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March 6, 2018

Why 1,000 doctors have pledged to talk about firearms with patients

Daily Briefing

    More than 1,000 physicians have signed a pledge proposed in the Annals of Internal Medicine to discuss the risks of firearms with their patients, partly in response to evidence that many people killed by gunfire—especially in cases of suicide—are in contact with their doctors shortly before their deaths.

    Members ask: How can our hospital prepare for disasters?

    Pledge details

    The pledge is part of a campaign that started with an editorial in the Annals after the mass shooting in Las Vegas last fall. In the editorial, Garen Wintemute, an emergency medical physician at the University of California-Davis School of Medicine and director of the Violence Prevention Research Program, wrote, "(T)here is a critically important and beneficial action that we physicians can take, right now and on our own initiative. … We need to ask our patients about firearms, counsel them on safe firearm behaviors, and take further action when an imminent hazard is present."

    The pledge included in the editorial states, "When risk factors for harm to my patients or others are present, I will ask my patients about firearm ownership and safety." According to Medscape, the campaign has gained attention following the school shooting that occurred in Parkland, Florida last month.

    Wintemute noted that people who engage in firearm violence often have risk factors that bring them into contact with health care providers, including abuse of alcohol and a history of violence. He added, "The relationship between fatal violence and recent contact with a health professional is clearest for people who commit suicide: As many as 45% have seen their primary care provider within a month of their deaths."

    Given these factors, Wintemute argued, physicians should "make a commitment to ask your patients about firearms when, in your judgment, it is appropriate, and follow through," drawing on existing materials—including practices that Wintemute helped author—that can help guide the physician-patient conversation.

    Comments and discussion

    Amy Barnhorst, who signed the pledge, in the comments on the website wrote, "Doctors think they should ask about guns. Our patients want us to talk to them about guns. And there are steps doctors can take to decrease risk if they think a patient with their gun is dangerous. So let's start doing something!"

    Marian Betz, associate professor of emergency medicine at the University of Colorado School of Medicine, wrote, "We can prevent suicides and other firearm injuries and deaths through respectful, nonjudgmental discussions with patients. This is not gun control—it's helping our patients and their families stay healthy and safe."

    Separately, Art Caplan, a medical ethicist at New York University, said he supports physician-patient discussions, but he added that doctors should admit to patients when they don't know much about the topic. "If you don't know how fast an AR-15 fires or what a bump stock is, then say so. Nothing will undermine patient trust faster than you claiming to be a gun expert if you're not."

    To help physicians become more informed about firearms and related risks, Annals has made its content on the topic available at no cost (Frellick, Medscape, 3/1; Wintemute, Annals of Internal Medicine, 12/19/17).

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