. https://www.rand.org/pubs/tools/TL354.html.

Gun Violence

Moms Demand Action and the Gun Safety Movement: Momentum is on Our Side

Joanna MacGugan, PhD

Ten years ago, on December 14, 2012, I sat down to start my workday, my five-monthold sleeping in his rocker beside me, as details of the grim scenes unfolding in the halls of Sandy Hook Elementary in Newtown, Connecticut began trickling in. This was the beginning of a new future for my child — lockdown drills, metal detectors, and bulletproof backpacks would soon become a normal part of his childhood. Apart from September 11, I don’t know of any other event in recent American history that has shattered our sense of security or faith in humanity in quite the same way. This is when grassroots activist Shannon Watts started the movement that would become Moms Demand Action for Gun Sense in America (https://momsdemandaction.org). This organization advocates for common-sense gun safety laws; supports local, community-based partners focused on disrupting violence; elects Gun Sense Candidates at every level of government; promotes safe gun storage practices; and raises awareness of life-saving gun safety legislation, such as extreme risk protective orders (also known as “Red Flag” laws) and universal background checks for gun purchases. Everytown for Gun Safety, another grassroots organization, provides the rigorous research that supports our evidence-based strategies for reducing gun violence in America.

After the February 14, 2018, shooting at Marjory Stoneman Douglas High School in Parkland, Florida, I attended a statewide Moms Demand Action meeting and met a young single mother who had lost her only child, a bright 17-year-old, to gun violence on the streets of Boston. Her extraordinary strength and commitment to creating positive change, despite her unimaginable grief, was the pivotal moment for me. I stepped in as lead for the Central Massachusetts chapter of Moms Demand Action and got busy growing our team, building community partnerships, and advocating for critical gun safety bills in the State House. Dr. Peter McConarty later joined as co-lead of our local group. Peter draws from his experiences as a family doctor and gun violence survivor to lead discussions on harm reduction in medical settings with our community partners, including the Center for Nonviolent Solutions, Grassroots Central Mass, and the Joint Coalition on Health. He recently discussed his gun violence prevention work as a guest on Dr. James Broadhurst’s cable show, “Health Matters.”

Focusing on the public health dimension of gun violence was a natural fit for our group. From the beginning, we found a strong ally in pediatric surgeon and gun violence survivor Dr. Michael Hirsh at UMass Chan Medical School. Every fall, Dr. Hirsh’s medical students organize an elective course on gun violence that features speakers who are involved in many different dimensions of gun safety. Engaging and sharing our perspectives on gun violence with these inspiring and dedicated students has become a highlight of our partnership with Dr. Hirsh.

Nationwide, Moms Demand Action has plenty of legislative successes to celebrate, and we appear to be winning against the massively powerful gun lobby as more state governments pass common-sense gun safety bills into law. Nineteen states and Washington, D.C., have now passed lifesaving Red Flag laws that allow families and law enforcement to seek a court order to temporarily remove firearms from someone in crisis if they pose a danger to themselves or to others (1). Here in Massachusetts, we scored a major victory in the state legislature in 2022, securing a historic $94 million in gun violence prevention funding (2).

But we also deal with daily reminders that our work is rooted in the bleakest of statistics. Mass shootings grab the headlines, but it’s critical to understand that more than 110 Americans die by guns every single day — many from suicide, city violence, or domestic violence. This level of violence does not happen in peer countries. Firearm suicides claim the

lives of 23,891 Americans every year, and guns are now the leading cause of death of American children and teens (3). As of February 1, guns have already killed 21 children and 131 teens (4). This number includes children who died from unintentional shootings, most often because adults left their loaded guns unsecured and accessible — a wholly preventable epidemic of gun violence. The data tell us that we have become a nation of gun violence survivors; by early February each year, more Americans are killed with guns than are killed in peer countries in an entire calendar year.

Even though Massachusetts has the lowest rate of gun deaths in the country and ranks sixth in the strength of its gun laws, we still see the toll that everyday gun violence takes on our communities (5).

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The data tell us that we have become a nation of gun violence survivors.

Each year in Massachusetts, guns kill an average of 255 people (56% are suicides) and wound 557, and an average of 20 children and teens die by guns. Worcester county has a rate of 3.4 gun deaths per 100,000 people. We clearly have more work to do to keep our communities safe from gun violence — and this is what keeps Moms Demand Action for Gun Sense in America volunteers going.

One of our current legislative priorities for Massachusetts involves analyzing and reporting annually on crime gun data to better understand patterns in gun trafficking and improve law enforcement’s efforts to resolve this problem. A second priority bill focuses on prohibiting the purchase or possession of un-serialized, “do it yourself” ghost guns that circumvent state gun safety laws. We also remain committed to electing Gun Sense Candidates up and down the ballot, here in the Commonwealth and across the country. Our volunteers recently scored a major victory by electing Gun Sense Candidate Maura Healey to the governor’s office. The next steps for our Central Massachusetts group involve connecting with Worcester’s veterans organizations to raise awareness of Red Flag laws and safe gun storage practices.

Moms Demand Action is a research-based organization, and the evidence is clear: Gun safety policies save lives (6). We find the strength to keep going because we know there are millions of Americans who agree that our country urgently needs common-sense solutions to this public health crisis. +

Joanna MacGugan, PhD, is a social historian, senior copy editor at Dragonfly Editorial, and co-lead for Central Massachusetts Moms Demand Action for Gun Sense in America.

