Imagine that your 16-year-old daughter has been bullied mercilessly in school, but hasn’t talked to you about it, or spoken about her suicidal impulses. One day, she is brought by ambulance to your local hospital emergency room, having made superficial cuts on her arms while in school. The emergency room physician tries to call you at work, but your cell phone isn’t picking up. The doctor begins her evaluation of your daughter, including an assessment of all relevant risk factors for suicide. Now imagine that the doctor believes she is forbidden by law from asking your daughter whether there are guns in your home — despite the fact that firearms in the home markedly increase the risk of gun-related suicide.1
You needn’t use much imagination. In Florida, Gov. Rick Scott is expected to sign a bill (SB-432) that will prohibit doctors from asking patients if they own guns, except when “…the information is relevant to the patient’s medical care or safety or the safety of others…”
The Florida bill was written with the help of — no surprise here — the National Rifle Association, which insists that this legislation is designed to prevent doctors from intruding on a patient’s privacy; “harassing” gun owners; and interfering with the patient’s second amendment “right to bear arms.” Similar bills are being considered in North Carolina and Alabama.
Before posting, please read our blog moderation guidelines. The comments below begin with the oldest comments first. Click on the last comments page to jump to the most recent comments.
Before posting, please read our blog moderation guidelines.
Post a Comment:
Copyright © 1995-2013 Psych Central. All rights reserved.
Site last updated: 20 May 2013
|
First, let me say nice headline. Unfortunately the mere repetition of a lie does not make it true. No law anywhere in this country, pending or passed, prevents doctors from counseling patients on gun safety. The Florida law only prohibits specifically asking if there are guns in the home, doctors are still free to offer information on gun safety.
Second: “… firearms in the home markedly increase the risk of gun-related suicide …” Ah, yes, the old “blame the rope for the hanging” ploy. Alert and attentive readers will notice the ‘gun-related’ modifier, but many people will not, which is why the myth that access to guns increases suicide rates abounds. Study after study has shown that while limiting access to firearms reduces gun-related suicides, it does not affect overall suicide rates, yet the falsehood is perpetuated.
Now, let’s look at the situation presented: an attempted suicide by a sixteen year old, mom is unavailable and *gasp* the doctor can’t ask the child about guns in the home. So WHAT? Is the child going to be released before the parents are contacted? Just gonna kick the kid to the curb and say “Better luck next time!”? Don’t be ridiculous. Of course the parents will be contacted, and of course the doctor can point out that “firearms in the home markedly increase the risk of gun-related suicide” and that prescription medications should be locked up, and that counseling is available, and all sorts of other information can be given to the parents. NONE of which necessitates asking if there are guns in the home.
So, you are justifying an inquiry into legal gun ownership, because a medical doctor is trying to make a psychologist’s determination is a short few minutes, as to whether somebody has the means to kill themselves? Do the questions also include, “Do you have an overpass or bridge to jump from between your home and your school? Do you have razor blades, sharp knives, prescription medicines in your house? Do you have a car and a enclosed garage at your house? Do you have a piece of rope and a sturdy tree or closet bar at your home?
It is ridiculous to try to narrow down a patients form of potential suicide to one form. How about you inform the people that the patient lives with, that they may be suicidal and include a list of common clues and methods, so that they can take the responsibility of trying to insure their patient doesn’t find a way to kill themselves?
Focusing your questions on gun ownership really appears to come with a hidden agenda…and personally, if my doctor asks me or my child regarding ownership…they better be prepared to lose a customer and get a verbal lashing.
I agree that the example given was not a good one for the point Dr. Pies was trying to make; but I still do agree with his basic points – that this law, though well-intentioned, could bring harmful consequences to those that it is meant to protect.
First, let it be known: I am not anti-gun ownership. Though I would personally never own one, primarily due to my long history of chronic depression, I would never lobby to prevent another person from owning one. In fact, I will fight for them. This isn’t about if gun ownership is a good idea; it’s about patient safety.
If one would like to admit it or not, having a gun in the house does raise the risk of death and injury. This could mean suicide, homicide or accidental death. Most certainly, this risk is higher with pediatric patients. Children are naturally curious, they are often given toy guns to play with, and they get into everything they possibly can. For the severely emotionally disturbed child or adolescent, as with the ten year old boy mentioned in this post, it is not unheard of for suicide and/or homicide to occur. Obviously, this can be prevented by securing all the guns in the house, and a doctor could easily educate a parent about the risks of gun ownership without asking the question directly; however, doctors’ time with patients is extraordinarily limited, and they don’t have the time to educate about risk factors that may not apply to a particular family or patient. Asking if a gun is in the house lets the doctor know what information and suggestions need to be given.
Guns are not signaled out in this situation, by the way. With the case that started this, the question about gun ownership was asked after a series of other questions relating to common risk factors for accidental death, such as having a pool. That’s not harassment. That is a doctor doing his job, and doing it well. You don’t see anybody trying to enact laws barring doctors from asking if someone has a pool in their home. It’s the same thing.
The situation becomes even more complex with adults, however. checknsix, you mentioned that the doctor should simply inform those living with the patient that he/she is suicidal, and educate them about the risks. Though that may sound good to the lay person, it does not work with clinical reality. Doctors and, more broadly, therapists, are bound by confidentiality. Unless the patient gives explicit permission, or expresses homicidal intent, the doctor cannot tell those living with him/her anything. Even if the patient is hospitalized as a result of being suicidal, the doctor still must keep to confidentiality. They would not be allowed to simply contact those people and educate them about gun violence, either. These are the rules and facts, all across the country.
When dealing with a suicidal patient – or any patient – the doctor must provide the highest standard of care possible. Part of that – once again, on a national level – is to collect necessary information about the patient’s history and current risks (otherwise, they risk malpractice suit). Gun ownership is part of that. So are other common risk factors: medications, for example. I promise you, inquiry about gun ownership is not signaled out in this process; but they are a necessary part of it.
Assuming that all of your concerns are valid (though I might quibble with a couple of them), all of it could be addressed just as well – and without invasive questioning – if the concerned physician were to adopt a policy of simply giving each and every patient an inexpensive pamphlet (produced by some organization that is actually qualified to give instruction on the subject) containing the aforementioned information.
Problem solved.
This is not about safety. It is providing gun ownership records to the government. My doctor apologized for having to ask. She told me she was required to ask. I am a 60 year old woman seeing a doctor about a thyroid problem. Makes no sense to me!!!
As the previous posts correctly point out, the old “increases the risk of gun-related ” cannard as employed here is grossly misleading at best. One must ask if the author considers the suicidal use of a firearm is somehow more tragic than suicide by other methods, since there is no evidence whatsoever that the availability of firearms in any way increases the likelyhood of suicide in general. In fact, according to the World Health Organization, countries like Japan and South Korea – where civilian ownership of firearms is essentially banned – have suicide rates nearly 3x that of the U.S. (which currently ranks 39th in terms of suicide rate when compared with all other countries). Japan and South Korea rank 5th and 2nd, respectively. In fact we rank well below most Western European countries in that category.
So…is the author merely ignorant of the subject matter, or is he being intentionally dishonest about it?
While I applaud the medical field for promoting safe firearms ownership, I find it absolutely amazing that a profession which prides itself on scientific integrity – medicine – would blindy accept (and vociferously repeat, as provided in the examples above) the results of a study which failed to consider contributing factors, lifestyles, and pre-existing conditions when determining its results.
If that wasn’t enough, continuing to treat the study as valid when the researcher (singular) repeatedly refused to release any of the questions, sample population information or raw data for examination, in blatant disregard of the long established scientific concept of reproducibility of results… all because the researcher signed “M.D.” after his name.
