Doctors and Guns

Dear Doctors –

Look, I realize that most of you really do care about the safety and health of your patients. I realize your intentions are, for the most part, honorable. I also realize that some of you consider yourselves experts on nearly everything.

So let me tell you something – you aren’t.

patient safetyYou’re – for the most part – smart, dedicated individuals, but unless and until you are at very least well versed in firearms safety and and use, you have no qualification to talk about “gun safety” to your patients or their parents. Sorry. None. You are no more qualified to dispense gun safety advice than the average gun owner, and probably less so.

The Washington Post last week ran an editorial by two doctors at the David Geffen School of Medicine at UCLA – Angelica Zen and Alice Kuo – asserting that as physicians, and as doctors who care about their patients, they should have the right to ask intrusive questions such as “Do you have a gun in the home?”

As far as basic freedom of speech issues go, doctors should be able to ask questions they feel are relevant to their patients’ case. That said, the subsequent advice should leave them open to lawsuits, should it lead to injury or death.

Let me explain.

Doctor asks patient whether they keep a gun in the house.

Patient answers in the affirmative.

Doctor recommends locking up this tool and keeping ammunition separate from the firearm fo da childs.

Patient follows said advice.

Patient’s violent ex-boyfriend one night breaks into patient’s house.

Patient runs to the safe to get her self defense tool out of the safe and to grab the magazine from a separate storage in order to protect herself and her children.

Violent ex surprisingly does not wait for his victim to grab her tool of self defense, but does club her to death with a baseball bat, while her children watch horrified.

Is the doctor liable for dispensing advice that ultimately led to the patient’s inability to defend herself?

In our litigious society, that doctor would be hauled into court for dispensing bad advice.

Similar situations do happen, as it did in Merced, California (sans court or doctor’s advice, but with the firearm being inaccessible).

There WERE guns available, her father had at least a .357 and Jessica not only knew where it was, she knew well how to shoot it. So why didn’t she? Because California has MANDATORY safe storage. The gun was locked up, high on a shelf where Jessica couldn’t reach it. Even if she could, she would have needed to retrieve ammo from another spot and load it. I can only pity the poor Father, who had done everything else right, but was more afraid of the state, than a pitchfork wielding maniac. So doesn’t it seem like the soccer mom crowd and people like that silly Watts woman are partly responsible for their death?

Having immediate access to self defense tools is a safety issue, but these doctors, despite their protestations to the contrary, make it a political issue.

So here’s a partial fisk. As always, their writing is in block quotes, but may not show on mobile devices, but I’m fairly sure you can distinguish their writing from mine.

And so began what’s come to be known as the Docs vs. Glocks dispute. In 2011, after a lobbying push by the National Rifle Association, Florida passed the Firearm Owners’ Privacy Act, restricting physicians from asking about gun ownership and from counseling about gun safety in routine appointments. Potential penalties include fines, suspension and loss of a medical license. A federal judge blocked the law as an unconstitutional restriction of doctors’ speech. Then an appeals court panel overturned the ruling, emphasizing patients’ rights to own guns and to privacy.

This Florida case is just the latest example of how the politics of guns have affected physicians’ ability to bring science to bear on what experts can see plainly: That gun violence is a public health issue. The full U.S. Court of Appeals for the 11th Circuit is now preparing to hear the case, and legislators in at least 12 states have expressed interest in similar bills. So it’s worth correcting what lawmakers and the court panel misunderstand about the doctor-patient relationship and about the relevance of firearms to pediatric care — in a country where more than 2 million children live in homes with unsecured guns.

It is a mistake to brand this a “Docs vs. Glocks” issue. It’s far from that. This is an issue of safety in the home. This is an issue of privacy rights. This is an issue of an individual in the position of authority dispensing advice they may not be qualified to dispense.

Despite the desperation of some to brand “gun violence” as a public health issue in order to justify doctors’ asking intrusive questions and dispensing bad advice to their patients, it’s hardly so.

