Doctors should be talking with their patients about gun safety, just as they talk with them about other potential risks to their health, such as smoking, wearing seatbelts and alcohol consumption, argues an article published online Tuesday in the Annals of Internal Medicine.
Yet few doctors discuss gun safety with their patients, the article points out. Sometimes, doctors believe — wrongly — that federal or state laws or regulations prohibit them from doing so. Other times, they simply aren’t sure how to go about it.
“Physicians generally do not do well at firearm-related injury prevention,” writes Dr. Garen Wintemute, director of the violence prevention research program at the University of California Davis, and his co-authors. “They ask infrequently about firearms and counsel poorly, if at all, though they are aware that the high lethality of firearms makes prevention efforts particularly important.”
Gun violence is a major public health issue in the United States. In 2014, more than 33,000 Americans died of gunshot wounds. Although the risk for gun-related homicide is highest among young African American men, most gun-related deaths are suicides — and the group at highest risk for those is older white men.
Young children are also at risk, often after finding loaded, unlocked guns in a home in which they’re living or visiting. So far this year, 202 children under the age of 11 in the U.S. have been injured or killed by guns, according to the Gun Violence Archive. Among the most recent victims were 10-year-old Colin Fraley, who shot and killed himself with his stepfather’s gun, and 5-year-old Mariah Davis, who died after shooting herself in the neck with a .38 caliber handgun she found under her grandmother’s pillow.
Physicians are in a unique position to help prevent these tragedies, stress Wintemute and his colleagues.
What the law says
Several barriers interfere, however, with physicians practicing preventive medicine for gun-related injuries. Some physicians hold the unfounded belief that it’s against the law for them to bring up gun safety with their patients.
“No federal or state statute prohibits physicians from asking about firearms when such information is relevant to the health of the patient or others,” write Wintemute and his co-authors.
The only existing gag law is Florida’s medical privacy act, which says that health practitioners “should refrain” from asking patients about firearms and “may not intentionally enter” information about firearms into medical records.
But even this law contains broad exceptions. “A practitioner who ‘in good faith believes that this information is relevant to the patient’s medical care or safety, or the safety of others’ may ask about firearms, and only information that ‘is not relevant to the patient’s medical care or safety, or the safety of others” is excluded from medical records,” Wintemute and his co-authors explain. (The Florida law is currently being challenged in the courts as unduly restricting the First Amendment rights of doctors and other health professionals.)
Wintemute’s article also mentions two Minnesota’s statutes, which prohibit the state’s health officials and MNsure from collecting information about individual firearm ownership. But Minnesota does not have a gag provision aimed at doctors.
Counseling high-risk patients
Wintemute and his colleagues recommend that doctors, at a minimum, determine the access to guns of patients who fall into a high-risk category for gun violence. They can then counsel those patients about safety measures for preventing gun-related injuries and deaths, such as safe-storage options.
“Studies of patient perspective on firearm counseling have found that most — though certainly not all — patients seem to be open to nonjudgmental education, especially for members of high-risk groups,” Wintemute and his co-authors write.
They offer detailed advice in the article to doctors and other health professionals about how to identify people at risk of gun violence — and how to talk with those people about gun safety.
High-risk patients include those who express suicidal or homicidal thoughts, those with a history of violence to themselves or others, those with alcohol or drug abuse, and those with serious mental disorders or other conditions that impair their thinking and judgment, such as dementia. It also includes patients in high-risk demographic groups, such as young African American men, middle-aged and older white men, and parents or others with children and adolescents living in their homes.
In some cases — when it’s necessary to prevent a serious and imminent threat to the health and safety of the patient or the public — the doctor may need to disclose the danger to third parties, including law enforcement officials and/or family members of the patient. No federal law prohibits such disclosure, Wintemute and his colleagues stress.
They also point out that most studies that have examined the effectiveness of doctors talking with their patients about the risk of gun-related injuries have concluded that such talks increase gun-safety behaviors.
None of the studies has found that the discussions result in any harm to the patients.
A needed start
“Just as with any other health behavior, no one expects that this [talking with patients about gun safety] will work all the time or even most of the time,” Wintemute told Time magazine reporter Alice Park. “But it’s going to work some of the time, and it’s going to be part of a continuing conversation we need to have about the net benefit or risk of exposure to firearms.”
“We don’t know nearly enough about how best to deliver this information to patients to maximize its effectiveness,” he added. “But the fact that we don’t know everything now is not a reason not to start now. We need to start now, and reserve the right to get smarter.”
FMI: You’ll find an abstract of the article by Wintemute and his colleagues on the Annals of Internal Medicine website, but, unfortunately, the full article is behind a paywall. For rules about gun safety in homes with children, see the American Academy of Pediatrics (AAP) recommendations. The best preventive measure, stresses the AAP, is not to own a gun. The organization also recommends that parents talk to the parents of their children’s friends to find out if they have guns in their homes and, if so, to confirm that those guns are unloaded, locked up and inaccessible to children.