I appreciate the interest shown by those who have written in so far, and I realize that this is an emotional topic for many. Before more responses come in, I’d like to familiarize readers with the protocol I follow in all internet communications. I respond directly only to those comments accompanied by the writer’s first and last names, and only to those comments written in a civil and responsible manner.
I will respond shortly regarding the issue of gun-related suicide rates, in order to counter the misinformation that has already been posted by some readers. The main, underlying issue, however, is not one of gun-related statistics. The underlying issue is the physician’s (and other clinicians’) right to make whatever clinical inquiries he or she deems relevant to a full professional assessment, without intrusion, monitoring, or muzzling by the government.
Sincerely, Ronald Pies MD
Oh, and I found this bit of cluelessness interesting as well…
“Since when is it the role of government to control what may or may not be said, in the supposedly confidential relationship between physician and patient? Since when are such communications subject to monitoring and muzzling by a state government?”
I assume most MDs are familiar with the legal concept of doctor/patient privilege. That’s not exactly the same as regulating what a doctor can ask a patient while under that particular legal umbrella, but it’s not as if the notion of state prohibitions on what a physician can/cannot say is unprecedented. Does Dr. Pies believe that Amendment I protects his right to repeat what his patient’s tell him whenever and to whomever he chooses? If not…then he recognizes that the state most certainly does have the authority to regulate to at least some extent what he can say when it comes to such communications.
Using a gun to suicide is the most common method in the United States. That is the important statistic, not the gun-related suicide rates in other countries. And contrary to many people’s beliefs, the average suicidal person does not change chosen method easily, thus the reduction in suicides due to barriers.
“Using a gun to suicide is the most common method in the United States. That is the important statistic, not the gun-related suicide rates in other countries.”
No, the important statistic is the overall suicide rate. Gun suicide is not somehow more heinous than driving off a bridge, or ODing and, again, numerous studies have shown that while limiting access to guns may reduce the “gun suicide” rate, it does not affect the overall rate. Case in point – Canada. As their gun laws have become more stringent over the last few decades their gun-related suicide rate has gone down, but their *overall* rate is unchanged (or possibly slightly higher).
I’d argue we only care about gun suicide rates logically. And in the U.S. only (since this is a U.S. based policy affecting only U.S. citizens).
If we enact DUI laws and keep lowering the legal limit, and see a reduction in the amount of deaths in motor vehicle accidents due to alcohol, but no movement on overall vehicle deaths, would we care? Of course we would.
Suicide is inherently irrational, but if you limit access to the preferred means of suicide — whether through a bridge barrier or removal of guns in the household — you’ve made it more difficult for that person to die. Not impossible, of course, since we don’t live in a world of absolutes.
And when it comes to suicide, limiting things is the best we as a society can do right now since we refuse to fully fund public health intervention and treatment programs that could do more to help such people in need, and instead rely on VOLUNTEERS (not even medical professionals! not even paid!) to help these people in crisis.
Thats an absolute load of ka ka.
For a barrier to be established by the removal of a tool will result in less suicides means only one thing.
You believe that the inanimate object has some form of esp, voice or brain wave control. Otherwise how could an inanimate object affect the suicidal persons feelings or mental instability?
Where is your world renown medical study not sponsored by an anti gun zealot or organization showing removal of a tool reduces suicides eh, LOL!
Why is it that Japan and so many other gun ban countries have higher suicide rates than the US? By all accounts, you should have very, very, very good and accurate suicide studies showing how those countries suicide rates have significantly dropped because some inanimate object is removed eh einstein?
You do know the only people who believe they hear voices or feel that an inanimate object can control a person by such methods as voice, esp, or brain wave control just by being in close proximity to said inanimate object have been diagnosed as schizophrenics eh?
If somebody has decided in their mind that they want to commit suicide, they are going to do it with or without a gun.Doctors can’t control what the patients are going to do once the patient leaves the hospital. It is evasion of privacy to ask a patient whether or not there is a gun in their residence, but all the doctor can really due is educate the child and the parents of the dangers.
- “The underlying issue is the physician’s (and other clinicians’) right to make whatever clinical inquiries he or she deems relevant to a full professional assessment, without intrusion, monitoring, or muzzling by the government.”
I’d love to hear your explanation for what bearing the presence/absence of firearms in a patient’s home has on a MEDICAL assessment of that patient.
- “Using a gun to suicide is the most common method in the United States. That is the important statistic, not the gun-related suicide rates in other countries.”
Only if you choose to ignore (as you have) the implication of the global statistics. Namely, that people bent on committing suicide will do so even in the absence of the most convenient/effective method of doing so.
- “And contrary to many people’s beliefs, the average suicidal person does not change chosen method easily”
Probably because they generally only make that particular choice once.
I would kindly remind commentors to keep your arguments to the topic at hand and not make personal comments against the author; Psych Central does not publish ad hominem attacks.
Also, making personal attacks against researchers who are not here to defend their decisions is inappropriate. If research appears in peer-reviewed journals and has not been specifically refuted or retracted, the scientific community considers such research valid.
Make your arguments based upon logic, reason and known data. That’s how doctors operate, and anything that works to handicap a doctor’s ability to ask any question they deem appropriate to their clinical interview smacks of government censorship to me.
The government has never previously gotten into micromanaging what doctors can ask of their patients. The data to back up this politically-motivated attack on doctors simply doesn’t exist… All the while there is more than sufficient data and scientific evidence connecting guns in households and risk of violence and/or death.
- “Make your arguments based upon logic, reason and known data. That’s how doctors operate, and anything that works to handicap a doctor’s ability to ask any question they deem appropriate to their clinical interview smacks of government censorship to me.”
State governments have been enacting similar restrictions for decades. For instance, in most states there are many questions that employers are prohibited from asking prospective employees during the job interview process (for example…if they are a part of some protected group based on age, etc.) Do you object to them as censorship as well? In a previous post I asked how the presence/absence of firearms in the home is material to a *medical* assessment. I’ve not seen an answer to that.
- “All the while there is more than sufficient data and scientific evidence connecting guns in households and risk of violence and/or death.”
For instance?
- “Make your arguments based upon logic, reason and known data. That’s how doctors operate”
Then it’s rather odd that, rather than referring to peer-reviewed research to support his contentions, the author has chosen to cite an opinion piece that itself relies on emotional anecdote for an opener (“Guns, fear, the Constitution and the Public’s Health”) and a story by NPR. Not exactly a reliance on the scientific method.
WuzYoung… We’re talking about doctors and their relationship with the government here, not other professions or other relationships (employer/employee), which are very, very different. You don’t have to entrust your life to your boss.
As for the evidence, I’ll be happy to provide citations over the weekend.
- “WuzYoung… We’re talking about doctors and their relationship with the government here, not other professions or other relationships (employer/employee), which are very, very different. You don’t have to entrust your life to your boss.”
Which is, of course, completely irrelevant with regard to the point being made. Namely, that state restrictions on inquiries that may be made in a professional setting are not unprecedented nor uncommon. As for the “entrust your life” bit, that’s not relevant either in this context. That is, unless you’d like to answer the extremely pertinent question that I’ve asked twice already (and this makes three times now) and that you and the author keep avoiding:
How is a question about whether or not a patient has firearms in his/her home necessary for a medical assessment of that patient? Unless/until you can adequately address that question, all the rest is just a diversionary side-show.
- “As for the evidence, I’ll be happy to provide citations over the weekend.”
I’d further request that you save us both time by restricting your citations to peer-reviewed studies that have not already been publicly debunked.
WuzYoung…. “Publicly debunked…” What do you mean by this comment? Studies that have been refuted by newer scientific studies also published in peer-reviewed scientific journals? Or do you have another definition of “publicly debunked”?