“Gun violence” is not different than any other type of violence, other than the tool used. Violence, by its definition, is a criminal justice issue, and objectivity would demand branding violence of any type as a public health issue, which would take away resources and attention from genuine public health issues, such as vaccinations, diet, etc.

First, there’s the suggestion that a doctor merely asking about guns infringes on the right to bear arms, because of how much power doctors supposedly have over patients. The court panel wrote: “When a patient enters a physician’s examination room, the patient is in a position of relative powerlessness. The patient must place his or her trust in the physician’s guidance and submit to the physician’s authority.” To support this contention, the court cited a 1994 law review article that describes how the doctor-patient relationship forces patients to “suspend their critical faculties” and limits their “ability to question physicians and redirect the course of a conversation.”

Most doctors nowadays would laugh at that idea. Perhaps there was a hint of truth to it in 1994 — two years before WebMD went live, and when less than 12 percent of U.S. households had Internet access. But long gone are the days when whatever a doctor said was law. Today, patients and their families are active participants in their medical care. They do their Internet research and come in with long lists of questions. And they don’t hesitate to make their views known, in the exam room and on Yelp, when they aren’t satisfied with the answers.

So the doctors admit that their patients don’t really consider them authorities on such matters, choosing instead to do their own research. Then why?  Why bother giving them advice on a matter in which many doctors do not have expertise?

Rather than trying to get the parents who come to our practice to submit to our authority, we try to build partnerships with them based on mutual trust and a shared interest in the well-being of their children. Sometimes we and the parents disagree — about vaccines, for instance. But we talk through their questions and concerns and try to come up with an approach everyone is comfortable with. We might settle on a plan to space out vaccinations over a longer period of time, say, but to make sure a child is caught up by kindergarten.

Doctors are certainly experts on vaccines, and they should, as responsible physicians discuss their patients’ concerns. Are doctors experts on firearms? Are they experts on firearm safety? Why would I discuss firearm safety with my doctor? Do I discuss my heart murmur with my plumber?

We wouldn’t instruct gun-owning families to give up their firearms, nor would we expect them to listen to us if we did. But we and the parents have a mutual interest in preventing gun accidents involving their children. That’s what we want to discuss. The point is not to pass judgment or to chastise people for their practices. It is to ensure that our patients, the children, have long, healthy lives.

Damn well, you wouldn’t instruct families to give up their tools of self defense! I would fully expect any family subjected to such arrogant ignorance to walk out of your office and seek a new doctor! And the rest of your article certainly points to the fact that you wouldn’t be even remotely objective when discussing gun ownership with your patients! From the biased “research” from Everytown, to disingenuous claims about the desire to discuss things that are a statistical risk to kids, everything you have written screams that you have no objectivity or expertise on the matter. That said, I can guarantee that most gun owners know much more about guns, gun safety, and their use than most doctors, and that given the millions of gun owners in this country, fatal accidental discharges of firearms are actually relatively rare. As a matter, of fact, according to the CDC, 50 children 0-14 died of unintentional firearm discharge in 2014 at a crude rate of 0.08 per 100,000. That same year, 249 died in fires and 1178 suffocated.

But beyond responding to immediate warning signs, responsible doctors need to be able to counsel patients on matters that pose the greatest statistical risks to their health and well-being. Heart disease is the leading cause of death in Americans 65 years and older, so doctors talk to their elderly patients about healthy eating habits, regular exercise and smoking cessation. For children between the ages of 1 and 14, the leading cause of death is unintentional injury, a category that includes car accidents, suffocation, burns, drowning and gunshot wounds.

So let’s see… According to the CDC, 5,330 children ages 0-17 died from unintentional injury in 2014.  Of those 74 were killed by unintentional firearm discharge – roughly 1.4 percent. In comparison:

  • 14 percent in the same age group died by drowning.
  • 5 percent in the same age group died in a fire.
  • 22.4 percent in the same age group suffocated
  • 44 percent in the same age group died in a motor vehicle accident.