References

1. https://everytownresearch.org/rankings/law/extreme-risk-law/

2. https://www.everytown.org/press/victory-for-gun-safetymassachusetts-legislature-makes-major-gains-on-gun-safety-toend-session-lays-groundwork-for-important-gun-safety-packagemoms-demand-action-students-demand-action-respond/

3. https://everystat.org/

4. https://www.gunviolencearchive.org/, accessed 1/18/2023.

5. Statistics for gun violence in Massachusetts come from the following sources: https://everystat.org/, https:// everytownresearch.org/rankings/, and https://www.everytown. org/state/massachusetts/.

6. https://everytownresearch.org/rankings/

Gun Violence

How To Stop Gun Violence: The Worcester Buyback Plan

Michael R. Weisser, PhD

Gun violence continues to be a major cause of fatal and non-fatal injuries in the United States; the fatal injuries for 2020 amount to more than 44,000 victims, the non-fatal injuries perhaps twice as many, if not more. Unfortunately, the source for this data—the CDC—has not been able to publish verifiable numbers on the non-fatal side, but an estimate of two non-fatal but serious gun injuries versus one fatal gun injury is probably fairly accurate, if not slightly under what the real number might be.

We also do not have numbers for 2021 or 2022, but from media and law enforcement sources, it appears that gun violence for the past several years will be at least as high as the 2020 number, which is the highest number since the CDC started tracking gun violence in 1981 and is 25% higher than the average yearly gun violence since 1999.

Looking at this data from a public health perspective, the per-100,000 national gun violence rate in 2020 was 13.28. Of the 50 states, however, Massachusetts ranked second-lowest for 2020 gun-violence, with a 3.71 rate, and the four-year gun violence rate for Worcester from 2017 through 2020 was 3.91, just slightly higher than the statewide rate.

When it comes to reducing gun violence, theories abound. In fact, over the last two years the CDC has awarded more than $15 million in research grants to study grassroots and community-based strategies which could lead to a drop in gun violence nationwide.

I have no problem with the government spending my tax dollars to figure out how to reduce or eliminate a threat to public health. However rather than just giving some research groups the financial wherewithal to come up with some new strategies for dealing with gun violence, the CDC might consider looking at the way in which Worcester deals with gun violence right now. I happen to believe that not only does Worcester confront gun violence in a positive and effective way, but the city’s strategy could easily serve as a template for other cities and jurisdictions as well. What I am basically talking about is the annual gun buyback program, which is the brainchild of the city’s Medical Director, Dr. Michael Hirsh, and was held last month for the 21st consecutive year.

Dr. Hirsh first started doing a gun buyback in Pittsburgh before he moved to Worcester and took his current position at UMass Memorial Health. What started out as a very localized effort to rid the city of unwanted firearms has now spread to 22 cities and towns in Central Mass. The Bay State buy-back effort is also coordinated with a growing national campaign which now enrolls 20 cities in 17 other states.

When buybacks first started, the activity received a black eye after a study was published showing no change in gun violence rates in Milwaukee the year after the city held its first gun buyback effort. The lack of impact of this single event in one city and the ever-present opposition to buybacks from the various pro-gun groups (National Rifle Association, et. al.) combined to create a negative attitude towards buybacks, which still finds its way into the public debate from time to time.

Many of the proponents of gun buybacks promote the effort simply as a method to reduce gun violence. As a result, if the numbers do not reflect an immediate, downward change, opponents point out that the buyback didn’t work. Unfortunately, this is not a proper way to evaluate the impact of a buyback, nor should it be used to solicit funding either from public sources or from local merchants whose gift cards provide an incentive for community residents to turn in unwanted guns.

In 1993, two physicians, Art Kellerman and Fred Rivara, published research in the New England Journal of Medicine which definitively linked guns

in the home to gun violence and categorized this link as a medical threat. These article not only provoked the pro-gun lobby to restrict funding of CDC gun-violence research (funding which was restored only last year) but also energized the gun industry to inaugurate and sustain a misinformation campaign which ultimately has produced a majority of Americans who, according to Gallup, believe that a home is safer with a gun than a home where no gun exists (1).

The real value of a gun buyback is to give the community an opportunity to think about gun risk and then make a tangible commitment to reducing that risk by getting rid of unwanted and unneeded guns. Thanks to Dr. Hirsh and his medical and law enforcement colleagues, the City of Worcester has engaged in those thoughts now for two decades and what has been accomplished can easily be copied throughout the rest of Massachusetts and to other states. +

Michael R. Weisser, PhD

Reference

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the CDC might consider looking at the way in which Worcester deals with gun violence.

Why is Worcester’s Gun Violence So Much Lower Than Other New England Cities?

Edward J. McGinn, Jr.

Like any other city its size, Worcester is not without its share of problems with respect to street gangs, illicit drug sales and abuse, the unhoused, mentally ill populations, and a host of other urban quality of life issues. That said, in the City of Worcester, gun violence is and has historically been considerably lower than that of other similarly sized cities in New England and indeed the Northeast. Why?

