Even as closing the wound matters more than stanching the bleeding, it’s how we think about whythe bleeding started that matters most of all. Dr. Rob Gore, an emergency medicine doctor in Brooklyn, New York, started the Kings Against Violence Initiative after he saw the same young men presenting to his ER as both victims and perpetrators of gun violence. As the KAVI website summarizes, “resorting to violence is often both the symptom and cause of longstanding and systemic inequities, poverty, and marginalization. Hurt people hurt people.” So at KAVI, they are looking to understand what starts the bleeding, and take steps to undo the cycle of violence before we’re in triage.

Which brings me back to Biden. “In that moment, I knew the threat to this nation was unlike any I had ever seen in my lifetime,” Biden says of Trump’s Charlottesville comments. It’s certainly true that Trump’s presidency is unusual. But to me, one of the most fundamental questions we’re going to have to address as we consider how to move forward from our current political moment is the same question we have faced in medicine around gun violence: Is it enough to stop the bleeding? Or do we also have to consider the broader picture of what is causing such wounds to rupture in the first place?

What strikes me as off about Biden’s announcement is the way he conceives of our current political moment as a peculiarity that can be smoothed over rather than as an obvious, hemorrhaging symptom that makes plain that we have a deeper societal ill.

There’s plenty of reasonable debate over whether Democratic candidates should focus on Trump in mounting their arguments, or if they should focus on what they want to do for voters—ensure access to health care, propel economic reform, take action on climate change. I suspect this is a bit of a false choice, as what we need is a little bit of both. But if we’re going to talk about Donald Trump, I think we need to acknowledge that he wasn’t created in a vacuum. Our systemic racism and sexism, coupled with our economic insecurities, built a world in which Trump could come to power. Biden’s announcement seems premised on the idea that we need to revert to the world we had before Trump, rather than dramatically rethink the world that produced him.

Our experience in medicine shows that if all you do is stop the bleed, people continue to die because the same system keeps opening new wounds. Trump is a bleed. We can stitch over the wound. But if we want to rebuild America, we need to consider what brought us here, not just how to survive the moment.

Update, April 25, 2019: This post has been updated to note that the author is a physician.

• 2020 Campaign
• Donald Trump
• Joe Biden
• Medicine