Tell me again how you focus on those statistical risks, ladies!

As pediatricians, we counsel parents about all of these issues. We explain how to properly install car seats. We caution against children playing with plastic bags. We teach about safe water temperature. We discuss safety around pools.

Gun safety is no different from any of these topics. Comprehensive numbers on gun accidents are hard to come by, in part because National Rifle Association lobbying and limited funding has deterred the Centers for Disease Control and Prevention from conducting firearm research. But outside research found that in 2015, children accidentally shot themselves or someone else at least 278 times, averaging more than five times a week. By some estimates, keeping guns locked up and unloaded could prevent 70 percent of unintentional shooting deaths among children.

Ah, yes! Citing Everytown “research” to bolster clearly anti-gun views! If you’re going to cite research, at least find an organization without open biases!

And by the way, no research because EVIL NRA, you say? You mean like this research that found, among other interesting tidbits, that mass shootings and accidental firearm deaths account for only a small fraction of gun-related deaths, and both have been declining despite increased gun ownership? THAT research?

“The number of public mass shootings of the type that occurred at Sandy Hook Elementary School accounted for a very small fraction of all firearm-related deaths. Since 1983 there have been 78 events in which 4 or more individuals were killed by a single perpetrator in 1 day in the United States, resulting in 547 victims and 476 injured persons.”

[…]

Unintentional firearm-related deaths have steadily declined during the past century. The number of unintentional deaths due to firearm-related incidents accounted for less than 1 percent of all unintentional fatalities in 2010.”

The doctors go on to discuss an incident in Florida in which Jamie Gilt’s four-year-old son shot her from the back seat of the car. “When doctors provide brief counseling about gun safety, families with guns are more likely to follow safe storage practices,” the doctors claim. Are those the same families that more and more get their medical advice from WebMD and aren’t likely to consider doctors an authority, as they mentioned? Which one is it, ladies? Are patients not going to take you as authorities, because they do their Internet research, or are they going to take your counseling to heart, especially since the majority of gun owners are more informed about firearms than you are? You can’t have both.

And the gun owners who don’t take guns in the home seriously are the same ones who you readily admit exhibit a broader lack of attention to safety issues.

Would a mother who is so ardently pro-gun have listened to a doctor’s counsel about gun safety? Her 4-year-old wasn’t strapped into his booster seat when police arrived, suggesting a broader lack of attention to safety. Perhaps a doctor’s advice would have made her more mindful. Perhaps not. Either way, though, Gilt probably wouldn’t be intimidated by a doctor’s questions. Her mother told the Sun: “All the gun control people are jumping on this, but it will not change her opinion about owning guns. She is very pro gun and will not change her opinion about owning them.”

So a woman who indicates a lack of awareness about safety of her child in general is hardly likely to pay attention to her doctor’s advice on gun safety, but that doesn’t stop these doctors from advocating this approach.

Again, for us as pediatricians, the issue isn’t ownership, it’s safety. And when we’re able to talk to parents about gun storage, we have the potential to save lives.

Again, your rhetoric belies your true intentions. Stick to actual health issues.

42 responses

  1. As they check the box on your obamacare medical records ..

    Liked by 1 person

  2. There’s always David Codrea’s FIREARMS SAFETY COUNSELING REPRESENTATION: PHYSICIAN QUALIFICATIONS AND LIABILITY. It’s a thing of beauty:

    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.

    Some years back, I plugged and chugged numbers on number of doctors vs. number of gun owners (per CDC), and firearms-related deaths vs. death by doctors’ medical misadventure. Turns out your far more likely to die by doctor’s error than be shot. True, the comparison isn’t completely valid, but it fun to watch gun controllers’ jaws flap wordlessly.