Central to gun violence in any city are street gangs and the drug trade that is so commonly associated with these gangs. Belonging to a street gang was once an optional, but affirmative, choice for young people. Today however, our city’s youth, especially in low-income areas, are heavily recruited to join gangs, often with compulsion; “Either you’re with us or you’re against us.” How many times can a neighborhood kid be threatened, beaten up, or robbed by gang recruiters before they relent and join the gang?

While some gang members are genuinely dangerous, many are not; particularly fringe members who do not want to be continuously set upon to join. Yet, once in a gang, a persuasive and perverse pack mentality comes about causing youths to adopt a faux “hardcore” persona, one that requires the individual to act out violently on behalf of the gang. This gives rise to violence against rival gangs, often with the player not even knowing what the original quarrel was about. These violent acts then beg retaliatory and other quid-pro-quo violent reactions by or on behalf of opposing gangs and members. Accordingly, shooters tend to know, or know of, their victims here and vice-versa. With this, Monday’s shooting victims become the shooters by the end of the week. Moreover, gang members, whether leaders or marginal followers, arm themselves with guns as a matter of self-protection. Then, once a firearm is in the mix, simple disputes once dealt with by fistfights now become shootings. This gun culture/mentality then continues into later life unless some intervention occurs.

In Worcester law enforcement, we take a multi-level approach toward preventing gang-related crime. Working with youth in the city, we partner with organizations such as the Boys and Girls Club, YMCA, PAL Leagues, and various church groups to expose kids to police in a positive and supportive environment. All too often, kids only see police when “something bad has happened.” These exposures allow our city’s kids to engage with cops as mentors, coaches or in other positive capacities. The key here is to get our kids to a safe place whether it be a part-time job, sports, or other activity where they can receive the mentorship of a concerned adult. The power of a mentor in a kid’s life cannot be overstated.

In response to the older youth, kids that may have already dabbled in gang activity, we reach out to them in the form of camps, jobs, and other job readiness approaches to lure them from the misery that gang lifestyle will surely afford them.

As the hallmark of any effective law enforcement agency is as much deterrence/prevention of crime as it is investigation of crime, it is incumbent on police to insert themselves into a place where initial and retaliatory gun violence cannot take place or is so fraught with risk of apprehension that it is deterred. Generally, our officers and detectives have a good idea who the players are, what teams (gangs) they associate with, and what the prevailing dispute is at any given time. The task then is leveraging a sufficient response to influence, separate, and mediate with the potential combatants so that cooler heads prevail. Conferring with family, clergy, teachers, mentors, probation officers, the courts, and other persons of influence for gang members is called to bear. Failing this approach, or in other circumstances, an intensified law enforcement effort is applied to these individuals to curtail their illicit activities, their source of illicit income, and that of all with whom they associate. In sum, they and their associates will not be able to conduct business as usual (drug sales, or other criminality) undetected. This is attention that they cannot long stand.

Other forms of gun violence are addressed by other means. In Worcester we have been fortunate to not have experienced a gun-related domestic violence death in the past several years. We attribute this to the intervention systems in place to intervene in domestic violence with the requirement that any such matter that comes to our attention is made part of the official public record, court protective orders are obtained, and that such matters are followed up by police as well as outside intimate partner and child protection agencies. Where applicable, gun licenses are suspended, and guns removed from homes.

Also, as part of our multi-prong approach, are such programs as the Guns to Gardens program, formerly known as the Good for Guns program. Now in its 22nd year, this program, pioneered by Dr. Michael Hirsh, partners medical professionals, public health, police, and the District Attorney’s Office to allow people to turn in guns anonymously and with immunity in exchange for a gift card to a local grocery store. This purely voluntary program has resulted in the collection of more than 3,700 guns since its inception, and the program has expanded to other areas of the Commonwealth and major cities in New England. The key here is to offer people a place to get rid of an unwanted gun so that it does not come into the hands of a child, become the subject of theft, or be used during a heated domestic situation, or be taken up by a person in the throes of a mental health crisis. Each year, this program brings

Why is Worcester’s Gun Violence So Much Lower Than Other New England Cities?

Continued

into the forefront mindfulness that guns can present a danger in the household if unwanted or improperly stored. The ability to remove a gun from the household without questions asked is readily embraced by those wishing to rid their home of these lethal devices.

Lastly, I would be remiss if I failed to give most honorable mention of the impeccable skills and abilities of the Worcester EMS system and emergency medicine trauma facilities. I have been a police officer for 38 years and over those years, I have sadly witnessed shooting victims in the field and have thought to myself that this poor victim isn’t going to make it. But time and time again, I have been pleasantly surprised to see the patient be wrenched from the jaws of death by the dedicated EMS squads to be followed upon by the incredible lifesaving interventions conducted at our local trauma facilities. While the violence has unfortunately occurred, its lethal effects are greatly mitigated, and the victim can live another day for us to pre-empt retaliatory violence.

All this work is difficult and can be tremendously frustrating, but the young lives that are lost or diminished as a result of gun violence is a societal cost of such magnitude that there is little we do as police that is more important than intervening. Avoidance of gun violence in the first place is the gold standard, but we’ll take turning a kid around from gang warfare and gun involvement any day. +

Edward J. McGinn, Jr. is Deputy Chief of Police for the City of Worcester.

