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Doctors can — and should — talk with patients about gun safety

Instructor Jerry Kau shows student Joanna Zuber how to hold a handgun during a Youth Handgun Safety Class in East Dundee, Ill.

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.

Comments (10)

  1. Submitted by joe smith on 05/17/2016 - 10:55 am.

    I would take advice from my Doctor

    on how to be safe with guns the same way I take his advice on being careful with ladders. If someone needs to tell a person to be careful when you are 20 feet in the air, maybe that person doesn’t need to be 20 feet up. When I want advice on ladder safety I go to my construction friends, who actually use ladders, as to which are safest and how to be more careful with certain projects.

    Maybe we let Doctors do what they are trained to do and let gun safety experts help folks who are looking to be more safe with guns.

    Just to cover all of my bases, I may set up a Doctors appointment to have him help with parallel parking. Been having issues with that lately.

  2. Submitted by Jim Million on 05/17/2016 - 11:49 am.

    “…health behavior…”?

    “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.” Sure, start now with little knowledge.

    Well, perhaps when American medicine gets other “prevention” issues in hand, physicians may speak in some way about “gun health.” I’ll ask my Primary why he doesn’t discuss Alcohol Health and Street Drug Health, as well. Until the FDA and CDC declare gun proliferation to be a social disease, I think he’ll stick to medicine.

    Who still hangs onto the notion that American medicine has much at all to do with prevention? Sorry, our system is based on triage of patient medical complaints, including measures to address elevation of those specific complaints.

    [Shall we address medical success in stemming the Obesity Plague?]

  3. Submitted by Kenny Christenson on 05/17/2016 - 12:10 pm.

    I haven’t laughed so hard in a long time.

    I didn’t know doctors studied firearms safety in medical school. I guess you learn something new everyday.
    As a white male senior citizen I am in the high risk group for suicide. Suicide is a real problem. I really don’t see how firearms safety is related to suicide. I own firearms, hunt with firearms, and have been a firearms safety instructor for over 20 years. I have handled firearms all my life. My doctor encourages me to get exercise and since my primary source of exercise seems to be grouse hunting, he encourages me to hunt. Yes, he does talk to me about whether I feel safe and is concerned about my mental health. But, I know a lot more about firearms safety than he does. My doctor is a hunter. He’s no dummy. I have a lot of respect for my doctor.
    The real problem isn’t firearms, its depression. If you want to do something about suicide, you have to talk about depression. Talking about firearms seems to be off topic.
    Just last fall I talked to my doctor about firearms. I hunt deer with a handgun. He wanted to know about hunting deer with a handgun.

    • Submitted by Jim Million on 05/17/2016 - 08:08 pm.

      My old GP needed your advice

      He once told me that he and some doctor friends sometimes went shooting with their 12 gauges for diversion and relaxation. One Saturday he was tagged for using lead shot (how embarrassing). Claiming he had grabbed the wrong box in a hurry had no prescribed effect that day. When the deputy learned they were all doctors, he swallowed a smile and slowly shook his head. Embarrassment works on smart people.

  4. Submitted by Kim Millman on 05/17/2016 - 12:22 pm.

    You’ve got to be kidding!

    Doctors can’t even give advice on the medical problems in which we seek to resolve. They’ve become 10 minute bit players in for-profit turn-style businesses where they do an equivalent of first impression “symptom” word associations to come up with a drug to prescribe, a test to order or another useless referral to a “specialist” and get you out the door. It’s become a twitter form of healthcare except you are limited to 140 words or less before they interrupt to order a useless test or prescribe an equally useless overpriced drug. They really tip you upside down and shake you out with a referral to a specialist where they can simply repeat the same treatment for double the price and more drugs or tests. Any possible remaining time is spent pushing “preventative” diagnostic tests and vaccines whether you are at risk for the ailment or not. Now you’d like them to take up half the time talking about guns? Has the world lost its collective mind?

  5. Submitted by Dennis Tester on 05/17/2016 - 01:26 pm.

    I received my NRA Gun Safety badge

    as a 13 year-old 7th grader at Marshall Junior high school in Saint Paul.

    The course was taught by my science teacher, Mr. Toussiant, as part of the 9-week school clubs program. It included time on the rifle range, which was in the school basement. I brought my Winchester .22 to school on the third Thursday of every month. Ammunition was provided.

    People who are concerned about gun safety should lobby to return the free NRA training back to the public schools so 7th graders can learn about firearm safety from a professional NRA instructor.

    • Submitted by Jim Million on 05/17/2016 - 07:58 pm.

      I went to Ramsey

      when it was a grade school for awhile. Nobody thought much about guns as personal defense then, not even in the Big City. That was sensible education then, not here when we need it.

      My later certified rifle safety training with buddies was at our American Legion Lodge. Most of my “town” buddies had .22s, which we used for target shooting and tramping the woods on Saturdays…never shooting little creatures, by the way…just boy stuff. I did shoot a robin once, and was immediately remorseful (definitely no hunter in me). I still feed my backyard birds and squirrels year round, perhaps as penance, more as value enhancement.

      My Drivers’ Training classroom course was taught Spring term in our 9th grade science class. If gun safety training is as important (apparently so), I’m with you here. Practical education in an educational setting. What a concept! Of course, the instructor would be held to an approved syllabus to assure objectivity. I’d use football or basketball coaches.

  6. Submitted by Jim Million on 05/17/2016 - 08:18 pm.

    Guns & Chain Saws

    I view both as pragmatic issues of practical living. If you believe you may need one, you buy one and learn to use it properly. In my neighborhood of large trees, chain saws are heard often, guns hardly ever.

    I’m sure there are dopes who use guns ignorantly in the suburbs, just as some guys use their chain saws on extension ladders. Stupid is stupid.

  7. Submitted by DENNIS SCHMINKE on 05/17/2016 - 11:45 pm.

    Yes. Of course…nanny state and its minions (doctors in this case) will solve ALL our problems.

    If my doctor asked, I am not sure what I would say. I would LIKE to say that I have a gun safe full of firearms (and a couple more near my nightstand). What I would probably say (as I don;t want it recorded in my medical record–or anything else that is SUPPOSED TO BE confidential, but is likely NOT) is that it is none of his/her GD business, smile, and refuse to answer in any more detail.

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