Intended for healthcare professionals

Careers

Medics speaking out against violence

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4742 (Published 02 August 2011) Cite this as: BMJ 2011;343:d4742
  1. Sue Learner, freelance journalist
  1. 1Wiltshire, UK
  1. suelearner{at}journalist.com

Abstract

Sue Learner speaks to a Scottish group of doctors who have left the confines of their hospitals to fight knife crime

“People don’t go out thinking that they are going to become a murderer—but slip a knife from the cutlery drawer in your pocket and that’s exactly what might happen,” says Michael Murray, who spends his spare time talking to schoolchildren about knife crime.

Dr Murray, a consultant neuroanaesthetist, is one of a growing number of doctors taking the message about knife crime directly to the people who get caught up in it.

He and 100 other doctors give up their own time and visit schools, youth clubs, and young offenders’ institutions to talk about the consequences of knife crime, which is a big problem in Scotland. The number of homicides in Scotland rose by nearly 30% last year to 93, 21 more than in 2009-10.

Detective Chief Superintendent John Mitchell, head of crime operations for Strathclyde Police, blames it on the country’s obsession with “booze and blades” and said, “The weapon of choice is the knife.”

Medics Against Violence

The charity Medics Against Violence (www.medicsagainstviolence.co.uk) was set up in 2008 in a bid to stop this violence, and since then its members have visited nearly 40 schools all over Scotland. Some of these schools are now on their third year of visits.

Each visit lasts an hour and involves a structured lesson that uses a DVD called “Your Choice,” followed by group discussions.

The DVD shows a young man who has murdered someone describe what it is like to be in a young offenders’ institution. A mother talks about losing her 17 year old son, who was stabbed, and a boy who is paralysed and in a wheelchair explains how he was injured during a gang fight.

Afterwards the doctor talks to the pupils about what it is like to treat people who have been stabbed or who have had their faces slashed with a knife.

Dr Murray, who works in the neurosurgery unit at the Southern General Hospital in Glasgow, has spoken at 15 schools, two youth clubs, and a secure accommodation unit and has made three visits to a young offenders’ institution.

“We do a trauma list every day in one of the theatres at work, and it is nearly all violence related facial injuries. When you read the statistics that there are around 100 people every day getting the same treatment across Scotland, and probably the same again who aren’t getting treatment, the numbers become quite frightening.

“This may mean there are a thousand people every week being damaged in Scotland by violence. I don’t see why we should have almost twice the murder rate of England and be prepared to sit back and do nothing about it.”

He believes that his visits really do make a difference, saying, “The film we show is pretty hard hitting, and I think it shows clearly the reality of what can happen. And I am sure, when we are targeting children at the appropriate age, it does have an indelible impact. I think most children have little contact with doctors, and we are still held in some regard, even if it is a morbid fascination.”

Becoming involved

Dr Murray says that those wishing to become involved with the group need to move out of their normal comfort zone and must enjoy having the chance to make a difference.

He says, “It has given me very interesting experiences, and I do feel rewarded by the efforts that we are making. I am usually warmly welcomed and appreciated whenever I attend a school.”

He believes that it is up to everyone to do what they can to change things. “It is in our own professional and personal interest to make the place we live safer. If we do nothing we will pay for it later, and the police can’t do it all. We have to change the way people think.”

Liz James, a consultant anaesthetist at Royal Alexandra Hospital in Paisley, visits eight to 10 schools a year. On average, however, doctors tend to do four visits a year.

Dr James got involved because “it sounded so interesting and a really useful thing to do.” She says, “It seemed really good that it is aimed at 13-14 year olds, as they are on the cusp of becoming involved with that kind of behaviour. If me going to speak to a class stops someone being killed, then from a public health perspective that is good intervention.”

She thinks the children listen to her “because, as I am a doctor, I am that bit different, and they don’t have a preconceived notion of how to speak to me. To some I am a creature from another planet.”

When she first started doing it she thought long and hard about what to wear. “I thought, should I dress more informally, so they can relate to me? But I decided to wear my smart, ‘middle aged’ consultancy clothes.”

She added, “Some of them tell you pretty amazing stuff that has happened to them, such as being involved in gang fighting and about relatives who have been murdered.

“There is some evidence from research that it does make them think, and they do seem to take on board what we say to them.”

Dr James has found that because teenagers live a lot of the time in a virtual world, they seem to lose a sense of reality. “We show them footage from CCTV, and there are often nervous giggles, and I tell them this isn’t something they are watching on their PS3. We also talk to them about keeping themselves safe and not going to places where there could be trouble.”

She admits to being “a little bit daunted” when she first started doing it. “The first school I visited was near where I live, so I was familiar with it and that really helped,” she says.

Dr James was one of the first doctors to step out into the unknown and go and visit schools, but now doctors tend to go in pairs.

“I have time that I am not paid for when I can do this. I think it is something you should do. Hospital consultants generally have some time in the week when they could squeeze in a visit to a school,” she says.

It very much depends on your personality, however, and what your clinical practice is.

Dr James often goes with a psychologist, and she finds that this combination works particularly well, as “I can talk about the acute side, and she can talk about the forensics and how stabbing someone can screw up your mind as well.

“I find it very interesting and fascinating and good fun, and hopefully we are influencing their behaviour. It is worthwhile if it stops somebody being killed or ending up in jail for assaulting someone.”

The charity was originally set up by Christine Goodall, a consultant oral surgeon, and Karyn McCluskey, deputy head of Scotland’s Violence Reduction Unit.

Dr Goodall felt driven to do something about knife crime after becoming involved in research in facial trauma and alcohol. She says, “I kept thinking I was closing the stable door after the horse has bolted.

“It is generally young men aged between 15-24 who are involved in violence and knife crime, and they have generally been drinking.

“We were talking about what we could do to prevent it happening in the first place, and I suddenly wondered if it would help if we had doctors going round schools. MAV [Medics Against Violence] has found that the problem isn’t getting people interested, it is whether they can spare the time.

“We find that the doctors who are able to spare the time are those who do more regular hours on a nine to five basis rather than shift workers. General practitioners are not going to be interested if they have to pay a locum to cover for them, as they are running their own business.”

She has found that “a lot of the children think you can be stabbed in the buttocks and nothing will happen, but we tell them they can still bleed to death.”

She added, “A lot of the kids feel invincible and think doctors will be able to fix everything. We try to make them think about the consequences. We do get kids telling us they have to carry a knife, as everyone has got one.

“We did consider going in with lots of gory photographs, but they see so much on YouTube and watch these awful horror films that we decided it wouldn’t really impact on them.

“We try and get across the concept of empathy, but many of them don’t come from loving homes, so it can be difficult,” she admits.

The charity mainly targets 13-14 year olds but soon hopes to start visiting primary schools as well. The format of the lesson would be very different, however, and would revolve around play.

Expanding the programme

Dr Goodall is also hoping to expand the programme and wants to recruit doctors to do something similar in London.

“The Metropolitan Police are interested in running something there,” she said, “and we have been to London to speak to the assistant commissioner about what we do and how it works. We are looking for more doctors to take part in our antiviolence work both in Scotland and London.”

Dr Murray is adamant that violence is not inevitable and that interventions do work. “If you were to have told someone 40 years ago that there would be a 60% reduction in smoking rates and that it would be banned in public places, people would have laughed,” he says.

“It is the same with violence. It will change.”

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