Neil Haley: Everyone, and welcome to the special simulcast of the Neil Haley Show and Doc Tales. I’m excited to welcome my co-host, [inaudible 00:00:36] Doc Alan Lindemann. Doc, what’s going on, man? I know you’re excited about our guest.
Dr. Alan Lindemann: We sure are. We’re doing really well here, Neil and you?
Neil Haley: I’m doing great. So who is our guest today?
Dr. Alan Lindemann: So do you actually see patients in the ER now? You’re so busy, you’re doing so many things.
Dr. Eric Fleegler: I basically have multiple full-time jobs. I’m a full-time pediatric emergency physician, 7:00 AM I’ll be in the ER tomorrow. And this morning I was doing sedations for patients and then doing my research in between. So it keeps me very busy.
Neil Haley: And what’s made you kind of look out there, to get yourself out there in the media, to talk about who you are and this? Because you go through such a long, long day as doctors, and I know this, the hours and different things from clients among doctors, and just to put yourself out there to give … is it giving back in a lot of ways? Is it wanting to make change where you’re seeing such a hole in these, just the visits and who ends up in the ER and stuff?
Dr. Eric Fleegler: Yeah. That’s a great question. There are many reasons why patients end up in ERs and some of them are out of our controls. We have an asthma attack, we develop pneumonia or ear infections. These things happen and sometimes there are reasons why some groups may get them more than others. But a lot of the times when people end up in emergency departments, it’s because of a lack of access to resources. Now, that may be healthcare resources, it may be things related to what we call the social determinants of health: food insecurity, housing problems. We see patients who come in who are homeless and experience not just being homeless, but the health consequences of it. We see kids who come in from violence, kids of mental health problems, and all of these things basically motivate me to say, “How can I do more? How can I be with them?” What leads me to do research is basically something that hurts my heart, something where I say, “This doesn’t have to be like this, and I wanted to be able to do better.”
Dr. Alan Lindemann: Well, it sounds like you had a lot of experience with a lot of things, and certainly I want to ask you a little bit about violence. You see injuries in children, what percentage of your ER practices is violence?
Dr. Eric Fleegler: Yeah. So as I’m sure you are aware, violence is not equally distributed throughout our country. And so when it comes to emergency medicine, where you work will really determine very much about the types of violence you see. So in our emergency department where we take care of about 60,000 kids a year, probably about a quarter of those are injury related types of things. But the majority of the injuries that we see at our place, because of where we’re located in Boston, are more oriented towards your sports and bruises and normal stuff, with a smaller percentage being specifically people being hurt from either being shot, or stabbed, or getting into fights.
But if you go downtown a couple miles from where I work to Boston Medical Center, it’s a completely different story. And in a place like Boston Medical Center, they see the majority of our firearm injuries that occur in Boston. Thankfully in Massachusetts, we have very, very low rates of firearm violence compared to many other states in our country. But that’s where it is. And so while the percentage of patients that I personally treat on a daily basis, specifically from violence, is relatively low, I do see many, many patients with severe mental health concerns and people thinking about suicide and depression, which is always been a problem with kids, but became almost intractable during the Covid pandemic. And we’re still trying to figure this out.
Dr. Alan Lindemann: Well, in obstetrics, that’s what I am, I graduated my residency in ’81, so a long time ago. But the number one cause of death now with mothers is what we call behavioral. So it’s in educated white women, it’s suicide, but for colored women, it has to do with homicide. Of course, you don’t see much pregnant women, but certainly that is a problem that we are seeing more of.
Dr. Eric Fleegler: Oh, absolutely. Now I can tell you some of the numbers. So as you’ve said, I do a lot of my research is in firearm injury violence and trying to understand it. In the United States, there are about 3,000 women a year who will die from firearm homicide. 50% of those firearm homicides are intimate partner violence related from current or previous partners. And it’s like, as I said before, it’s not evenly distributed. If you are an African American woman in the United States, the likelihood of dying from intimate partner violence is fivefold greater than white women in the United States. And as you correctly pointed out, suicide, which affects everybody is, has its highest rates among the white population and as well among the American Indian and Alaska Native populations.
Neil Haley: And there’s such involvement in mental health, Dr. Fleeger, that we’re really seeing is biggest, one of the biggest issues that leads to all this violence is the mental health, the lack of really figuring out the right mental health resources for children and families. Because that’s where all this develops and it leads to these things, unfortunately, in specifically some of the biggest cities.
Dr. Eric Fleegler: The mental health crisis, it’s important to think about when we think about violence. Mental health, probably the greatest, not probably, the greatest impact is certainly going to be around suicide. There’s a very close and obvious link between suicide and mental health problems. And when we think about firearm violence, specifically in our country of in 2021, there were over 48,000 people who died from firearms in our country, 60% of those fatalities were from suicides. When it comes to homicide, it’s really not about mental health, although we frequently hear about that, especially with mass shootings, but is about interpersonal violence. It’s about high rates of gun ownership and conflict that is we’re turning to the guns for resolution.
Dr. Alan Lindemann: Well, yes, suicide, I’ve always said, is a permanent solution to a temporary problem. So you’re right about the weapons. If they weren’t there, you wouldn’t have those five minutes to think about it.
Dr. Eric Fleegler: Oh, the data, when people think about suicide, is really amazing. When you think about lethal means. Lethal means how lethal is it your action. So when most people try to commit suicide in the United States, 85% of them will use pills or other type of harm. The fatality rate, when they’re at that desperate moment with a pill overdose is about 3%. However, if a gun is in the house and it’s used, it’s 91%. It’s a huge difference. And that’s why even though guns are only used in 5% of attempts, they account for close to 50 to 55% of all fatalities.
