Patients and guns: When should doctors ask questions?

Critics say risk-based screening is potentially discriminatory

Physicians should discuss firearms with their patients in certain situations, researchers write in an Annals of Internal Medicine editorial.

While gun violence causes many deaths in the United States—about 33,000 Americans died of gunshot wounds in 2014 alone—many doctors are uncomfortable speaking with patients about firearms.

That hesitancy may be the result of misconceptions, note Garen Wintemute, director of the violence prevention research program at the University of California, Davis, and colleagues in the editorial. They write that, contrary to what many doctors believe, there is no law that prohibits physicians from talking about firearm risks with their patients.

The only state that may appear to have such a law—Florida—directs doctors only to "refrain" from talking about guns and to avoid "intentionally" recording such information in medical records. It includes an exception, the editorial notes, for when a physician "in good faith believes that this information is relevant to the patient's medical care or safety, or the safety of others."

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Knowing when to speak up

The more difficult issue is helping physicians determine when discussing firearms is relevant to the health of their patient, Wintemute says.

Specifically, the editorial advises that doctors bring up firearms when patients:

  • Take actions that suggest a risk of violence against themselves or others;
  • Have risk factors for violence such as substance misuse; and
  • Belong to an at-risk demographic group such as young African-American men (who are at higher risk of being victims of gun violence) and middle-aged white men (who have a high rate of suicide).

"Depending on the circumstances, interventions may include education; counseling in support of behavior change; or more direct efforts, such as disclosure to others, to prevent death or serious injury," the editorial reads.

Steven Weinberger, CEO of the American College of Physicians, tells Reuters that his organization supports doctors engaging with their patients on firearms issues.

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"Physicians need to consider gun safety and reduction of firearms-related violence as an important public health issue, one which they have a responsibility to address with patients," he says, adding, "this includes assessing risk and recommending ways to mitigate the risk of injury or death."

The wrong approach?

But some critics say that basing questions about firearms on demographic risk factors is misguided and potentially discriminatory. "You are labeling these perfectly ordinary demographic groups as people who should not have weapons," says Robert Young, a clinical associate professor of psychiatry at the University of Rochester Medical School and spokesperson for the group Doctors for Responsible Gun Ownership.

Other clinicians approve of the framing of gun violence as a critical public health issue. Erik Wallace of the University of Colorado School of Medicine says, "Given the public health crisis of gun violence, we as a society need to decide how many deaths each year are acceptable" (Harrison, Medscape, 5/16; Park, TIME, 5/16; Boggs, Reuters, 5/16).

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