@John M Grohol PsyD
You state: “We’re talking about doctors and their relationship with the government here, not other professions or other relationships (employer/employee), which are very, very different.”
Is this the same Government than wants to make all medical information “internet accessible”, meaning gun information given to the doctor will be able to be extracted remotely?
Which would in actuality allow Government agencies to determine which law-abiding citizens are exercising their constitutionally enumerated Right? (For confiscation?)
In effect, allowing a “secret” gun possession database. (Sounds like just another conspiracy theory don’t it . . . until you look at past Government actions like illegally storing gun sale approvals, and the “Fast and Furious”, “Gunwalker” projects.)
You state: “You don’t have to entrust your life to your boss.”
Since you brought it up: What is the percentage of “death due to medical misadventure” to the number of gun related deaths accidental and deliberate?
Doesn’t Japan have a suicide rate many times higher than the U.S., nearly double ours?
Do you believe it is because Japan doesn’t have enough guns?
Or is it because someone wanting to commit suicide badly enough will find a way.
Dr. Pies, I understand the reasoning behind your protocol with online communication.
Just in case you wish to respond to my comment, my full (actual) name is Erika Svenson.
I don’t know that a law is necessary here, but I also wouldn’t be interested in seeing physicians who felt the need to educate me about gun safety. It’s paternalistic, unnecessary, and having grown up with guns in the house I probably know more about gun safety than they do.
http://www.ocala.com/article/20100724/ARTICLES/7241001/-1/news?Title=Family-and-pediatrician-tangle-over-gun-question
Funny, how this is an example of one of those unenlightened doctors reactions and the driving force behind the law.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/4/888
This statement reaffirms the 1992 position of the American Academy of Pediatrics that the absence of guns from children’s homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents. A number of specific measures are supported to reduce the destructive effects of guns in the lives of children and adolescents, including the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on handguns and semiautomatic assault weapons; and expanded regulations of handguns for civilian use. In addition, this statement reviews recent data, trends, prevention, and intervention strategies of the past 5 years.
Abbreviations: AAP = American Academy of Pediatrics a member organization of…..
HELP Network
Children’s Memorial Hospital 2300 Children’s Plaza Chicago, Illinois 60614 Phone (773) 880-3826 Fax (773) 880-6615 www.helpnetwork.org
HELP Network was formed in 1993 and claims to be the “health voice in the national debate about handgun violence.” HELP endorses reducing civilian access to handguns, and funds research to support that agenda.
Any group that supports “the regulation of the manufacture, sale, purchase, ownership, and use of firearms; a ban on handguns and semiautomatic assault weapons; and expanded regulations of handguns for civilian use” has shown their real agenda. It’s nice of them to disguise it under the concern for patient safety.
Funny how such concern for children’s safety was put in place in the questionnaire oh what less than 15 years ago? Where is the measurable impact in the number of accidental deaths by firearms by this action?
I mean it is so easy to just look at the CDC data and see how in the 1930′s there were 2,500 plus deaths by accidental firearm discharge (pop. somewhere between 112 to 130 million).
Then in 2007, there were 613 per CDC database, 116 were age 18 or younger with a population at 302 mil.
Why then has the accidental deaths where a firearm was the tool used, has the number of accidental deaths not increased by between 130% to 169% like the population eh?
The US government acknowledges there are an additional 100 million firearms and an increase of 30 million households in the last 34 years that own a firearm?
Funny how the consistent factor during the last 4 plus decades of a safety program, are those provided by pro gun and conservation organizations that teach children how to handle and use a firearm correctly. I have been through both pro gun and anti gun safety classes. Bad gun don’t touch is NOT safety training to a child.
Your comparison of accidental firearms deaths between the 1930s and 2007 fails to take into account vastly increased access to emergency medical care for most of the population, as well as the incredible advances in the efficacy of that care and it’s ability to prevent death from gunshot wounds.
Now, if you can lay your hands on some data comparing accidental GSWs for the two periods in question then maybe you can attempt an at least semi-meaningful comparison.
Oops. My apologies to Jarhead1982. I seem to have misread a couple of your posts (including the one I’m responding to…again). Please disregard my hasty responses.
I am a lay person and not nearly as educated as the rest of those who are posting. But, everything I read today is always disguised as love and care for others when in fact it supports one’s political agenda. We are Americans, and when we are told we must comply with someone’s ideas of what will make us safe, we immediatly push back. I am one of those who holds tightly to his Bible (Religion) and his guns. Always have and hope to always will. All of my forefathers did and so does my son. Guns have always been a part of my life and lifestyle and if you look who is in the military/law enforcement you will see that the vast majority are me not the inteligentsia. I don’t care about suicides, people will off themselves no matter what is espoused. Some cultures are very suicide friendly, but we always put our individual american face on everyone we come into contact with, including psychologists. Many of us are not of your social gatherings, don’t drink wine and scoff at the unwashed masses. I personally don’t care what my Doctor asks me, heck we talk guns all the time even go shooting together at the range. I am from Texas so perhaps there is differance in individuals’ beliefs. I say get the politics out of the Doctor’s office, including the Doctor’s. I read what is published at the AMA and the comments above and even I can sense the political beliefs being espoused. Thank you, Daniel
When I want expert advice about gun safety I’ll go to a medical doctor.
When I want expert advice about my health concerns I’ll go to a gun range and talk to the range master.
Right. Whatever.
- “The underlying issue is the physician’s (and other clinicians’) right to make whatever clinical inquiries he or she deems relevant to a full professional assessment, without intrusion, monitoring, or muzzling by the government.”
The reason for the law in Florida is not about mere INQUIRY…it is about action and advice from the medical professional. Let me be very clear. If a psychologist or physician is giving advice about gun safety or personal defense without having undergone training and certification in those latter topics, he is committing a BOUNDARY VIOLATION, and should be reported to his professional societies and state authorities. I suspect that there are very few M.D.’s with the requisite training to be appropriately offering advice about guns.
Exactly. Given the large proportion of suicides that are driven by economic factors, should we also expect to hear from our physicians a series of questions regarding our personal finances so that they may give us advice on money management and retirement planning?
There is no need for a law “muzzling doctors”.
Doctors should be able to ask any pertinent question of their patient that they are qualified to ask.
Simple enough?
So if asked about guns in the home, the patient should ask for the doctor’s certifications in firearm training/safety.
Failing to be shown valid certifications the patient should then:
1) Contact the doctor’s insurance carrier and determine if the carrier is aware of the doctor practicing, in an official capacity in a field in which the doctor is unqualified, while under their coverage.
2) The patient should then file an official complaint with the State Medical Board about the doctor’s Boundary Violation.
All the legislation for nothing, is a waste of taxpayer resources.
I like this. Any doctor giving advice should have a certification in that field. I had posted something to this effect earlier, but the moderators didn’t like that idea.