This Is Our Lane: Bringing Gun Violence Prevention to Medical Education and Clinical Care

Peter T. Masiakos, MD, MS, FACS, FAAP

While many national health professional organizations have stated it is the responsibility of physicians to discuss firearm safety with their patients, few clinicians do – even among high-risk patients (for example, among those who have expressed suicidal or homicidal ideation). In June 2019, Massachusetts General Hospital launched the MGH Center for Gun Violence Prevention with a mission focused on clinical care and education, research, and community engagement with the goal of reducing morbidity and mortality from firearm-related violence. Our Center’s early quality improvement work determined that many of the reasons underlying this lack of directed counseling among clinicians were straightforward: few clinicians had received training in how to have these conversations or knew what to do next if a patient or family member did report having firearms at home.

To begin to fill these knowledge and practice gaps, we developed an innovative training program to empower healthcare providers with tools to discuss this issue with patients in a culturally competent way. We assembled a team of resident and attending physicians— gun owners and non-gun owners--from across disciplines (including internal medicine, surgery, pediatrics, psychiatry, obstetrics/gynecology, and emergency medicine) to develop a didactic introduction and provide authentic and relevant clinical cases unique to each discipline. We then hired and trained a team of standardized patients. With buy-in from the residency program leadership in each department, every incoming intern in these departments at MGH in the summer of 2019-2021 went through a mandatory training. This didactic session teaches an evidence-based framework for incorporating violence prevention and firearm safety screening into clinical care, followed by a case-based simulation session to practice these skills. Since 2019, nearly 600 residents, medical students, and nurses have been trained in at least four other medical institutions: Harvard Medical School; Tufts School of Medicine; Dell Children’s Hospital’s emergency medicine residency program; Boston University’s Physician Assistant program; and Rutgers School of Nursing.

In our analysis of the first year of this work, we determined that 70% of participants reported having had no prior training related to gun violence prevention and only 3% of participants reported knowledge of resources available at our institution and in Massachusetts to help facilitate conversations with patients. For example, prior to the training, 3% of participants were aware of Extreme Risk Protection Orders, a law passed in 19 states

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As health care clinicians and educators, we must stand front and center to address the gun violence epidemic.

including Massachusetts to facilitate removal of firearms from persons who may be an imminent risk to themselves or others, and of how to appropriately use this law. After the training, 98% reported awareness. In addition to review of these data, we conducted qualitative feedback sessions with the participating standardized patients to elicit feedback and improve the clinical cases. Overall, we concluded that this case-based gun violence prevention training program was feasible with good uptake in a single institution. We also sought to formalize this training as a part of residency curricula to ensure its continuation year-to-year as well as to explore partnerships to 1) improve this training and 2) expand its reach beyond MGH.

During the 2020-2021 academic year, the emergence of the COVID-19 pandemic presented challenges to our training program, which had been characterized by close in-person standardized patient-learner interactions. We adapted and redesigned the sessions to be able to implement them by remote (Zoom-based) simulations. With shortened, remote orientations for incoming interns, making this part of every orientation was not possible, therefore we have sought to embed this training in other parts of the curriculum. We successfully completed the Zoom-based curriculum in several departments, and this has been integrated in our standard approach to expand opportunities for remote learning throughout the academic year.

Along the lines of expansion, we have developed a virtual reality (VR) curriculum based on an existing standardized patient curriculum created by the MGH Center for Gun Violence Prevention. Curricular objectives have been established and simulation flowsheets have been developed by experts in medical education at Cincinnati Children’s Hospital Medical Center (CCHMC). This novel platform allows clinicians to deliberately practice screening and counseling on gun injury and is currently undergoing formal usability testing. The next phase of our work will be a randomized controlled pilot study assessing the comparative efficacy of Resident Education and Counseling on Household REACH Firearm Safety

versus standard training at CCHMC and MGH as measured by documented discussion of gun violence prevention topics during pediatric outpatient clinic visits. This will support broader assessment of implementation metrics of VR-based training to inform future scale and spread. Additionally, in alignment with our confidence in this approach, we aim to begin foundational work to inform expansion of the VR platform for training school-based nurses and counselors in gun violence prevention strategies.

Our society often addresses healthcare problems only after they occur. It is clearly preferable to prevent deaths and injuries rather than to treat them. As health care clinicians and educators, we must stand front and center to address the gun violence epidemic. We are hopeful that the foundation of the novel work described here will elevate the voices of our diverse community of key stakeholders, centering their perspectives in decision-making, and identifying upstream opportunities where we could interrupt the cycle of preventable gun violence. +

Peter T. Masiakos, MD, MS, FACS, FAAP is an Associate Professor of Surgery at Harvard Medical School, Director Pediatric Trauma Services at the Massachusetts General Hospital, and Co-Director of the MGH Center for Gun Violence Prevention.

Recent Scholarly Publications from the MGH Center for Gun Violence Prevention:

• Naureckas Li C, Sacks CA, Cummings BM, Samuels-Kalow M, Masiakos PT, Flaherty MR. Improving Pediatric Residents’ Screening for Access to Firearms in High-Risk Patients Presenting to the Emergency Department. Acad Pediatr. 2021 Jan 09. PMID: 33429102.

