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.
You’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.
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.