How about:
Join Date: Jun 2009
Location: Oregon
Posts: 1,173
FIREARMS SAFETY COUNSELING REPRESENTATION:
PHYSICIAN QUALIFICATIONS AND LIABILITY
Part One: Qualifications
I affirm that I am certified to offer (Name of Patient: ), herineafter referred to as
“the Patient”, qualified advice about firearms safety in the home, having received:
Specify Course(s) of Study:
__________________________________________________ _______________________
from:
Specify Institution(s)
__________________________________________________ _______________________
on:
Specify Course Completion Date(s):
__________________________________________________ _______________________
resulting in:
Specify Accreditation(s), Certification(s), License(s) etc.:
__________________________________________________ _______________________
__________________________________________________ _______________________
Check one, as appropriate:
___ I represent that I have reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of private
firearms ownership. I further represent that I have reviewed all other relevant home safety issues with the Patient, including those
relating to electricity, drains, disposals, compactors, garage doors, driveway safety, pool safety, pool fence codes and special locks
for pool gates, auto safety, gas, broken glass, stored cleaning chemicals, buckets, toilets, sharp objects, garden tools, home tools,
power tools, lawnmowers, lawn chemicals, scissors, needles, forks, knives, etc. I also acknowledge, by receiving this document, I
have been made aware that, in his inaugural address before the American Medical Association on June 20, 2001, new president
Richard Corlin, MD, admitted “What we don’t know about violence and guns is literally killing us…researchers do not have the data
to tell how kids get guns, if trigger locks work, what the warning signs of violence in schools and at the workplace are and other
critical questions due to lack of research funding.” (UPI). In spite of this admission, I represent that I have sufficient data and
expertise to provide expert and clinically sound advice to patients regarding firearms in the home.
OR
___ I am knowingly engaging in Home/Firearms Safety Counseling without certification, license or formal training in Risk
Management, and; I have not reviewed applicable scientific literature pertaining to defensive gun use and beneficial results of
private firearms ownership.
Part Two: Liability
I have determined, from a review of my medical malpractice insurance, that if I engage in an activity for
which I am not certified, such as Firearms Safety Counseling, the carrier (check one, as appropriate):
___ will
___ will not
cover lawsuits resulting from neglect, lack of qualification, etc.
Insurance Carrier name, address and policy number insuring me for firearms safety expertise:
__________________________________________________ _______________________
I further warrant that, should the Patient follow my firearm safety counseling and remove from the home and/or disable firearms
with trigger locks or other mechanisms, and if the patient or a family member, friend or visitor is subsequently injured or killed as a
result of said removal or disabling, that my malpractice insurance and/or personal assets will cover all actual and punitive damages
resulting from a lawsuit initiated by the patient, the patient’s legal reprerentative, or the patient’s survivors.
Signature of attesting physician and date: __________________________________________________
Name of attesting physician (please print):___________________________________________ _______
Signature of patient and date: __________________________________________________ __________
Name of patient (please print):___________________________________________ _________________
Patient: Indicate if physician “REFUSED TO SIGN.” Have physician place a copy in your chart/medical record.
Dr. Pies writes, “Furthermore, patients who decline to answer a physician’s questions about gun possession should never be harassed, disparaged or denied care…”
I agree. In fact this issue was raised because a physician did exactly what you write should not happen. He denied care when people refused to answer the physician’s question about gun possession which was none of his business to begin with.
I would like to thank all those who have commented for taking the time to address a critical—and obviously, controversial!—issue. I believe many of the strong, negative reactions to my article stem from a misunderstanding of the physician’s medico-legal responsibilities in our society, as well as a misunderstanding of the main point of my article.
To be clear: I recognize and respect the right to bear arms, as granted under the second amendment, and my article was not intended to disparage this right. My article was, fundamentally, not about “gun control,” but about “speech control.” It was about the right of physicians to use their best clinical judgment in assessing risks to their patients, without facing legal penalties or loss of license, if they stray from the government’s dictates. Specifically, in my view, no law should restrict the doctor’s judgment with respect to asking about firearms access, any more than laws should restrict a doctor’s ability to ask about alcohol or drug use.
Patients, of course, must be free to decline to answer such questions, and their care should never be jeopardized, if they do. Furthermore, nobody is suggesting that each time a patient goes to see her family doctor, or visits an emergency room, questions must be asked about firearms. I am simply saying that we don’t need the government to regulate a matter that has been between the patient and the doctor for the entire history of this country. (I suspect that if Florida passed a law prohibiting members of the clergy from raising certain questions with their parishioners, there would be quite an outcry from the general public!).
As for education regarding firearms safety, I certainly agree that doctors must first carefully study what is known about gun safety, before offering “education” to patients. But physicians and other health-care professionals should be free to provide basic gun safety guidelines, and patients should be free to say, “Thanks, but no thanks, Doc—I already know about gun safety.” We don’t need the government to regulate these basic, doctor-patient interactions.
Nobody is arguing that “freedom of speech” is absolute, for doctors or anybody else (nobody has the right to yell “Fire!” in a crowded theater). But there is simply no comparison between a state’s prohibiting unauthorized disclosure of patient-doctor information—which is totally consistent with the cornerstone of medical ethics—and a state’s prohibiting a doctor from asking certain questions within the confines of the doctor-patient relationship. The first is based on a mutually-agreed upon restriction of speech (i.e., part of the traditional doctor-patient “contract”); the second is an unwarranted incursion on free speech, representing government interference.
The physician’s role carries immense powers –including the right to hospitalize suicidal individuals, declare quarantines, and restrain violent patients– and equally immense responsibilities. We are guided and regulated by the professional “standard of care” within any given medical specialty. If a state passed a law saying, “Doctors will no longer be allowed to ask about alcohol use when a patient presents in the emergency room in a confused state,” that would not alter the ER physician’s professional standard of care by one iota. And, it is simply incontestable that the nationally-accepted standard of care in emergency medicine, pediatrics, and psychiatry often requires an assessment of the patient’s overall safety, and his dangerousness to self or others. The question of gun possession and access is one important part of that assessment. We can’t do our job with one hand tied behind our back, and that is precisely what Florida-type regulations would mean.
Now, as to the actual data on firearms and suicide: the most honest and accurate statement that can be made is that we don’t have all the answers, and that the best available research is very complicated and often contradictory. I would strongly encourage all readers with an open mind on these issues to read the National Academy of Sciences’ (NAS) report “Firearms and Violence: A Critical Review”, which is available on line at http://www.nap.edu/catalog.php?record_id=10881. Chapter 7 deals specifically with the issue of firearms and suicide. While acknowledging many uncertainties in existing studies, the NAS Executive Summary finds that,
“…gun suicide rates are strongly correlated with gun prevalence across space and possibly across time, in the United States and across countries.” However, while “…overall, the body of ecological studies has firmly established that firearms access is positively associated with gun suicide… the association between firearm access and overall suicide is less certain.”
In particular,
“It is not yet clear if the individuals who used a gun to commit suicide would have committed suicide by another method if a gun had not been available. Overall, the U.S. studies have consistently found that household gun ownership is associated with a higher overall risk of suicide, but the estimate of such an association was significantly smaller in a study from New Zealand.”
It’s fair to say that the jury is still out on the issue of “substitution”; that is, it just isn’t clear how many people who are prevented from shooting themselves would find an alternate means of suicide. However, there is evidence in other contexts that even if “suicide substitution” occurs, the net suicide rate can decline. For example, as the Harvard Injury Control Research Center website
http://www.hsph.harvard.edu/research/hicrc/
points out,
“Prior to the 1950s, domestic gas in the United Kingdom was derived from coal and contained about 10-20% carbon monoxide (CO). Poisoning by gas inhalation was the leading means of suicide in the UK. In 1958, natural gas, virtually free of carbon monoxide, was introduced into the UK. By 1971, 69% of gas used was natural gas. Over time, as the carbon monoxide in gas decreased, suicides also decreased (Kreitman 1976). Suicides by carbon monoxide decreased dramatically, while suicides by other methods increased a small amount, resulting in a net decrease in overall suicides, particularly among females…One author has estimated that over a ten-year period, an estimated six to seven thousand lives were saved by the change in domestic gas content (Hawton 2002)
The Harvard School of Public Health goes on to say:
“Every U.S. study that has examined the relationship has found that access to firearms is a risk factor for suicides. Firearm owners are not more suicidal than non-firearm owners; rather, their suicide attempts are more likely to be fatal. Many suicide attempts are made impulsively during a short-term crisis period. If highly lethal means are made less available to impulsive attempters and they substitute less lethal means, or temporarily postpone their attempt, the odds are increased that they will survive. Studies in a variety of countries have indicated that when access to lethal means is reduced, both the means-specific suicide rate and, very often, the overall suicide rate decline.”
http://www.hsph.harvard.edu/means-matter/means-matter/
Furthermore, the entire “suicide substitution” argument falls apart entirely when we look at accidental deaths from guns. The US unintentional firearm death rate is 5.2 times higher than in other high-income countries (Richardson & Hemenway, J Trauma. 2011 Jan;70(1):238-43). Even if we bought a theory of “100% substitution”—that is, every person who would have committed suicide by gun will simply commit suicide by some other means—a notion that has never been proved—the “substitution” argument doesn’t work for accidental gun deaths. Nobody would seriously argue, “Well, sure, Joe accidentally shot himself to death. But sooner or later, he would have accidentally died falling through the ice, or accidentally gotten hit by a train.”