• Masiakos PT, Sacks CA. Moving beyond descriptions-developing a strategy to prevent gun violence. Surgery. 2020 Sep; 168(3):385-386. PMID: 32654860

• Sacks CA, Bartels SJ. Reconsidering Risks of Gun Ownership and Suicide in Unprecedented Times. N Engl J Med. 2020 06 04; 382(23):2259-2260. PMID: 32492309.

• Gondi S, Pomerantz AG, Sacks CA. Extreme Risk Protection Orders: An Opportunity to Improve Gun Violence Prevention Training. Acad Med. 2019 11; 94(11):16491653. PMID: 31397705.

• Naureckas Li C, Sacks CA, McGregor KA, Masiakos PT, Flaherty MR. Screening for Access to Firearms by Pediatric Trainees in High-Risk Patients. Acad Pediatr. 2019 08; 19(6):659664. PMID: 30853577.

Two Medical Students’ Perspectives: Utilizing Research as a Means of Advocating for Firearm Safety

Christopher Zaro, BA and Symren Dhaliwal, BS

Despite the dismay that comes with every national atrocity and the frustration and pain with every local tragedy, the general community has long seen firearm violence as an issue discrete from the world of healthcare (1). As the medical community shudders at the recent statistics ranking firearm violence as the leading cause of death in children, there is little consensus on what physicians can do to solve the firearm violence epidemic (2). Beyond the National Rifle Association (NRA) and gun lobbyists’ incendiary treatment of the firearm conversation, there are many reasons why clinicians and institutions are loath to address and appropriately combat the problem. The temporary gag law in Florida which prohibited clinicians from asking patients about firearms, while since struck down decisively in the United States Court of Appeals, still reverberates through clinical practice (3). Even

with children with histories of trauma—often stemming from witnessing firearm violence—where I saw the long-lasting and complex effects these events have on young minds. After these experiences, I wanted to understand the topic from a more clinical and research-based perspective. I was lucky enough to meet Dr. Michael Hirsh during my first year at UMass Chan Medical School and join a research project analyzing a national database of pediatric firearm injuries. We evaluated who was getting injured, what types of injuries were most common, and how sick these kids were compared to other kids in the hospital. Dr. Hirsh and I have continued working together on a project focused on medical students’ comfort around firearm counseling and injury prevention. We conducted a survey to evaluate whether medical students felt comfortable having discussions with patients and parents regarding firearms in the home and safe storage techniques, whether they remembered having a provider address the topic, and whether they wanted this topic incorporated into their curriculum. We hope to use this information to create a longitudinal lesson plan where students are taught the basics of firearm violence in America, made aware of safe storage techniques, and are given opportunities to practice counseling on standardized patients as well as in clinical settings. We are hopeful that this project will lead to increased awareness and sustained comfort around firearm counseling.

though most clinicians see firearm violence as a public health issue, the pervasive stigma, discomfort, and lack of experience surrounding this topic remain (4). However, as medical students, in researching firearm violence, we are attempting to bring this epidemic a sense of legitimacy and urgency in and beyond the healthcare community.

symren

On December 12, 2012, I was sitting in my high school cafeteria when we heard news of a mass shooting at an elementary school just miles away in Sandy Hook, Connecticut. While I watched the landscape of my neighboring town change as the school was demolished and multiple playgrounds built in the children’s honor, I felt myself becoming hypervigilant to stories of firearm violence in the news. Before medical school I worked

chris

The first physician I shadowed was a pediatrician in rural, southwestern Vermont. During every physical, she asked a few direct questions: “Is there a gun in the home? Where is it stored? Is the ammunition stored separately?” In the six years since, I have not heard a clinician ask those questions again during a visit. Confused as to what force kept snatching this question from the lips of physicians, I found myself enamored by the field of preventative medicine and the role clinicians can play in averting calamitous everyday injuries and acts of violence that ravage the

“

As medical students, in researching firearm violence, we are attempting to bring the firearm epidemic a sense of legitimacy and urgency in and beyond the healthcare community.

health of our communities. The project I am crafting with Dr. Hirsh at UMass Chan Medical School first surveys pediatricians about their practices with regards to firearm safety relative to other areas of injury prevention such as automobile and sports safety. From there, we plan on working directly with a group of pediatricians to create a standardized system of dispensing gun locks to any patient who wants one. Lastly, to address the threat posed by gun violence, we aim to work with gun ranges and local police departments throughout Massachusetts to create a Firearm Storage Map: a resource available online and in emergency departments that patients can use to find a temporary place to store a gun outside of the home for 48 to72 hours. Beyond preventing morbidity and mortality, our hope is that by probing these caregivers, gun ranges and police departments about their approach to firearms and pushing forward this research, medical students can have a hand in helping UMass Chan establish innovative and effective strategies for addressing the firearm epidemic.

There are organizations at UMass Chan Medical School and in our local community that offer opportunities for everyone to learn more about and take action against gun violence. The Worcester Gun Buy Back program allows students to run events where community members can relinquish their firearms to local police departments. Our local chapter of Scrubs Addressing the Firearms Epidemic--a national alliance of medical schools focusing on combating the firearm epidemic with research, advocacy, and education--has enriched us with a pool of various strategies, contacts, and inspiration to transform the perspective of the healthcare community. The Massachusetts Medical Society Committee on Violence Intervention and Prevention works on broader issues of violence in the community and allows community members to get involved in local policy efforts.

