Gun Discussions Should Not Be Required for Physicians
Gun Discussions Should Not Be Required for Physicians
So the AMA in its infinite wisdom sent a letter to President Obama requesting funding partly for programs that would enable physicians to speak to patients about their gun usage. Naturally, the president supports this and says he wants doctors to speak to patients about responsible gun use.
Don't misunderstand me. After the Newtown shooting, as a mother of two small children, I was beside myself. I couldn't even talk about it without tears for days. I definitely believe that there are people in this country who have guns but shouldn't. I have my own opinions about gun control and the freedom to bear arms, but that is a whole other discussion.
My concern at the moment is that physicians are once again being called to be in the front line; to be the screeners and enforcers. So in addition to asking about symptoms and risk factors for illness, alcohol, tobacco and other substance abuse, diet, exercise, signs of domestic abuse, use of seatbelts, safety of the home environment, and social support systems, we are now supposed to ask not only if patients own weapons, but we are supposed to counsel them on responsible gun use? We need to assess their ability to be safe gun owners?
So is this someday going to be part of meaningful use of our EHR or PQRS?
Here's an option: How about the people who sell you the gun be held accountable? Why don't they, in addition to a background check, require psychiatric evaluation? Maybe the gun license needs to be renewed on a semi-annual basis and require that the applicant be assessed for safety.
Or, if we are going to put the onus on physicians, you're going to have to find a CPT code for "evaluation for safe gun usage" and an ICD-9 code for "gun owner." With the way our health system is now and the way physicians are compensated, there just isn't time to add 15 more minutes of evaluation and counseling. If they expect primary-care physicians to do this, they need to be properly compensated for all the counseling and hand holding they already do. Furthermore, who is going to be held responsible if one of their patients decides to take out some poor store clerk? Is the shooter's doctor now a potential target for a lawsuit? Can the shooter claim at his trial that he was not properly counseled by his physician?
The AMA once again reveals that it does not truly represent the physicians who are out there in the trenches seeing patients every day.
What's next? Are we going to be required to ask patients if they've cleaned the lint trap in their dryers?
Dr. Young responds to her critics and allies in a follow-up blog here about the increasing likelihood of gun discussions becoming a healthcare mandate.
"Physicians shouldn't be restricted from asking almost anything." What are you a god.
"Physicians shouldn't be restricted from asking ALMOST anything." God already knows everything. He doesn't have to ask.
ALMOST anything involving a patient's health should be fair game in a patient-physician relationship if the provider in their judgement feels it is a factor in their health improving or deteriorating OR for the health and well-being of someone else.
Agreed - physicians should be able to ask, and yes, right now they are asking for programs to allow us to ask. But I fear the slippery slope. It makes for good political fodder. Now that the door has been cracked open...
Bully for you! I whole-heartedly agree.
Ditto. Physicians should not be barred from asking about things they think could harm their patients. The patient of course has the right to refuse to answer. But having the doctor ask at least raises the question.
Physicians should not be required to ask, if they own a gun, it's utterly irrelevant. I think it does NOT help at all. This is a slippery slope-what's next? The AMA also is making their own agenda-political of course, these people are completely out of touch physicians who are in the forefront of actually seeing patients on a daily basis.
I agree that there are things that should be considered as you pointed out in the article. Most likely the target population are not the ones seeing their primary caregiver, but I do think healthcare providers in school systems could be active participants.
How could "healthcare providers in school systems" have prevented what happened in Newtown?
Adam Lanza was mentally ill and his mother knew it. She was trying to find out about involuntary commitment. If physicians, had known the facts beforehand, they could have recommended that she not have all of those available where he could get his hands on them, and they could have been proactive in dealing with his mental health issues, including speeding up the process of involuntary commitment!
"If physicians, had known the facts beforehand, they could have recommended that she not have all of those available where he could get his hands on them"
You don't need to have an MD degree to give that advise. Any person with enough common sense could have given that advise, including the president of the US. Why not make it the President's personal responsibility to counsel every gun owner to get rid of his guns if they feel angry at the world and they have diabetes? After all, he is the commander in chief and should take care of all of us. And if he fails to do it, impeachment must follow. The physician is the last person who should be responsible for telling somebody to get rid of his guns, as this is common sense knowledge and has nothing to do with medicine and yet if you want the physicians to do it, then at times they will not remember to do it and you will have huge liability for the deep pocket defendant - the physician, higher cost of medical care and shortage of care. What's next - physicians must inform their patients not to spill hot coffee on themselves, not to drink bleach, not to put their cat in the microwave?