Finally, let’s be clear: gun possession is just one risk factor for suicide and homicide. No physician would argue that doctors shouldn’t assess other relevant risk factors, such as the presence of depression; alcohol or substance abuse; access to powerful poisons; lack of social support; and a past history of suicide attempts. Nobody is trying to “single out” gun possession, as Akire (Erika Svenson) correctly noted in her comments. But doctors cannot ignore gun possession and access in their assessment, and still fulfill their oath and obligation as physicians. Let’s take the government out of the equation, and make these issues a private matter between doctors and patients.
Respectfully,
Ronald Pies MD
Sorry, Doctor, but you lost me when you stated that the Second Amendment was “granted under the constitution”. Please don’t try to teach history any more than gun safety; the Second Amendment is part of the Bill of Rights, which were written to make it clear that we are “endowed by our Creator with certain unalienable Rights”, one of which is the Second Amendment. In other words, the government is required to recognize and not interfere with that which is ours by a gift from our Creator; that government’s role is to ensure that these Rights are not infringed upon. Yes, I know that pesky old paper was written by a bunch of rich, white slave-holders, as current history education describes our Founders, but it is the basis of our liberties. For what it’s worth, I am an Emergency Department RN, and have also worked for 9 years as an EMT in a 50k population community; I have seen death by many forms in suicide. It’s a bit messier by gun than other forms, but a 14-year-old girl who ties panty hose on the knob outside of the bathroom door, tosses the other leg over the door, ties it around her neck while standing on the toilet, locking the door and stepping off is just as dead. Shall we monitor for pantyhose? Also, mention has been made re: internet medicine. I have absolutely no doubt that HIPPA will be ignored when it comes to a political agenda. The various regulatory agencies have in excess of 2,500 new regs already, mostly semi-secret thanks to Ms. Sebelius, and an agenda-driven administration now or in the future will find this a goldmine to micro-manage our lives. Paranoid? How many lies have been exposed about “Obamacare” so far? Sincerely, Mick Wood
You lost me when you suggested it’s not in a doctor’s purview in the doctor/patient relationship to try to prevent suicide by any means possible.
I hear a lot of people apparently okay with the government interfering with the doctor/patient relationship, and dictating what can and cannot be discussed. Wow. If this is the kind of government some of you would like, I think it’s only one more step on the road to facism.
Frankly, the less Big Government is sticking its nose in any of my private business, the better. And yes, that includes my healthcare, which is a private matter between me and my doctor.
- “Patients, of course, must be free to decline to answer such questions, and their care should never be jeopardized, if they do.”
Ahhhh…and therein lies the rub, eh? We’ve already seen examples of physicians refusing to continue to see patients who do refuse to answer such questions. So, what would you do to prevent that from happening?
- “Now, as to the actual data on firearms and suicide: the most honest and accurate statement that can be made is that we don’t have all the answers, and that the best available research is very complicated and often contradictory.”
So then you disagree with Dr. Grohol when he claims, “All the while there is more than sufficient data and scientific evidence connecting guns in households and risk of violence and/or death.” Very good.
OK, so you acknowledge that no definitive correlation has been demonstrated between firearms presence and overall suicide rates. Excellent. Now we’re left with the following, the silliness of which should be quite apparent…
“Furthermore, the entire “suicide substitution” argument falls apart entirely when we look at accidental deaths from guns. The US unintentional firearm death rate is 5.2 times higher than in other high-income countries (Richardson & Hemenway, J Trauma. 2011 Jan;70(1):238-43). Even if we bought a theory of “100% substitution”—that is, every person who would have committed suicide by gun will simply commit suicide by some other means—a notion that has never been proved—the “substitution” argument doesn’t work for accidental gun deaths. Nobody would seriously argue, “Well, sure, Joe accidentally shot himself to death. But sooner or later, he would have accidentally died falling through the ice, or accidentally gotten hit by a train.””
Really? You’re attempting to draw a meaningful analogy between accident rates involving something and rate of the intentional and purpose-driven use of that same thing? That’s like attempting to draw inferences about how many people would switch to using mass transit if their cars were no longer available based on how likely someone is to be run over by a commuter train if their car were taken away.
I’m amazed by your patience and professional demeanor while replying to some extremely misinformed, and sometimes downright nasty comments from some people who obviously didn’t read or comprehend your original article. You’re a better man than I in that regard.
So, we are assuming you have banned plastic bags, ropes and all other means of oxygen deprivation, that you have banned or restricted places that people jump from, and how you have effectively banned medications used for overdose suicide attempts?
We should see the study of how such bans or restrictions on all the OTHER suicide methods have significantly reduced successful suicides. Or is this focus on only one type of suicide attempt a biased unhealthy obsession/fear of an inanimate object? Please forward all the studies for banning and removal of all those other methods for a comparison doc!
By the way, what is the moral issue of people successfully committing suicide eh? I bet there is an even greater societal moral issue for those that fail to commit suicide.
Maybe you can relate in real numbers doc since you are oh so learned, how many of those 30% who survive suffocation attempts, the 50% who survive falls from high places, and the 98% who survive overdose suicides, were incapacitized? How many of those survivors were brain damaged by lack of oxygen, physically incapable of caring for themselves? How many of those people then become a burden on their family or state requiring such care?
Since 90% of all suicides using a firearm are fatal, maybe you would care to identify this perplexing moral issue as to how that number of incapacitized and physically unable to care for themselves people who attempted suicide by other methods do or do not exponentially increase year, by year and what that cost to society is.
Again, I will warn against ad hominem attacks against people who post to the comments. If you continue to violate the terms of service of our website, you may find zero of your comments approved (and we’ve already censored many comments because of these violations). If you can’t abide by the rules of the discussion, then you shouldn’t try and be a part of it.
As for assessing risk, doctors assess risk all the time in clinical practice for all sorts of activities, from behaviors that increase the risk of heart attack or stroke, to behaviors that could contribute to future health problems not yet applicable to the patient (perhaps because of a family history of them). It’s all relative — not absolute. Doctoring has never been about absolutes, and anyone who tries to make it about them has no understanding of the art of being a physician.
After all, if physicians were just plumbers following a manual, they probably wouldn’t be making the kinds of salaries they have. Humans are a lot more complex than plumbing, btw.
So when you talk in these absolutes, it’s really hard to have a rational discussion, because what I’m hearing is if we control one variable, the other variables must show a direct effect.
Here’s another example — the speed limit. Speeding kills more people in motor vehicle accidents each year than drinking while driving. So the logical, government response would be to reduce the speed limits and increase enforcement. If less speed = less death, we should all be driving 45 MPH, tops.