The issue of gun violence in America is extremely complex and requires change from multiple angles. As medical students at UMass Chan we are in a privileged position to engage in research with experts in the field and complement this work with community activism and policy advocacy. +

Christopher Zaro, BA, is an MD Candidate in the Class of 2025 at UMass Chan Medical School.

Symren Dhaliwal, BS, is an MD candidate in the Class of 2023 at the UMass Chan Medical School.

References

1. Knoepke CE, Allen A, Ranney ML, Wintemute GJ, Matlock DD, Betz ME. Loaded Questions: Internet Commenters’ Opinions on Physician-Patient Firearm Safety Conversations. West J Emerg Med. 2017 Aug;18(5):903-912. doi: 10.5811/ westjem.2017.6.34849. Epub 2017 Jul 11. PMID: 28874943; PMCID: PMC5576627.

2. Goldstick JE, Cunningham RM, Carter PM. Current Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2022 May 19;386(20):1955-1956. doi: 10.1056/ NEJMc2201761. Epub 2022 Apr 20. PMID: 35443104.

3. Parmet WE, Smith JA, Miller M. Physicians, Firearms, and Free Speech - Overturning Florida’s Firearm-Safety Gag Rule. N Engl J Med. 2017 May 18;376(20):1901-1903. doi: 10.1056/ NEJMp1702516. Epub 2017 Apr 12. PMID: 28402707.

4. Thai JN, Saghir HA, Pokhrel P, Post RE. Perceptions and Experiences of Family Physicians Regarding Firearm Safety Counseling. Fam Med. 2021;53(3):181-188. https://doi. org/10.22454/FamMed.2021.813476.

Gun Violence

A Medical Student’s Perspective on Gun Violence as a Public Health Emergency

Eugenia Asipenko

As of the writing of this article, there have been an estimated 6,052 deaths in the United States from gun violence (1). This means that 116 people have died every day this year from a firearm-related cause. These numbers do not even include the injuries that occur from firearms. Therefore, to say that gun violence is a public health threat in this country is an understatement. Despite it being shown that gun safety laws reduce gun violence deaths, last year was the first time in ten years that major federal legislation was passed regarding this problem (2). Although there are many individuals and groups that have done incredible and impactful work to improve gun safety, more work clearly must be done. The disconnect between the severity of this problem and the response to it is partially what drew me to focus on it as a realm of advocacy.

For the past three years I have co-led an optional elective at the UMass Chan Medical School: A Public Health Approach to Treating Gun Violence. In this elective, speakers are invited who approach the topic of gun violence prevention from a variety of perspectives. Our speakers range from lawyers to grassroots advocates to justices to artists to physicians. They often speak of their personal experience with guns or gun violence and how it has shaped what they do. We learn strategies for discussing firearms with patients and how programs that focus on reducing gun violence help the community. Most importantly, we learn why students and medical providers should deeply care about this topic. Some students who take this elective state that this is the first time they have had the opportunity to learn about gun violence from a public health perspective. This gap in education makes discussing guns and gun violence with patients a daunting challenge. A Public Health Approach to Treating Gun Violence is highly constructive in that it provides not only information, but also specific tools that healthcare providers can utilize to facilitate these conversations. It is also impactful because the stories we hear make the topic more personal and real. Our speakers candidly share their personal experiences, and their openness creates a lasting, emotional impression for those who attend. Ultimately, the elective demonstrates the importance of educating nursing and medical students on gun violence early so that they may carry these lessons and disseminate them as they move forward in their careers. The truth is, the subject of guns can be a touchy one, and the strength of emotions that swirl around it can make it seem too intimidating or taboo to discuss. The problem is that people die from gun violence in this country every day. This is now a norm that many have accepted. Our friends, family members, neighbors, community members – we are all affected by this very real public health threat. These same people are the patients to whom we have dedicated our professional lives.

So, the question must not be whether we should do something about it, but what we should and can do. We all have the ability to advocate for ourselves and for our patients. This advocacy can begin by asking all our patients about what firearms they have in the home, how they store them, and how they feel about having those firearms. It may take the form of education about safe storage, risks of having firearms in the home, or gun buy-back programs in the area. Perhaps it could evolve into making these questions a standard practice in your institution or having your institution partner with local advocacy groups. If you are involved in medical education, you might integrate gun safety into the curriculum and encourage nursing and medical students to be advocates. You could even take your advocacy to a larger scale by contacting your local government representatives and advocating in favor of legislation that imposes stricter bans and regulations on the purchase and possession of firearms.

For one person to do all this would be a truly impressive feat, but the power of the medical field is that there is space for collaboration and connection among colleagues, specialties, and institutions. It is also important to note that many healthcare workers already focus their efforts on many of the other aspects of healthcare that are worthy of advocacy. It is possible that in this essay I have simply reiterated what you already know. However, I think the reiteration is needed. I would encourage us all to treat gun violence as a public health emergency because, in one way or another, it will touch us or our patients. This will require steadfastness and dedication, not only after tragedies occur but consistently every day. Together we can collectively turn our outrage into action. If we can all make a meaningful change in the life of at least one patient, it will be worth it. +

Eugenia Asipenko is a fourth-year medical student at the University of Massachusetts Chan Medical School and co-leader of the optional elective titled “A Public Health Approach to Treating Gun Violence.”

