Marlene Busko

September 30, 2015

DENVER — Family physicians voted to accept a resolution stating that excessive use of force by police is a public health issue following an emotional session here at the American Academy of Family Physicians (AAFP) 2015 Congress of Delegates.

These practices often discriminate against minorities and can cause post-traumatic stress disorder in patients seen by family physicians in community practices.

One of several resolutions presented to the AAFP reference committee on health of the public and science, resolution 406, entitled Discriminatory Policing Is a Public Health Concern, was put forward to a six-member committee chaired by Louis Kazal, MD, from the Dartmouth–Hitchcock Medical Center in Lebanon, New Hampshire.

"It's a complex issue," Dr Kazal told Medscape Medical News. Some physicians testified that "they have been stopped themselves inappropriately, yet they understand what the police force is up against," having to make quick decisions when they feel their lives could be in danger.

"You have people who are scared to go one mile an hour over the speed limit," he said. This type of chronic stress is known to lead to disease in susceptible individuals.

The wellbeing of our patients is our "number 1 priority," Dr Kazal explained, adding that the community people live in has an effect on health.

The wellbeing of our patients is our number 1 priority.

In voting for resolution 406, the delegates direct the AAFP to develop a policy statement that recognizes that use of force beyond what is reasonable to accomplish a lawful police purpose "poses a serious ongoing public health issue that disproportionately affects minority communities." In addition, they direct the AAFP to support the promotion of "communication, transparency, and accountability in everyday interactions between the police and public."

The reference committee recommended referring two other clauses — that the AAFP advocate to abolish discriminatory law-enforcement strategies and endorse community policing — to the board of directors. This was done to ensure that these policies will be evidence-based and consistent with the President's Task Force on 21st Century Policing.

Powerful Personal and Patient Stories

In the initial debate during the advocacy session, Shani Muhammad, MD, a delegate from California, who was involved in the development of a similar resolution passed at the AAFP National Conference of Constituency Leaders, explained that "the resolution asks that we, as an academy, do what we have always done — advocate for our patients," especially those who are disproportionately affected by discriminatory strategies.

Tricia Elliott, MD, a delegate from Texas, pointed out that "service to our patients does not stop within the four walls of our examination room." Young black men are routinely taught "how to relate to law enforcement. No sudden moves — this is imperative."

However, this resolution is not about blaming the police, she cautioned. Rather, this is about developing collaborations to empower patients and help law enforcement bridge the gap. "Family medicine — we're the ones who lead the way as a health organization; we realize that this impacts health. What a powerful statement that would be," she concluded, to applause.

Sarah Nosal, MD, a delegate from New York, who brought the resolution forward, explained that she works in an underserved community in the South Bronx. "We, as providers who are perhaps not from that community and not of color, have to realize the harm and danger that's there," she said. "This is a health concern that needs to be addressed."

None of the other medical professions are bold enough to do this, but as family doctors, we will not take injustice any longer.

Another delegate, looking at the situation from a different perspective, pointed out how the brutal actions of a few police officers affect all other police officers. "We as physicians already suffer from being overworked and burnt out. Imagine if, in addition to that, patients blamed us for mistakes made by another physician," she said.

Marie-Elizabeth Ramas, MD, a delegate from California, told two moving stories to "put a face" to the resolution.

First, she described how a young man of Haitian background, like herself, had an anxiety attack and went to a Houston tertiary medical center to get help, where he was shot in the chest by two police guards. "Luckily he lived," she reported.

Next, she described how, when she was a medical student, she and her husband were driving home and her husband was pulled over and handcuffed with no explanation. After 15 minutes of deliberation, the police officer apologized and told them he had mistaken their car for a stolen vehicle.

"As family physicians, it is our duty to speak up for those who are not heard. It is our mission to take care of patients," she said, to boisterous applause. This resolution says that "none of the other medical professions are bold enough to do this, but as family doctors, we will not take injustice any longer."

Another delegate described how police brutality is not limited to people of color. One of her patients, a middle-aged man with Parkinson's disease, wanted to go into his house to see the body of his son who had just committed suicide. Because it was a crime scene, the police would not allow him to do this. "He came to me with a torn rotator cuff, broken ribs," she explained. "I think it is the power that we need to address;" police officers should not use more force than is required.

A delegate from Montana echoed this, saying that people of all races can be on the receiving end of inappropriate force. However, "I also have a son-in-law who is a police officer, and they fear for their lives all the time," she added. "They have to be very careful or they might judge wrong and wind up dead."


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