Of course, like Prohibition, the government tried that — the 55 MPH federal limit. Didn’t work. Didn’t budge driver behavior, didn’t decrease motor vehicle accidents by any significant amount. Why not? Shouldn’t one cause directly impact another effect?
Well, no, it doesn’t always. Because when it comes to human behavior, it’s not a direct cause and effect. That’s why there’s a whole field of science devoted to studying the complexities of human behavior — psychology.
And that’s why doctors assess risk the way they do — because they know humans aren’t always rational beings. So if you ask about their preferred means of harm — whatever that means is — you also work with the patient’s loved ones to temporarily remove that means of harm from the patient’s environment.
Trust me, if nobody used a gun to commit suicide, we wouldn’t be having this conversation. But since it remains a primary means of suicide in this country, it’s an appropriate risk assessment for a clinician to query. (And to top it off, if they didn’t, they’ll likely be facing a lawsuit by the surviving patient’s family for failing to do so.)
- “Here’s another example — the speed limit. Speeding kills more people in motor vehicle accidents each year than drinking while driving. So the logical, government response would be to reduce the speed limits and increase enforcement. If less speed = less death, we should all be driving 45 MPH, tops.”
Good point. Motor vehicle accidents kill FAR more people in this country every year than all uses of firearms combined. Does the author make a habit of questioning his patients regarding their driving habits and/or offering instruction on driver safety?
“Trust me, if no one used guns to commit siicide, we would not be having this onversation” you said. I do not trust you and neither does anyone else. This is not about suicide or children safety…it is about gun control and the government. They will eventually require you to provide names and responses.
Dr. Pies provided strong citations and a great followup argument that I have nothing to add to at this time. If you don’t agree with the quality of the reports emanating from Harvard and the National Academy of Sciences, then I suspect there’s little reasoned discourse to be had here.
People are responding to the political agenda of the physician who started all of this by asking every parent if they own a gun – he needed to butt out. This also has to do with the liberal political agenda of the AAP who pushes for increased restrictions on gun owners.
I think it’s an excellent idea to ask physicians who feel the need to educate patients about gun safety to produce evidence of training in gun safety.
Still, I do not support restrictions on the questions a physician asks. Parents can go somewhere else, and they’re probably better off doing so. The physician involved in all of this is now known as the pediatrician who denies care to parents who refuse to answer the question about gun ownership. He has earned some nice online reviews. Serves him right.
Having a car greatly increases the risk of a car crash. So what. Apparently some Doctors think it’s their business to be Big Nanny and control our lives. Thank God they’re not in elected office. America the land of the FREE! Stop being so self righteous. And what liability does the the good Doctor assume if someone locks up or gets rid of their guns, and then is killed because they are unable to stop a lethal assault or home invasion? I don’t consult my Doctor about guns and I don’t consult the NRA about my diabetes. Get over it and move on. Your attitude is the very reason WHY these laws are being proposed.
I am Alan Rose by the way…
“You lost me when you suggested it’s not in a doctor’s purview in the doctor/patient relationship to try to prevent suicide by any means possible.”
That’s a strong statement. I would interpret it to mean if the AMA could wave a wand and make every firearm magically disappear, they would do it because it might prevent one suicide. Or, more realistically, have Congress outlaw the manufacture, possession or use of firearms in the United States.
I am a Paramedic and self described “gun nut.” Based on my many years observing Doctors and their mistakes, this is just the latest reason why my faith in health care is at an all time low.
What percentage of depressed people kill themselves? I’m thinking not many, but I don’t know. Should all depressed people have their guns taken away? Should depressed police officers be disarmed? That would probably cut the police force in half at least!
What if asking about guns spurs the patient into buying one? You can’t just call the FBI and tell them not to approve a background check because your patient is feeling blue or having a bad day.
The whole affair is fraught with controversy. Personally, I make sure that all my Doctors are at a minimum firearms neutral. There are a fair share of rabid anti-gunners with MD behind their names but they don’t get my business. I am not going to be berated for owning and carrying guns legally.
I must have missed something. Once you have queried your patient about gun ownership, and his/her answer is yes they do own guns… then what? What advice do you plan to dispense? Into what record is this information entered and for what purpose?
On second thought… never mind. I suspect the answers are predictable.
First off, as mentioned by several others, but perhaps not made clear, having a gun in the home is NOT a significant risk factor, in and of itself, for suicide. If it were, there would be many (a statistically significant number) more suicides in homes that have a gun, and there are not. More than half the homes in the USA have a gun in the home today; very, very, few are used in a suicide. If the gun significantly increased the risk, FAR more americans would be killing themselves than actually are.
Secondly, the whole example given is simply ludicrous. If you are dealing with someone who has been threatening suicide and cuttng her arms, normal psychiatric SOP would involve questioning her about whether or not she has a plan, her history of prior impulsive behavior, etc. If she has no plan, and no history of unusual impulsivity (which seems unlikely in the case described), then there is no need to ask about a gun in the home. In any case, if the Dr. thinks she is currently at risk of an imminent suicide attempt or impulsive gesture that might go wrong, then the law would not proscribe asking about guns, (or drugs, knives, ropes, etc.) in the home that might be used. It would be clearly be “relevant to the patient’s medical care or safety, or the safety of others.”
Thirdly, for the person who hypothesized having an adolescent patient, who is NOT suicidal, but has been bullied. Good grief man, what universe do you live in? Have YOU never been bullied? Did YOU go kill anyone? The odds that a student will go out and kill someone because (s)he has been “bullied” are astronimically small. Being bullied is a very common adolescent experience virtually never resulting in lethal responses of any type, let alone shootings. If you are thinking of Columbine HS, I suggest you read the excellent book “Columbine” by Dave Cullen, an investigative reporter for the NYT. You’ll find that the two kids who did the shooting, not only were not bullied, but were themselves, bullies.
I appreciate the strongly-held views and feelings of those who have commented. As I noted at the beginning of this exchange, my standing policy is to respond only to those who take full responsibility for their postings by using their full names, and who post comments in a civil and respectful manner. I’m disappointed to see that so few of the postings fit the bill.
That said, I do want to try, one final time, to clarify the main point of my original article, which has often been read through the lens of individuals’ fears, fantasies, and misconceptions.
The main point of my article is that what patients and physicians say to one another in the privacy of the doctor’s office should not be controlled, constrained, monitored, or manipulated by legislators or government officials.
Doctors and other health care professionals (including psychologists, social workers, nurses, etc.) must be free to ask whatever they feel is relevant to safeguarding the health and safety of the patient and his/her family; as well as to ensure that the patient is not an immediate danger to him/herself or others. There is simply no way these obligations can be met unless doctors are free to inquire about risks such as guns in the home.
In my view, this is best done as part of a broader assessment of major safety risks, including but not limited to where prescription drugs are stored; where household poisons (such as weed killers, insecticides, etc.) are stored; and a variety of other home risk factors. The fact that doctors can’t and don’t ask about many hundreds of possible risks (“Any poisonous snakes in the basement?” “Any tarantulas in the attic?” etc.) does not mean that questions about firearms should not be raised. The fact that some persons chronically intent on harming themselves can find non-firearm methods of doing so is completely irrelevant to the physician’s professional responsibilities in assessing risk.
The nature of the physician-patient relationship is such that many, many “private” matters must be discussed, ranging from sexual practices (such as unprotected sex); to tobacco and alcohol use; to the presence of suicidal intentions. It is impossible to carry out a thorough medical evaluation—particularly on a new patient—without inquiring about dozens of “private” matters. Access to firearms is not always on the list, but it should not be singled out for legislative and governmental control. The “relevance” exception in the Florida law is too vague to eliminate the chilling effect of the law as a whole, which will intimidate doctors from carrying out a thorough assessment.