    Liked by 1 person

    1. That’s so true! Now, for some reason the CDC WISQARS database does not keep statistics on how many die via medical mistakes. I tried to get those, as they are directly relevant.

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  3. As both an Emergency Physician and a gun owner the only advice I’d ever give my patients is a proper evaluation of caliber and grip based on pre-existing medical conditions, pointers on proper shot placement so I won’t have to try to resuscitate said dirtball and maybe an extended discussion on bullet types on stopping attacks based on prior trauma cases. Recommend center mass with a pelvic recovery shot– higher chance of not missing and instant incapacitation.

    Liked by 1 person

    1. You are MY kind of Doctor!🙂

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    2. Emphatically agree, Nicki.

      Dr Mike cares about his patients.

      (One of the more reassuring sounds I can hear is a friend of mine racking a slide or especially a shotgun pump. It says “I have your six, should the elephant come romping in..” Needless to say I make sure to make the same reassurances to them, myself.)

      Liked by 1 person

    3. Loving this reply so very very much!

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    4. (Golf clap)

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  4. Nicki (Yay, I didn’t type the ‘e’ that time), yep, that category is gone now. There’s stilll something called “Medical care, adverse effects” (2,156 for 2014; 2,591 for 1999), but that doesn’t look right…

    Ah. I pulled up my old 2000 piece on the subject. I was using the National Safety Council’s 1997 Accident Facts (for 1996): “attributes 48,000 to 98,000 deaths to doctors’ errors” compared to “1,400 total firearms-related accidental deaths” (I thought it fair to compare accidents to accidents).

    “Even more interestingly, the CDC estimates that there are 80 million gun owners in the US, yet only around 240,000 doctors; it appears that you are approximately 1400 times more likely to be accidently killed by a doctor than a gun owner.”

    I thought that Brit chick’s head was going to explode. Not quite. Darn it.

    Liked by 1 person

    1. Haven’t had to, yet – but I can imagine responding to “do you have a firearm in your home” with “do you have opioid painkillers in yours?”
      “Why?” he says
      “Because, if we’re going to talk about risks in homes, a lot more people die from them than from firearms”
      (he, stiffly) “I think I’m pretty well qualified to judge how to manage that risk in my home”
      (Me) “Exactly…”

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  5. On those times when I have to deal with a doctor asking intrusive questions that have no bearing on the care I am seeking, I respond with “Doctor, I believe that question is a boundary violation.”

    This tends to make doctors turn green.

    And then I find myself a new doctor.

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  6. As it happens, I’m taking both 11 year-old Kenneth and 9 year-old Alicia to the pediatrician tomorrow morning, followed by other activities, which, up until a few minutes ago, included a trip to an outdoor range. Kenneth got invited to a birthday party, though, so the range trip is off. Maybe I’ll wear my Wilson Combat shirt tomorrow and see if she comments.

    Liked by 1 person

  7. The last time *I* went to the doctor I was asked if I feel safe in my home. The last time I took my (then 17 year old) to the doctor, the doctor asked in my presence if he felt safe in the home. I don’t recall if anyone asked about guns. I don’t recall if any pediatricians asked about guns ever, but we weren’t really regular doctor-goers once everyone had their shots.

    The “bring science to bear” is the most ridiculous and insulting statement in the whole thing, as if simply by being the opinion of a doctor something becomes magically becomes “science”. They’d be far better off and do more good by encouraging car seats, or even doing some research on how to keep kids *in* car seats and offering practical advice for the parents of squirmy-noodles, and putting their “scientific” foot down over vaccinations, than getting on their personal hobby horse about guns and calling it “science”.

    Liked by 1 person

  8. When I changed primary physicians last year, the patient forms contained a question about gun ownership. I think it was mandated by the major hospital associated with this local physician’s office, which was shared among several doctors. Needless to say, the intrusive snooping ticked me off. Still, for obvious reasons, I didn’t want to rattle cages unnecessarily at a newly adopted medical practice, so I gritted my teeth and wrote in the margins something like the following wording:

    “This question has no bearing on medical care.”
    “Refrain from stomping into political controversy over the Second Amendment.”