References

1. Gun Safety Policies Save Lives. Everytown Research & Policy. (2023, January 13). Retrieved February 20, 2023, from https:// everytownresearch.org/rankings

2. Gun Violence Archive. (2023). Retrieved February 20, 2023, from https://www. gunviolencearchive.org

8 kids a day are accidentally killed or injured by FAMILY FIRE.

FAMILY FIRE is a shooting involving an improperly stored gun, often found in the home.

ENDFAMILYFIRE.org

Health Matters

Health Matters is a cable accessed TV Program by the Worcester District Medical Society and WCCA TV channel 194, reaching over 34,200 households in Worcester.

This program is taped bi-monthly and produced in a 1/2 hour interview format. Celebrating over 230 shows, Health Matters airs in Worcester, Holden, Hopkinton and Shrewsbury, offering valuable information on disease prevention, treatment options, current public health issues, and more...

Our Hosts

To Learn more about our hosts and previous showsVisit our website: www.wdms.org (Community Services, Health Matters) Or Click Here

Some of our past shows:

Saving Lives – Interviewed: Dr. Joseph Sabato, Jr. ~ January 24, 2023

Updates at UMass Chan Medical School – Interviewed: Dr. Terence Flotte ~ December 13, 2022

Impact of Stigma in Public Health – Interviewed: Dr. Alfred DeMaria ~ October 25, 2022

Robotic Surgery – Interviewed: Dr. Mark Maxfield ~ September 13, 2022

If you are interested in being a guest or have an idea for a future programs, please email Melissa Boucher at mboucher@wdms.org

James Broadhurst, MD Michael Hirsh, MD Bruce Karlin, MD Trent Taros, MS4 Lynda Young, MD

Med Moth

Society Snippets

Hybrid Event held at the UMass Chan Medical School on Tuesday, December 13, 2022

The event was very moving and educational thanks to the story tellers; Drs. Michele Pugnaire, David Hatem, Karen Rothman and Joseph Sabato.

Held on Wednesday, February 8, 2023 Beechwood Hotel, Worcester

“What They Need to Know–The Medical Students of Today, Becoming the Physicians of Tomorrow”

227th WDMS Annual Oration

Giles Whalen, MD WDMS, President

Orator: Anne Larkin, MD, FACS

Robert B. McGan, MD, 89, passed away December 4, 2022, in New Canaan, Connecticut.

Bob was a colleague of mine, our offices being next to each other for many years on Julio Drive in Shrewsbury. I always appreciated his referrals and the discussions that followed. It was a pleasure to practice with him next door. He was a member of the Worcester District Medical Society (WDMS), joining in 1966. Here is an abstract from his obituary:

A native of Albany, NY, he was born April 24, 1933, to Dr. Harold Patrick and Dr. Beatrice (Belser) McGan. He graduated Georgetown University and, in 1956 attended Albany Medical College where he was President of the medical fraternity Nu Sigma Nu. Dr. McGan was born into a family of physicians. His mother, father, and uncle were all doctors and Medicine was the guiding light that truly defined him. His sole goal in life was to help other people.

In 1959, he married Barbara S. Potter, to whom he remained devoted for 61 years until her death in 2020. Shortly after medical school, they relocated to Tacoma, Washington for several years while he was in the Army, stationed at Fort Lewis, and then finally settled in Shrewsbury, Massachusetts. Dr. McGan had a private practice for over 30 years after which he joined Fallon Clinic. Over the course of his 50 years as a practicing physician in the Shrewsbury area, he served as the Medical Director of St. Vincent Hospital and the director of several local nursing homes, as well as a longtime member of the Board of Health.

Dr. McGan was a dedicated “country doctor” held in high regard by colleagues, patients and throughout town. He continued to make house calls with his black medical bag in tow, long after the practice had gone out of fashion. Whenever asked what type of doctor he was, he would smile and respond, “A good one”. He loved being a doctor. He saw his role as not just a healer, but as a teacher, and took joy in mentoring younger doctors throughout his career.

After retiring, he continued as a consultant at Massachusetts Disability Determination Services, embarking on a new adventure in his early 70s, retiring at 83.

Dr. McGan was one in a million: a wonderful man, husband, father, grandfather, uncle, friend, and colleague. He was the King of “dad” jokes, the creative designer of Halloween costumes, the elegant waltzer, the master of jigsaw puzzles, and the loudest cheerleader at his daughters’ and grandchildren’s sporting events. He was an accomplished saxophone player, with a beautiful singing voice who, at 89, still remembered fondly his years at Georgetown as a member of the band and the Collegians. He was a devoted Patriots and Red Sox fan and a devout Catholic who loved his family above all things. +

B. Dale Magee, MD

Dr. Robert B. McGan

Dr. Rudolf Jakob “Rudy” Utzschneider

Rudolf Jakob “Rudy” Utzschneider, MD, age 92, passed away at home in Shrewsbury, Massachusetts, on January 12, 2023.

Those who knew Rudy, and especially those who worked with him (as did I), saw a man of exceptional intelligence and skill as well as a clarity of thought and razor-sharp ethics who, fortunately for everyone, was willing to take on big things. What follows is a snapshot of those things from his obituary.