This philosophy was just reaffirmed by the Massachusetts Medical Society, at their annual meeting. The resolution (405) that was adopted states:
“Delegates adopted a resolution [#405] that opposes legislative interference in the right of physicians and patients or parents and guardians to discuss gun ownership, storage or safety in the home. The resolution also opposes any legislative or regulatory limits on a physician’s ability to take a complete history and document relevant portions of the history into the permanent medical record.”
None of this means that physicians are trying to restrict anyone’s legitimate second amendment rights, confiscate legally-held firearms, harass gun-owning patients, or anything of the sort. Such actions were certainly not advocated in my original article, and I deplore any physician who has withheld medical care from a patient who refused to answer questions about gun ownership.
As a personal observation: my early experiences with firearms were with a family member (an avid hunter) who was exceptionally responsible and careful with his guns. I assume that most gun owners are caring, responsible individuals, as well, and want to protect the health and safety of themselves and their families. I also believe that some are simply not aware of the dangers these firearms may pose, in certain circumstances; for example, when a family member is severely depressed.
As to the complex connections between firearms and suicide, I would urge those with open minds to go to the Harvard School of Public Health website and review the relevant research.
http://www.hsph.harvard.edu/means-matter/means-matter/risk/index.html
The main points from the Harvard Injury Control Research Center are as follows, and references are provided. **
•Every study that has examined the issue to date has found that within the U.S., access to firearms is associated with increased suicide risk.
•Twelve or more U.S. case control studies have compared individuals who died by suicide with those who did not and found those dying by suicide were more likely to live in homes with guns.
•Ecologic studies that compare states with high gun ownership levels to those with low gun ownership levels find that in the U.S., where there are more guns, there are more suicides.
•The higher suicide rates result from higher firearm suicides; the non-firearm suicide rate is about equal across states.
•Guns are more lethal than other suicide means. They’re quick. And they’re irreversible. About 85% of attempts with a firearm are fatal: that’s a much higher case fatality rate than for nearly every other method. Many of the most widely used suicide attempt methods have case fatality rates below 5%.
•Attempters who take pills or inhale car exhaust or use razors have some time to reconsider mid-attempt and summon help or be rescued. The method itself often fails, even in the absence of a rescue. With a firearm, once the trigger is pulled, there’s no turning back.
Unfortunately, given the nature and tone of the comments thus far, I don’t see much benefit in engaging in further exchanges at this time. However, I remain open to replying to any respectful question or comment by any reader who provides his or her full name; and who is truly interested in an informed and civilized exchange of views. –Sincerely, Ronald Pies MD
**References:
Brent DA, Perper JA, Allman CJ, et al. The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study. JAMA. 1991; 266:2989-2995.
Brent DA, Baugher M, Bridge J, Chen T, Chiappetta L. Age- and sex-related risk factors for adolescent suicide. Journal of the American Academy of Child and Adolescent Psychiatry. 1999; 38(12):1497-505.
Miller M, Lippmann SJ, Azrael D, Hemenway D. Household firearm ownership and rates of suicide across the 50 United States. J Trauma. 2007 Apr;62(4):1029-34.
Bennewith O, Gunnell D, Kapur N, et. al. Suicide by hanging. British Journal of Psychiatry. 2005;186:260-1.
Wang JL. Rural-urban differences in the prevalence of major depression and associated impairment. Social Psychiatry and Psychiatric Epidemiology. 2004 Jan;39(1):19-25.
Ilgen MA, Zivin K, McCammon RJ, Valenstein M. Mental illness, previous suicidality, and access to guns in the United States. Psychiatr Serv. 2008 Feb;59(2):198-200.
“The main point of my article is that what patients and physicians say to one another in the privacy of the doctor’s office should not be controlled, constrained, monitored, or manipulated by legislators or government officials.”
Theoretically, true. However, a professional’s work can always be second guessed by licensing boards and malpractice juries. Perhaps you are correct, that this law puts us in a catch-22 position, perhaps moreso now than ever. OTOH, perhaps it is a continuation of the ever increasing amount of regulation being placed on us professionals….
Comparing guns to spiders and snakes is silly, because people don’t have control over animals the way we do over guns, and animals are much less lethal.
A MUCH BIGGER problem than suicide is the risk of unintentional injury or domestic violence.
I agree with Dr. Borkosky that physicians and other clinicians, including psychologists, are burdened by an increasing amount of “regulation”, paper work, administrative oversight, etc. However, the issue with the Florida law goes well beyond such annoyances, and goes to the very heart of ethical and responsible medical practice.
It is true that medical licensing boards have always monitored compliance with accepted standards of medical care, and responded to patient-initiated complaints of substandard care, inappropriate boundary violations (such as sexual misconduct) and other clear instances of dereliction of duty or ethics. But the prior restraint on a clinician’s speech and inquiry has nothing to do with such recognized professional standards. On the contrary, as a recent resolution by the Mass. Medical Society makes clear, the Florida law undermines the very ethical and medical “due diligence” required by physicians, and ordinarily monitored by medical review Boards.
The reference in my earlier comments to “spiders and snakes” was not intended to be serious; but merely to highlight the point that in the limited time clinicians have with patients (especially in the ER), we must necessarily limit our risk assessment to the most readily available and potentially lethal hazards, including but not limited to guns in the home.
I agree with Dr. Borkosky that unintentional gun-related injury and domestic violence are enormous risks related to guns in the home; however, domestic violence involving guns is also
not uncommonly associated with suicide. For example, Liem et al found that, cross-nationally, homicide-suicides are more likely than other types of lethal violence to involve a female victim, multiple victims, take place in a residential setting and to be committed by a firearm [Forensic Sci Int. 2011 Apr 15;207(1-3):70-6. Epub 2010 Oct 8.]
Ronald Pies MD
I don’t get it…physicians are not firearm instructors and frankly not even trained enough in pharmacotherapeutics to warrant them writing prescriptions. These so called Doctors are humans and not biased enough to not misuse information for their political views. This information can also fall into the hands of insurance companies which WILL use it to bias their decisions in the course of their business. I also have the right to my privacy which is a consitutional right.
“The main point of my article is that what patients and physicians say to one another in the privacy of the doctor’s office should not be controlled, constrained, monitored, or manipulated by legislators or government officials”.
—Yet you are bound by legal confidentiality, and subject to the same laws (constitutional) that all Americans are.
“Doctors and other health care professionals (including psychologists, social workers, nurses, etc.) must be free to ask whatever they feel is relevant to safeguarding the health and safety of the patient and his/her family; as well as to ensure that the patient is not an immediate danger to him/herself or others. There is simply no way these obligations can be met unless doctors are free to inquire about risks such as guns in the home.”
—Why not knives, swords, books about different forms of Government?
What do you think this will eventually do to your liability?
Here’s my gripe. Why did my 60 year old wife get questioned about gun ownership, ammunition, and gun safety issues when she went in for a sinus infection? Did they suspect she had a bullet stuck up her nose? Or do people with sinus infections tend to use a handgun to open their sinus passages? Why wasn’t she told why they were asking such questions? I guess they can ask if appropriate, but why does it have to be summarily put in her medical records? It’s none of their business. How are we supposed to know exactly why these questions are asked? Why should we blindly trust everyone who wants information about our right to privacy? And why would we want the biggest drug dealers in town to know if we were armed or not?!
Terry…loved it!,,
I’m sixty and went in about my thyroid. Still got questioned about guns. Someone is gathering very private information.
