Just Shoot Me…

Cambodia 437

When I saw the article a few months ago about the state of Florida actually making it a criminal act for physicians to ask about guns in the home during an office visit I shrugged it off.

Surely they can’t be serious!

But they were. In fact, the courts upheld the law. Read about it at the NY Times here.

Now, as a kid I shot guns. Lots of them. Automatics. Semiautomatics. 9mm’s. 22 caliber rifles and pistols. My father was preparing us for the apocalypse. Seriously. Someone, somewhere should have told him what he was doing was wrong. No one did.

My brothers and I were given guns for birthdays and Christmases. We were completely unprepared for the responsibility and honestly it is a miracle that no one got killed. We were not living on the wild frontier protecting the homestead from marauders and preventing the livestock from being torn to shreds by wild animals. We were silly kids with no serious sense of responsibility with cavalier attitudes about very dangerous weapons.

I completely respect patient privacy. No one has to answer any question I ask, ever. I also understand a paranoia and mistrust of the establishment to an extent. I grew up with it.

But asking about guns is relevant to healthcare. I don’t ask every patient, generally I stick to my pediatric and depressed patients.

Don’t get me wrong. I don’t believe all guns should be destroyed, that no one should have access to them at all necessarily. It is not my place to decide, really, and certainly it is not my job to police it. What I do believe, however, is that we need to remind parents how serious these things are in the hands of kids and remind them protect those kids if needed.

There was a time I used to get indignant when patients lied to me or withheld information. Then a patient’s medical record, and myself, were subpoenaed during a divorce proceeding. What about physician, patient confidentiality? Can they even do that?!?! Yes. Yes they can. Nothing in writing is ever truly private. I understand the fear. I really do!

On the other hand, I take issue with a government entity criminalizing what I do or do not discuss during the course of an office visit. If I sexually assault a patient, hell put me away. Malpractice? Take my license. But at least respect my professional judgement enough to allow me to decide what counseling I need to give my patients.

What is next? A script for me to follow item by item or face jail time? Patients have every right refuse to answer a question or to ask me to not document their answer in the chart, but I should have every right to ask a question if it is relevant.

As always, I learn a ton from you all. I would love to hear your views and perspectives about this…

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45 thoughts on “Just Shoot Me…

      • Even with children in the home, unless there was an injury or conversation that brought it up I am not sure I can see it necessary.

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      • Again, I would reference my own experiences with guns. Not everyone is stupid enough to not teach their kids good gun safety but where I grew up and where I practice, it is an issue. Asking the question does not imply judgement or wrong doing or anything of the sort, it merely opens a dialogue about gun safety. Now, I am not aware of any studies pointing to whether or not doing this prevents deaths, but I am not really sure talking about it is harmful, either. I also ask about using seat belts and sex and sunscreen and even bug spray during West Nile season.

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      • Yes, I read that you don’t judge. I don’t either however, maybe I am missing something. Sex, sunscreen and bug spray actually all seem relevant in a conversation with a doctor.

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  1. I was stunned when this first came out, and I was stunned when it was upheld. I usually always ask about guns in well-child visits. A physician discussing gun safety does not infringe on anyone’s right. Most physicians aren’t saying, “You can’t have guns.” They’re saying, “If you have guns in the home, here are some safety things to consider.” I feel bad for those Florida physicians. I hope it doesn’t extend elsewhere.

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  2. I’ve never had a physician, either my own or one of my children’s, inquire about firearms in my home. Honestly, I am not certain how I would have responded, truthfully I’m sure, but with what demeanor, I just don’t know.

    We are gun owners, always have been. My children were never allowed to play with toy guns, we began teaching them from the get-go they were not toys, when they were old enough we gave them the opportunity to learn more.

    There is a part of me that understands why this is a concern, but the other part of me thinks it is my personal business, especially these days when it seems so many seem to vilify legal and responsible gun owners.

    While I might be off-put, I would, as I said, answer truthfully. Well, maybe not if PMS is involved :o), I have a difficult time thinking the very people who concern may be warranted for would be forthcoming though.

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    • I understand the feeling of being judged, given media and such. Maybe some physicians are being judgmental but from my standpoint, I just want to talk about safety. You want guns? Sure. Fine. How do we make that safe for kids? You are teaching them gun safety? Cool! We are done with the discussion. What people may not realize is that the American College of Pediatrics recommends discussing gun ownership as a standard of care. Technically for a physician to not discuss it is considered poor care nowadays. Not so when I was a kiddo, though.

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      • I read the heartbreaking stories about children getting their hands on guns, I cannot imagine being so careless. It’s sickening. If even one tragedy could be prevented by opening a dialogue with parents it is worth any amount of opposition.

        Do you think many are truthful? I just imagine many wouldn’t be. I hadn’t heard about this until earlier this year, like I said, I’ve never been asked, even with the many psych docs we’ve seen.

        I wouldn’t have thought twice if one of my son’s docs had asked, truthfully, it would have made sense. He is bipolar . . . He was hospitalized three times during severe episodes. I’m curious if this ruling effects psychiatric practice as well . . .