    I figured that the blunt reference to a political controversy would forestall future annoyances. I was also quite careful to provide bland, reassuring answers to questions that were sneakily intended to allow any anti-gun sawbones to falsely accuse an individual of being mentis non compos, which is absurdly easy in certain states. Even admitting to occasional depression is dangerous, so it’s always best to admit only to a relentlessly cheerful state of mind. -_-

    Liked by 1 person

  9. Thanks for linking the NAP. There’s some really good stuff there; and I’ve always found it fascinating to read about research topics done with regard to medicine and biology.

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  10. I don’t take medical advice from lawyers, I don’t take religious advice from writers, I don’t take writing tips from priests. Why would I take civil rights advice from a doctor?

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    1. Well said.

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  11. All this talk of “gun violence”, never is it mentioned that the “gun violence” is not being perpetrated by law abiding gun owners. The “gun violence” is being committed by black and mexican gang members. Yet I never hear of black and mexican gang control laws.

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    1. Never heard of a gun being violent. People, on the other hand…

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  12. You misunderstand. This anti-2d-amendment questioning does not come from your doctor. It comes from the federal government. You doctor is doing what his elite masters tell him to do. He checks the ‘guns in house’ box, or his reimbursement is cut.

    Guns are the new cigarette. The federal government is constructing an apparatus to regulate them out of our lives.

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    1. This is the key. If my doctor were simply concerned (and had shown some actual knowledge on the subject) about safety, it wouldn’t be that bad. I might go find a new doctor, or I might not. The real problem is the doctor entering it into my medical record. Once there, it can be used against me in numerous ways. It’s not a medical issue, so putting it in my medical records is a problem.
      Understand this, Doc: It’s none of your danged business.

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  13. Is it any coincidence that this big push to ask all families about guns comes at the same time that the Federal government is busily creating a massive electronic database of medical information through the Affordable Care Act? Are your answers to these questions going to wind up in your Electronic Patient Records?

    Uncle Sam wants his registry, and is not to particular about how he gets it.

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  14. National safety council statistics show that despite increases in population and increases in gun ownership the percentage of accidents in the home concerning guns causing death is the same for 90 years it is only homicides with guns that have gone up guns in the home is not The problem

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    1. it is only homicides with guns that have gone up

      Except homicide rates–gun or otherwise–have not gone up. We’re at a 100 year low:

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  15. If the safety advice was limited to Eddie Eagle pamphlets on the table along with the rest of the general medical literature, that would be fine. It’s the asking of kids when parents are not in the room, the declining to answer getting a checkmark on a .gov form that gets shared with who knows what agency making you wind up on the no-fly list.

    “Do you feel safe at home”. Last time I was asked that, I took a long time to answer “yes”. Got an inquisitive look from the doc, told him “Well if I didn’t say yes my wife would kill me”. Took him about 15 secs to realize I was busting his chops.

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  16. Sean D Sorrentino

    Safety Solutions Academy Podcast dropped an interview on Monday with Doctors for Responsible Gun Ownership’s Dr. John Edeen, their Membership Director. It’s a great interview with a very pro-gun pediatric orthopedic surgeon. He covers how any doctor who dispenses gun advice is operating outside of his scope of practice and is committing a boundary violation.

    SSA Podcast is on iTunes, and also available at this link.

    http://safetysolutionsacademy.com/blogpodcast/

    Like

  17. Well, my Father returned home one day with a prescription from our Doctor. It was for a specific model of a cartridge based muzzleloader.

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  18. David Hoggberg

    When I was working on my book on Medicare, I interviewed a doctor at his office, and told him that I was going target shooting with my girlfriend’s father later in the day. He asked what kind of gun I had. Glock 9mm, I said. “Well, take these, I don’t need them,” he said, as he opened up a drawer and handed me a box full of bullets. Best thing I ever walked out of a doctor’s office with!