Marsha clark
I believe that H.I.P.P.A. should always prevail. Yes, the professionals should ask questions that are pertinent to the situation being presented. If someone presents with a condition that needs to have the question ask about gun accessibility; then it should be ask. The only two that comes to mind is hurting oneself or others; the question about gun ownership should not be asked. It really is not relevant. Because our county has such a history of back and forth on our right to bear arms; it has become a very, very touchy point. Thus, this forum. One of thousands.
This doctor in Florida,
http://www.ocala.com/article/20100724/ARTICLES/7241001/-1/news?Title=Family-and-pediatrician-tangle-
over-gun-question
told the mother she had 30 days to find a new Doctor and that she wasn’t welcome at Children’s Health of Ocala anymore., because she refused to answer his question about having a gun in the house. Shame, Shame everyone knows your name, Doctor Chris Okonkwo.
“I don’t tell them to get rid of the guns,” he said. “The purpose is to give advice.”
“He said the doctor and patient have to develop a relationship of trust and that if parents won’t answer such basic safety questions, they cannot trust each other about more important health issues. Isn’t this a backhanded way of calling them lairs?
He said he respected a patient’s right not to answer questions, but it was also his right to no longer treat them, and he isn’t required by law to do so.”
This really “looks” like “it’s his way or the highway”. I think that the couple is better off without the “Doctor”. I think that if he really respected their right not to answer that particular question, he could have moved on and gave the “advice”. Is he really interested in education or getting a answer?
Even the American Academy of Pediatrics states the following:
“The issue of gun ownership is a particularly frustrating and difficult one.
Pediatricians should be prepared for resistance.”
If the goal is to educate about safety, then educate. The American Academy of Pediatrics goal goes beyond just simple education; their goal is to remove guns from citizens. As follows:
“When pediatricians identify risk factors for violence or actual violence-related problems during the screening process, appropriate treatment or referral should occur. Some of the problems can be handled by the pediatrician through follow-up visits and office- based counseling, particularly when the issues are television viewing, removal of handguns, and non-urgent behavioral issues.
The American Academy of Pediatrics feels they have the right to have doctors tell their patients parents to remove handguns.
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/4/888
“reduced availability or elimination of handguns in all communities through handgun regulation and public education”
“Practicing pediatricians can be involved directly in violence-related research through practice-based research projects. Practicing pediatricians are crucial in this work because they bring direct clinical experience to choosing the right questions that will lead to useful interventions”
Advocacy and Policy
1. That the Academy continues and intensifies its focus on violence prevention in its goals and objectives.
• Action Necessary: That the Academy promote and enhance, where possible, its involvement in handgun regulatory activities.
Research
1. That the Academy identifies opportunities to promote expanded attention to research in the area of violence prevention.
Action Necessary:
That the Academy’s Department of Research place emphasis on pediatric practice-based research projects on violence prevention via ongoing AAP
research programs.
The ability for doctors to ask about gun ownership and have that information used against the gun owner, to further American Academy of Pediatrics cause to eliminate handgun ownership makes me sick.
The reason that Florida even started this was due to some doctors going beyond just simple education to interrogations and dropping patients because there is no law that states that they can’t. Some let their person view come into play. Some preach, try intimation and are rude. There definitely needs to be a law that absolutely does not allow doctors to drop patients because they don’t answer the gun questions. Getting a answer does not prevent them from giving the information. If the doctors are truly interested in giving education about guns, then give it. It should not be derogatory or inflammatory.
I feel that Florida should pass laws that have specific language about what is not allowed; and laws that do not allow for dropping of patients.
Florida only went into this situation due to a few doctors wrong attitudes. If a few, act like idiots and the powers that be don’t step in to prevent it, I don’t want to think about how bad things could get. Florida needs to go back to the drawing board and get it right this time. They shouldn’t infringe on the doctors free speech; but by the same token, doctors shouldn’t infringe on my right to bear arms. I am not talking about giving good, balanced non-inflammatory information. I don’t want to have to hear crap about their personal views, have them try to intimidate me or listen to some rude diatribe. (“Rude” may be redundant here but necessary). Once again, why is it necessary to find out if someone owns a gun or has access to one? Shouldn’t the whole idea be about education no matter if there is a gun at home or available elsewhere?
And, as they are using primarily statistical evidence to support their claims, a much greater number of people die WHO GO TO HOSPITALS than those who do not! An absolute fact… more people do die of the whole population who ‘go to a hospital’ than those who do not go to a hospital. Ridiculous? Well, no… and their gun argument is of the same nature. Homes that have guns in them often (statistically) have them because of ‘concerns’ based on local conditions… like crime. Criminals don’t abide by laws and they often use guns in the commission of their crimes. If those crimes occur in a home then that ‘statistic’ of a ‘gun in a home’ criteria and it is made to look like ‘simply owning’ a gun creates the safety hazard. Bullpucky!
Quoting the author: “They ask, ‘If doctors need to inquire about guns in the home, why don’t they ask about poisonous snakes or dangerous dogs in the neighborhood? Why don’t they ask about tall buildings with unprotected balconies, open sewers, etc?’ The emptiness of this argument should be evident to any clinician with a modicum of forensic experience. Obviously, there are infinite risks a physician, psychologist, or social worker could inquire about, but our time with the patient is finite — and few domestic dangers pack the lethality of a loaded gun in the house.”
Why, Doctor, is this an empty argument? Tell, me how many gun related incidents have you treated compared to incidents caused by the situations you mention, and related scenarios? You have a doctorate, and yet you seem to jump to unsubstantiated conclusions based on your opinions and anecdotal “evidence.” I have never been queried as to whether I skydive, mountain climb, hike, kayak, play soccer or football, drive a sports car, surf, bicycle, climb ladders, spelunk, ski, snowboard, ride a skateboard, or drive except only of necessity and not for pleasure. Before you come out gushing in favor of one specific “health related” question, take some time to look up the statistics on the causes of death and injury in this country, prioritize those causes in the order in which you find them, and then ask questions that address the leading causes. I realize that this suggestion will never be implemented by those who are emotionally committed to the gun-fear mentality, because the gun-blame crowd just “knows in their heart” that those ugly things that go “bang” are a root of evil, and the most dangerous things on the planet. Please, Doc. We know you must have the mental wherewithal to study the situation before you speak. Why not try it? Many of us have and have arrived at logical and better thought out conclusions.
Update on situation in the courts:
Adapted from Medscape
August 1, 2012 Robert Lowes
- “As expected, the state of Florida is turning to a federal appeals court to resurrect a law that prohibits physicians from asking patients whether they own a gun.
The state is seeking to undo a permanent injunction that US District Court Judge Marcia Cooke in Miami issued against the law in June. Cooke said the law, called the Firearm Owner’s Privacy Act, violated the free-speech rights of physicians.
Individual Florida physicians, including pediatric cardiologist Dr Louis St Petery (executive vice president of the Florida chapter of the American Academy of Pediatrics [AAP]) and state chapters of the AAP, the American Academy of Family Physicians, and the American College of Physicians had challenged the law in court, saying that physicians need to ask young parents about gun ownership for the sake of advising them about safe storage. The Florida law bans posing such questions, recording the responses in the patient’s chart, and “unnecessarily harassing” or discriminating against gun owners.
The law makes an exception for gun questions when a physician believes that the information is relevant to the medical care or safety of the patient or someone else. However, Cooke ruled that the law failed to define relevance to medical care and safety as well as harassment and that this vagueness discouraged physicians from asking any gun questions lest they face disciplinary action by the state health department. She also said the state presented only anecdotal evidence about discrimination against gun-owning patients and that the law had nothing to
do with the Second Amendment right to keep or bear arms.”