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      • I think it applies to all physicians, including psychiatrists. Even if patients aren’t truthful, getting asked the question makes anyone think. Many of my teens aren’t going to admit to sex, either, but talking about sex and STDs hopefully makes them think harder about protecting themselves in the future. The more we talk, the less taboo it becomes, I hope.

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  3. When I check a patient into the hospital, it is on the screen template for me to ask her / or him if they feel safe in their home – the subtle domestic screening question. I don’t see the difference in asking any other question that promotes people living in a healthy environment. And it’s not like the patients are forced to say anything in response.

    I think the law is dumb – government is questioning intent with this issue. They continue to work hard to chop you folks off at the knees!

    Good example below – and real story.

    A friend of mine, her mother died two years ago. Her father, a stubborn gruffy type, had chronic health issues, but he was living independently with weekly visits from his daughter, my friend. Eight months after the mom had died, my friend went to check on her dad. She found him sitting in his lounge chair a pool of blood at his feet, and a single shot through his head.

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  4. It makes me crazy. Every package is child proofed. Bike helmets, seat belts, not letting kids out Lone until they’re 16 and they get the car keys. We mandate every form of protection for our kids. Except when it comes to guns. Then we pretend until there is an accident “no one could have predicted.” What fools we are.
    Just today I read that some NRA brain trust thinks it’s stupid to ask about guns before letting your kid over for a play date.

    The gun folks seem to have lost their ability to see reason.

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  5. You write, “Patients have every right refuse to answer a question or to ask me to not document their answer in the chart, but I should have every right to ask a question if it is relevant.” Agreed. But here’s the rub. If, as a parent, I refuse to answer questions I do need to be concerned about how that refusal will be interpreted. I learned some very hard and painful lessons via providing foster care, and unfortunately parents (bio and foster) are too often assumed guilty before proven innocent. So while you and I agree that provider/patient confidentiality should be a primary value in our culture, it simply isn’t. Thanks for the thoughtful post.

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    • You are right about physician/patient confidentiality. As I mentioned, that point was driven home to me by the subpoena of my patient’s records for their divorce proceedings. Hell, anything in an electronic health record isn’t really private anymore given the current state of IT, particularly as we move toward sharing those records across institutions. But should I then not ask a potentially life saving question? Should I just be able to document a discussion of gun safety without going into specifics? That might be a solution that would make everyone happy.

      Liked by 1 person

      • Your solution sounds very informed, compassionate, and helpful. I hate the thought of good information exchange being thwarted based on fear or the long arm of entities that, I believe, over-reach their authority. Sheesh, as if being a care-provider and a patient/parent isn’t hard enough already!

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  6. If you discuss and don’t document, you could find yourself being criticised for not doing so in the event of a suicidal/homicidal patient who later commits an act of violence with his gun. In the UK that would be reported as “bungling GP knew my husband was depressed and had thoughts of suicide but didn’t ask if he had a gun” says wife of man who blew his head off and slaughtered his 3 children”. You can’t win, but the Florida law is truly bananas, it also seems a waste of time and money to have bothered passing such legislature. What kind of person would lobby for this?

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    • You are right. There is risk. I think the issue, really, is more with discussing it in the perview of a well child visit, though this law does not make that distinction. In that context is the only time I ever get pushback on answering the question, parents who believe that the government will have access to their admission of guns in the home if they answer my question and that the government will then come and take their guns. This law is a reflection of that fear.

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  7. I live in the UK (although not there at the moment) and must admit to having my own thoughts about the issue of gun ownership, but I’ll keep those. I was working as a forensic psychiatrist, and of course, as part of the job we would ask questions not only about suicidal ideation and access to methods, but also about ideas of harm to others (as part of the risk assessment). We would not be doing our jobs if we didn’t and in the UK if you think somebody could be at risk you would have to report (and of course if somebody was suffering from a mental disorder this could be grounds for detaining them in hospital). Circumstances and laws are different though, but maybe it’s something that needs to be discussed at the beginning of the visit, with clear reasoning as to why you think this is important information you need to know to be able to do your job properly and to ensure the health and safety of all. That might ease somewhat suspicion that you are asking because you’ve made up your mind about them or there is something you find worrying. Explain that is your general policy and why and they can take it or leave it…
    We of course need to work within the law, but the law should facilitate our job rather than put us at risk and dismiss our expertise and criteria. When it isn’t one thing is another… As if the job wasn’t hard enough already…

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    • Most parents are really great about answering the question. If body language or words suggest otherwise I explain why I ask the question. And you are right, in the context of a person who is a threat to themselves or others, discussing guns is absolutely necessary. Ignoring that would be malpractice. But not in Florida.

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  8. I’m trying hard to not always be so judgmental and dismissive of Florida, but…why does it always seem like the crazy is happening in Florida, whether be crazy acts by people, or crazy laws being enacted?

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  9. Vico, it’s time to define what a dictatorship is and isn’t. Freedoms are allowed in free countries and taken away in ones that are not. That said, I think many Americans need to look in the mirror and ask the question, “What the heck is going on.”

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