Born in Munich, Germany on March 28, 1930, Rudy was raised in Bavaria and, as a child during World War II, he hid in basements during bombing raids.

At age 18, he entered medical school, and five years later he graduated a summa cum laude Doctor of Medicine (MD)from the Ludwig-Maximilians University in Munich. In 1954, he interned at the Elizabeth, New JerseyGeneral Hospital. He also met a smart and witty young nurse anesthetist, Patricia “Pat” Edridge, and, a year later, they married. They spent a year in Germany before settling in Worcester, where Rudy began a residency in general surgery at Saint Vincent Hospital.

In 1960, Rudy and Pat moved to Shrewsbury, where they lived for 60 years and raised nine children. They loved listening to opera, classical music, and jazz, and Rudy was an accomplished pianist and saxaphone player. Rudy and Pat also loved to dance. The whole family joined Rudy and Pat as parishioners at St. Mary’s Church for 60 years.

In 1960, Rudy became the sixth physician to join the Fallon Clinic, a Worcester multispecialty group (now Reliant). For 22 years he helped grow the organization and was instrumental in its expansion, overseeing the move from a house on Institute Road to a building many times larger on Plantation Street. He served as treasurer for many years.

He practiced general and vascular surgery at Saint Vincent Hospital for almost 40 years, where he served as a member of the Executive Committee and Chief of Staff. He loved teaching, and served as Associate Professor of Surgery at the University of Massachusetts Medical School (now UMass Chan Medical School. In 1982, Rudy and Pat decided to build their own private practice and they opened offices in both Worcester and Clinton. Rudy retired from private practice in 1998.

In 1989, Rudy was elected Chair of the Board of Central Massachusetts Health Care, Inc., a physician-initiated, not-for-profit HMO, where he played a critical role in their development and growth. He helped start the Health Foundation of Central Massachusetts, where he served as a Founding Director.

The focus, dedication, and dexterity that made Rudy an exceptional surgeon also made him a prolific woodworker. Rudy always whistled while he worked, content to be working with his hands, making gifts for the people he loved.

He also loved “messing around with boats.” Rudy and Pat sailed the waters of New England as well as reaching as far as Florida and the Bahamas. A boat was the perfect vehicle to bring together many of his passions: a sense of adventure, navigating towards a goal, dealing with the unexpected, working together with family, teaching, and working with his hands.

Rudy joined the Worcester District Medical Society and the Massachusetts Medical Society in 1961. +

B. Dale Magee, MD

Willard G. Rice, Jr., MD

Dr. Willard “Bill” G. Rice, Jr. died on January 19, 2023. This marked the end of a remarkable era when, for about 100 years, there was a Dr. Rice caring for ophthalmology patients in the city of Worcester. Bill continued the traditions and values exemplified by his father and grandfather before him. It was important to him to be respectful of past generations of physicians, kind to his patients, and helpful to his colleagues. He did this faithfully with skill, caring, and dignity.

Bill was a quiet and gentle man. He was always kind. He served his country in the United States Air Force. He was well read and liked talking about current events concerning many things, including politics and sports. He liked the physical challenges of being outside and puttering in his yard. Those are things he liked. The two things he loved the most were his family and practicing medicine.

His love for his family was always evident. He enjoyed raising his family and watching his children mature and succeed. He was not an excitable person, but nothing would bring a bigger or prouder smile to his face than discussing and showing pictures of his grandchildren. He loved being the patriarch of the family.

He also loved medicine and being a practicing physician. In many ways that was who he was as he proudly carried on the example of preceding generations. He was a wonderful colleague and was frequently the first to offer help when someone was ill or needed coverage. He never declined. He would avoid conflict and arguments if possible and never spoke ill of anyone. Equally as important, he was always a source of quiet and wise counsel in all matters relating to practicing medicine. His many good qualities and respectful demeanor will be remembered by all who knew him as a wonderful example of an exceptional colleague. +

Source: https://www.telegram.com/obituaries/pneo0416687

Ed Kazarian, MD

2023

WDMS Annual Business Meeting & Awards Ceremony

Presentation of the 2023-2024 Slate of Officers, the WDMS President's Award, WDMS Career Achievement Award, MMS/WDMS Community Clinician of the Year Award and Anniversary Members

2023 MMS House of Delegates

HOD Opening Session

WDMS Delegates may submit a resolutions

WDMS Legislative Breakfast

Friday

WDMS members collaborate with local and state legislators on public health and healthcare policy

WDMS Women In Medicine Leadership Forum

Title: "The Power of Food, The Power of the Pause: How Lifestyle Medicine, Plant-based nutrition, and biological selfawareness build stronger selves, and help us empower our patients"

Speakers: Drs. Michelle Dalal and Hari Kirin Khalsa

2023 MMS Annual Meeting & House of Delegates

Second Session: 9:00 am

Annual Meeting: Noon

All WDMS members are invited to attend as a guest and may submit a resolution to the MMS.

Meet the Author Series

Author: Mark Vonnegut, MD

11 24 28 3 13 24 For more information about our Society, please visit

Title: "The Heart of Caring: a Life in Pediatrics"

• Medical History Projects and Book Club

• Music Worcester Performances (For WDMS Members Only)

www.wdms.org