The Question Doctors Can't Ask

Is there a gun in your home? If so, is it secure? A Florida law now prevents physicians from discussing firearm safety with patients.
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Florida man Doug Varrieur on the personal gun range he set up at his home in a residential subdivision earlier this year (Andrew Innerarity/Reuters)

When police in Texas City, Texas, arrived at a suburban apartment on August 7, they found an eight-year-old boy who was seriously injured. He had been shot in the face, and the shooter was still in the home. His seven-year-old cousin pulled the trigger.

A helicopter swept the victim 40 miles north to a Houston hospital, where he was taken into emergency surgery in critical condition. He is alive, and poised to elude a place among the 3,000 U.S. children who will die this year as a result of gunshot wounds. In 2009, 114 kids died as a result of unintentional gunshots—almost all of them in their own homes, and most commonly shot by other children.

In recent years a mantle to prevent these shootings has been taken up by physicians. Most professional governing bodies now recommend that doctors ask patients some variation on “Is there a gun in your home?” If the answer is yes, the physician is meant to ask about it being properly secured. 

The American Academy of Pediatrics likens counseling on gun safety to counseling on lead paint avoidance or seat belt use. Pediatricians, the group’s recent policy statement reads, are “urged to counsel parents about the dangers of allowing children and adolescents to have access to guns inside and outside the home.” Doctors are encouraged to promote trigger locks, lock boxes, and gun safes. Some distribute cable locks. The American College of Physicians is similarly proactive, calling gun violence a public health issue "requiring immediate attention." The group, of which most practicing internal-medicine doctors are members, declared in its recent position statement: "Physicians must become more active in counseling patients about firearm safety." The college implores doctors to open that conversation by asking patients (with and without children in their homes) about gun ownership.

As of two weeks ago, that is no longer legal in Florida. In a 2-1 vote, a U.S. Court of Appeals upheld a law called the Florida Privacy of Firearm Owners Act, ruling that doctors asking patients about firearms violates patients' right to privacy.

“The act simply codifies that good medical care does not require inquiry or record-keeping regarding firearms when unnecessary to a patient’s care,” Judge Gerald Tjoflat wrote in the court's majority opinion.

Legislation Restricting Physician Counseling on
Firearm Safety; Blue = Introduced, Yellow = Adopted
(American Academy of Pediatrics)

The American Medical Association calls gun violence a horrific epidemic. In 2011, the group issued a call for doctors to counsel patients on gun safety. In response, Florida Governor Rick Scott, backed by the National Rifle Association, signed the Privacy of Firearm Owners Act that June. Florida physicians objected immediately. A federal judge in Miami issued an injunction on grounds that the law violated First Amendment rights of physicians, and for three years it sat neutralized. As Robert McNamara and Paul Sherman, attorneys at the Institute of Justice, put it in a New York Times editorial just after the July 25 injunction overturning by the appeals court, “Everything a doctor says to a patient is 'treatment,' not speech, and the government has broad authority to prohibit doctors from asking questions on particular topics without any First Amendment scrutiny at all.”

Dr. Bart Kummer, a gastroenterologist at New York University Medical Center, says he always asks his patients about guns.

“It's part of reducing risks, and taking a view of the patient as not just a GI tract that ambles in on two feet," Kummer told me. "So I ask about seat belts, helmets, safe sex, the standard questions about alcohol, tobacco, caffeine, hours slept, hobbies—some people work with molten metal—and what the American College of Physicians has asked us to ask our patients: whether there's a gun in their house.”

If the answer is yes, he asks what kind of gun. "Is it a hand gun, a long gun, a rifle, a shotgun? You can lock them up differently, but all of them can have trigger locks, and all of them can have ammunition stored separately." Independent of the gun question, Kummer asks, "Who's in your home?"

"People think they can hide things from their children," Kummer said. "Those of us who are parents know that children will find anything in your house. You cannot hide a gun from a child. It has to be in a locked safe."

People are also more likely to kill themselves in a moment of despondency if they have a gun handy, Kummer noted. "When we're screening for depression, gun ownership is worth knowing."

Sometimes the questions come on waiting-room paperwork, and sometimes a nurse or physician assistant might do the asking. In any case, lifestyle questions do make many patients nervous, Kummer said, "often because they’re not used to doctors taking an interest in their social setting." Some patients get downright angry by screening questions. “But the gun question is the one that upsets people the most. And the people who get upset are usually the people who own guns—they get really, really offended by my asking that question."

"I think they often feel that they're beleaguered," Kummer said, "that they're going to be demonized as being crazy because they have a gun. Or that I'm some liberal nut who's going to tell them that they should throw it in the river. Or they're afraid I'm going to denounce them to the police and the FBI, and the black helicopters are going to come napalm their house."

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James Hamblin, MD, is a senior editor at The AtlanticHe is the host of If Our Bodies Could Talk.

 
 
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