Neil Haley: It’s crazy to think about those numbers and everything that happens and what can be done next to help children and help families in so many ways. What do you recommend, especially going out here and talking about this, how we can change some of this narrative?
Dr. Eric Fleegler: There’s a lot of things that can be done. The first and foremost … may I pause so I can just hang, stop that phone from ringing?
Neil Haley: Sure, sure. Go ahead and do that. We’ll just keep it rolling till that happens.
Dr. Eric Fleegler: Apologize about that. Okay. Serious questions and not so serious phones. So what can be done the mental health crisis and suicide specifically? First, the mental health crisis has blossomed in ways that we’re still grappling with. And if you come to the emergency departments, you will see it in a truly profound way. We have a 50 bed ER, on average, any given evening over the last two years, we can have 25 to 30 of our beds occupied by patients who are there just waiting for placement, for psychiatric placement. This is a chronic, chronic problem that has gotten so bad during Covid. We sometimes have patients who wait week or more in our emergency departments just waiting for placement. That’s just wrong. We need much more mental health resources available to them. And of course, it’s not just about having inpatient units for these kids to go to, but we need psychiatric therapy and therapists who can come and help and work with these patients. And it’s a phenomenally underserved community of people who need this type of help.
But going beyond that, we try to, of course, prevent people from dying. And so as I mentioned, if you have access to a gun, the likelihood if you attempt to kill yourself is very, very high. You lose the opportunity to have regret. You lose the opportunity to make a phone call. You lose the opportunity for somebody to find you and get you help. So part of the solution is trying to limit access to firearms, in particular by kids. And part of that is either not having a gun in your home, especially if you know you have a child with mental health problems or at a minimum, keeping the gun appropriately locked up and inaccessible, locked and accessible doesn’t help, locked up and inaccessible. And likewise, keeping the ammunition locked up and inaccessible to those kids.
Dr. Alan Lindemann: Well, I can tell you at 75, I’ve never had a weapon in the house, and I have three children, so I didn’t have to worry about them shooting anybody. But it is amazing that I think kind of … you have an uphill battle with trying to get weapons out of the house.
Dr. Eric Fleegler: It is challenging. I approach it from a number of ways, and I’ll say I was raised in a family that had guns and I have many relatives who are gun collectors and avid shooters. So I’ve been around it. When I talk to parents, especially when they bring in their kids who have been severely depressed, and are thinking about suicide, I take an assumption that they want their kids to be safe. And I think that’s fair whether you own a gun or you don’t. You want your kids to be safe. These are the most precious parts of our lives.
And so when I talk to them, we kind of go through understanding how are they taking care of say the pills first and talk about locking them up and emphasizing it’s not just about the kids’ medicines, but it’s the parents’ medicines. They’re siblings, medicines, the Tylenol and Motrin. Those are all things that can harm. And they get it and it clicks and, “Okay, yes, I can do this.” Well, then I talk about the guns and I ask them if there’s a gun in a home. And regardless of whether they say yes or no, I tell them why I’m asking. And the reason is because of the lethality and how they can get ahold of these and what happens.
And what is remarkable is the families who talk about their own gun ownership, the most common comment when I get to the point about talking about why you want to lock them up and about possibly we’ve been getting them out of the house and bringing them to that bank safety deposit box or a gun shooting range, the most common comment I get from the families is, I hadn’t thought about it. It’s not that they don’t believe in safety. It’s not that they don’t want their kids to be safe. It’s at this framework of I’ve trained my kids about proper gun own usage, about how to be safe around them, I’ve taught if you find a gun, you don’t touch it. These are the frameworks with which we are, that these families are taking, but not recognizing there are actually downhill consequences once you reach depression.
Neil Haley: Oh, depression’s impossible to get there. So I think your mission is both twofold, mental health and also gun awareness. To make sure that the kids, that they lock up their guns, protect them, different things. It’s not eliminating guns, it’s making sure that they’re safe. And ultimately, at the end of the day, you have your house locked and you have a gun locked up, you can easily get that gun out of your safe if there’s an intruder. You don’t have to have it out and about. It’s like allowing a pit bull, if you have a pit bull living in your house to be not chained up in different ways. It’s a conversation that needs to be out there. You’re not promoting gun control. You’re promoting gun awareness and safety and that’s-
Dr. Eric Fleegler: Gun safety.
Neil Haley: That’s powerful.
Dr. Alan Lindemann: I was just thinking about, I mean, one of the first things we did when my kids were little was to house proof. They can still get into soap and Drano and all kinds of other dangerous equipment. They can pull the frying pan off the stove. There’s all kinds of ways they can get injured, but house proofing is something that everybody needs to do before they get their first child.
Dr. Eric Fleegler: Yeah, and that’s a great point. With all those things that you mentioned, what we’re typically worried about is kids getting injured. But when it comes to guns, just by the very nature of them, we’re almost always worrying about the kids dying. It’s a whole another framework.
Neil Haley: Is there a place we can find information on you, Dr. Eric, and learn more about you?
Dr. Eric Fleegler: Absolutely. So Boston Children’s has a way to look up the doctors that are there, and if you type in my name, you’ll find me. I’ve also written a book with one of my colleagues, Lois Lee, on Pediatric Firearm Injuries and Fatalities, available on Amazon. And then I’m a member of a lot of organizations and I do a lot of writing. I’ve published over a hundred papers, so they’re out there and they’re happy to have you take a look, and I’m always happy to communicate with people.
Neil Haley: All right. We appreciate it. Thanks again for stopping by.
Dr. Eric Fleegler: Thank you for having me. I appreciate it.
Dr. Alan Lindemann: Thank you, Dr. Fleegler.
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