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  19. I have noticed that Dr.’s we’ve seen have started asking that question.

    I know some people (from the So. Calif variety) who would say no guns at all, or guns and ammo locked and separate from each other, which as you mentioned cuts way down on tactical use and accessibility. I know others who swing to the far end, leaving loaded guns on all tables of their home while toddlers run around. I always thought the best medium was to keep the loaded guns on a high shelf (you know about), where they could be grabbed (by a tall person) and used if needed, but not easily accessible to kids.

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    1. That’s exactly what we did. The gun was loaded and on top of the bookshelf. The kids never even knew there was a gun in the house.

      Good thing it was easily accessible – and loaded. I needed it once …. in a hurry.

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  20. I used to say, if you want to talk about guns with patients, then preface the discussion with, “this will not be recorded in the EMR,” but trust has eroded so much on this issue that I no longer think that patients would believe this. So, if a doctor asks you about guns, my advice (as a doctor) is to lie and say you don’t own any. Virtually any doc who asks this question has an anti gun agenda, and even if they don’t, it’s going to be put in the EMR, which, even if there never is a government sponsored EMR record search for gun owners, the government cannot guarantee that the records will never be hacked.

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  21. A few years back, when I went to a doc appointment, his nurse in the pre-interview asked if I “felt threatened” at home. I looked her in the eye and said “well I AM married”. She exited the room and I heard her burst out in laughter.

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  22. styrgwillidar

    Want to get government out of preventing folks from having firearms available?

    Make the police, LEOS, city, county and state governments liable for injuries to the victim of any attack in any jurisdiction putting limitations on firearms for self-defense- Storage laws, restrictions on carry etc.

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    1. Good luck getting THAT passed, anywhere. No government is going to volunteer to become liable for a lawsuit.

      Besides even if such a law were to pass, the courts would overturn it; they’ve already “found” that police do not have ANY duty to protect you.

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  23. My doctor is a friend and a fellow Aikidoka. But I have no qualms about lying to him in the doctor’s office.

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  24. One of my doctors is a member of the same indoor range I shoot at. I ran into him there.

    I don’t know what he does about this intrusive question.

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  25. Shouldn’t she ask if i have my clothes dry cleaned? I mean those plastic bags are a death trap!

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  26. As a physician I feel it is my duty to counsel my patients on gun control…
    1. Both hands on the pistol, with stacked thumbs if using a 1911.
    2. Present to eye level to obtain a flash sight picture if danger close, and press trigger straight back. Reset trigger and repeat as necessary.

    I also advies all my patients to get plenty of exercise…
    Of their Second Amendment rights!!!

    Most of the docs I work with in Montana are like minded, and are as horrified as you at the repeated attempts by the Federal Government and the AMA to use physicians to backdoor gun control into American homes. The Centers for Disease Control has put out multiple junk science papers in support of gun control or elimination. Medicare/CMS/JACHO has issued requirements including anti-smoking and “gun safety” counseling, and they will withhold physician payment if this is not documented in the Electronic Medical Record. Remember that the EMR’s were mandated by Obamacare, and allow the Feds access to everyone’s medical history, including now gun info. Remember also how the AMA supported Obamacare? All those idiots in Obama supplied butcher length white coats on the White House lawn. They are also rabidly anti-gun, so folks assume that most physicians are therefore anti-gun. Actually only about 15% of America’s docs are AMA members, and I will never join them because of these issues!
    This is what my kids think about gun control; https://www.youtube.com/watch?v=5Qma4LGot9E
    Nicki, feel free to discuss guns any time with me.
    And trust me…I’m a Doctor!

    Liked by 2 people

  27. Far more dangerous to “the children” is an unrelated, unmarried adult male living in the household — the live-in boyfriend. Wonder how often docs ask about those domestic arrangements?

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