Every year in the U.S., more than 32,000 people die due to gun-related violence, suicide and accidents. That number includes the deaths of seven children and teens every day. So it’s not surprising that health care providers — those who witness the tragic results of gun violence — are often vocal proponents of gun safety reform. But when it comes to the intimate patient-provider relationship, do people want to discuss gun safety with their doctors?
A group of researchers set out to explore that question in what may be the first nationally representative survey on whether Americans feel it’s appropriate to discuss guns in a doctor’s office. In an online survey of nearly 4,000 adults conducted in April 2015, researchers asked: “In general, would you think it is never, sometimes, usually or always appropriate for physicians and other health professionals to talk to their patients about firearms?” They asked the same question regarding alcohol, seat belts and cigarettes. Overall, 66 percent said it is “at least sometimes appropriate” for providers to discuss firearms with their patients. The survey results were published yesterday in the Annals of Internal Medicine.
More specifically, the survey found that 23 percent of respondents thought provider discussions about firearms were “always appropriate,” 14 percent thought they were “usually appropriate,” 30 percent said “sometimes appropriate” and 34 percent believed they were “never appropriate.” Among those who thought such discussions were at least sometimes appropriate, 95 percent also thought talks about seat belts, tobacco and alcohol were at least sometimes appropriate.
Breaking down responses by gun ownership, the survey found that 54 percent of gun owners thought such discussions were at least sometimes appropriate, compared to 67 percent of respondents who didn’t own a gun but lived with someone who did and 70 percent of those who did not own a gun. Among gun owners, 62 percent with at least one child at home believed such discussions were at least sometimes appropriate, compared to 52 percent of gun owners without a child in the home. Gun owners were also more likely to say such discussions were at least sometimes appropriate if they believed having a gun at home was a risk factor for suicide or made the home more dangerous.
Overall, more women, at 71 percent, thought firearm discussions with a doctor were at least sometimes appropriate, compared to 61 percent of men. Study authors Marian Betz, Deborah Azrael, Catherine Barber and Matthew Miller write:
The observed heterogeneity in opinions highlights the need for communications research to better understand the viewpoints of all types of firearm owners when creating targeted firearm safety educational materials and interventions; the assumptions that may underlie these views; and what information may help open up the possibility of dialogue for different people, especially in higher-risk situations, such as when a patient is experiencing a mental health problem. It is important that any messaging about firearm safety be factually accurate and presented in a way that neither overstates risks nor alienates patients.
Several leading medical associations, such as the American Academy of Pediatrics and the American Academy of Family Physicians, already recommend that providers talk with patients about firearm risks and how to prevent gun injuries. And last year, eight professional health organizations joined forces to support a number of policy measures to reduce the toll of gun violence. Unfortunately, some doctors are legally restricted from discussing guns with their patients — Florida was the first to enact such a doctor “gag order” law and a number of states are trying to follow suit. Such laws come despite the fact that doctors are often highly effective messengers of safety information, and previous research finds that up to 1.69 million children and teens in the U.S. live in homes with loaded and unlocked guns.
“For the practicing clinicians…some patients may be uninterested in or resistant to discussing firearm safety in a clinical setting, at least initially,” the new Annals of Internal Medicine study stated. “Finding ways to routinize these discussions or, more generally, to optimize approaches to addressing firearm safety may help clinicians and their patients navigate these conversations in the clinical setting in ways that lead to more informed decision making.”
Visit the journal to request a full copy of the new gun safety survey results.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.
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“In general, would you think it is never, sometimes, usually or always appropriate for physicians and other health professionals to talk to their patients about firearms?”
By the way, about 21,000 of those 32,000 gun-related deaths are suicides. And those 21,000 are only about half of all suicides.
So, in general, would you think it is never, sometimes, usually or always appropriate for physicians and other health professionals to talk to their patients about, say, rope or razor blades?
In general, would you think it is never, sometimes, usually or always appropriate for physicians and other health professionals to talk to their patients about mental health?
In general, would you think it is never, sometimes, usually or always appropriate for physicians and other health professionals to talk to their patients about seat belts?
The Florida "gag law" forbids doctors to ask patients whether they own guns, unless there is a medical reason (such as suicidal feelings attributable to mental illness). It does not forbid telling all patients what safe gun handling and storage practices are or asking whether they are aware of safe those practices. Those who have no contact with guns (or, conversely, those who are pretty sure they know more than the doctor) are free to volunteer that further discussion would be a waste of everyone's time.
The Florida law was inspired by the case of a pediatrician who reportedly asked whether a child's parents owned guns, and then said that unless they promised on the spot to get rid of them posthaste, he would refuse to treat their child because their continued gun ownership would "endanger" the child and make it "neglected." In a country where an M.D. can easily telephone local authorities and have a child seized because his parents because do not follow the upper-middle-class, usually-white, professionally risk-averse M.D.'s preferred child-rearing practices, the use of these words can represent a serious threat to the family on the receiving end. I don't blame them at all for calling their legislators and raising hell.
The lesson is that if you want to be an "effective messenger of safety information", don't sneer down your nose at the unwashed peasants you're supposed to be trying to educate.
Thanks for reading and for your comments. Just to provide our readers with more context, opinions and background on Florida gag law, here's some info from the Law Center to Prevent Gun Violence (http://smartgunlaws.org/eleventh-circuit-upholds-florida-law-preventing…):
"In reinstating the (Florida gag) law, the Circuit Court found that the gag rule is a legitimate regulation of professional conduct that imposes only incidental burdens on speech and sufficiently advances the state’s interest in protecting patients’ privacy and Second Amendment rights. In his lengthy dissent, Judge Wilson agreed that the state’s “asserted interests in protecting the rights of firearm owners, including their privacy rights, their rights to be free from harassment and discrimination, and their ability to access medical care, are incredibly important.” However, the state “has offered no evidence to show that those rights are under threat, nor is there evidence…suggesting that the [law] will either directly or materially advance those interests.” If anything, “the record and common sense lead inexorably to the conclusion that children will suffer fewer firearm related injuries if they—and their parents—know more about firearm safety.”
Statement from the American Medical Association on physician gag laws is here:
2014 statement from the American Academy of Pediatrics on the Florida gag law:
Research has shown that physician counseling about gun locks and safe storage, tailored to a child's specific age and development, increases the likelihood a family will take the steps to store their firearms safely. Pediatricians routinely counsel families about firearm safety just as they offer guidance on seat belt use, helmets and parental tobacco use to reduce the risk of injury to children where they live and play.
"State legislatures should not stop physicians from practicing good medicine. This law has a chilling effect on life-saving conversations that take place in the physician's office," said James M. Perrin, MD, FAAP, president of the AAP. "More than 4,000 children are killed by guns every year. Parents who own firearms must keep them locked, with the ammunition locked away separately. In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming – young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility."
Strange. I wouldn't think that a doctor would have any authority on the topic of gun safety.