I disagree, I think physicians should ask about gun ownership.
We should wholeheartedly encourage gun ownership.
I think we should encourage healthy behaviors, like being protected from harm, whether from hypertension, hyperlipidemia, diabetes, or violent people.
M. Young, MD
Dr. Young wrote, "We should wholeheartedly encourage gun ownership."
Dr. Young, you have received my Doctor of the Day Award. Congratulations!
Dr Young, you get a second vote for Doctor of the Day!
To the rest, it is not the issue per se of asking patients questions relevant to their mental health. The problem is having to report it to the "authorities". What ever happened to patient-doctor confidentiality.
There's also the question of making a mistake, not reporting the issue, and getting criminally charged for not being able to avoid/prevent a violent event.
So, doctors will be punished both ways, by breaching confidentiality, and by not breaching it.
Can we just get government our of the exam room, and the patient's chart?!
Paty / Practice Administrator
This is one of my concerns
EMR has completely destroyed any relic of patient-doctor confidentiality. The government now has access to everything done with a patient in a doctor's office. I now write my notes with this in mind, given that I do not necessarily know who will be the reader of my notes.
And Obamacare has destroyed any relic of the Hippocratic Oath. I am just an unpaid enforcer of government edicts now. And of course, if anything goes wrong I will be blamed.
Anyone going into medicine now is a fool.
I absolutely agree, Dr. Young. Unfortunately, in today's society, individuals and parents have a new responsibility for their continued life and health for them and their children: the responsibility to help provide for their physical safety. With regards to personal defense, remember that when seconds count, the police are only several minutes away.
I agree that government mandates for meaningful usage without financial support or clinical indication are problematic. I disagree that owning a gun has been shown to promote safety and increase health. Those with a gun in the house are highly more likely to die from a gunshot than those without one. The capacity to skillfully use a deadly weapon to protect oneself or others is something that requires much training, intelligence, and discipline. I have a great respect for the first responders that I have treated over the years. Their skill set does not come easily to most people. The fact that Australia banned semi-automatic weapons about 10 years ago, after a particularly horrendous massacre and since then, has not suffered a mass shooting, says something .
So many myths, so little space... Generally it's annoying to see links and cut-and-paste responses, but please indulge this one. The link is well sourced and neatly organized:
http://gunfacts.info/pdfs/gun-facts/6.1/gun_facts_6_1_screen.pdf
Apologies ahead of time.
Stop spreading baloney: Read the following article published a month ago -- Chart: The U.S. has far more gun-related killings than any other developed country http://www.washingtonpost.com/blogs/worldviews/wp/2012/12/14/chart-the-u...
Great Britain where even the police do not generally carry weapons except a billy club -- a nightstick -- and which has very strict gun laws is has a miniscule number of homicides compared to the US. Who do you really think you are fooling?
http://www.telegraph.co.uk/news/uknews/law-and-order/9551667/Police-shou...
http://www.snopes.com/crime/statistics/ausguns.asp
Philip, you are correct, we have a lot of gun homicides in the US, but it is most often caused by illegal guns by illegal owners. And I am for banning these. But not law abiding citizens with legal guns.
I am the very doctor you so vehemently hate. I am an NRA Life Member and a firearms expert. The reason your study of ballistic wounds was rejected, not by the NRA, but by your grant provider, was for the simple fact that these studies have been done over and over ad nauseum. You can easily look up the wound channels in ballistic gelatin or cadaver reports. Its readily available on youtube.
First, you could not be any more off base with regard to the research that was proposed. I never said what was planned. Moreover, as a physiologist I would tell you that cadavers and gelatin have nothing whatsoever to do with function. The kind of studies that were contemplated are most definitely not available on YouTube and no reputable scientist would ever publish anything in that manner! The only thing ad nauseum here is the continued stupidity by the NRA and its members!
And when are you people going to stop with the nonsense about illegal guns? Most homicides are NOT committed with illegal guns, but rather with guns legally owned where both the victim and the perpetrator KNOW each other -- i.e. as neighbors, family, friends, coworkers, etc. You are obviously not as "expert" as you think. And I am not impressed, I have both an MD and a PhD AND a law degree. Your post is simply more baloney from yet another gun nut who just plain does not get it!
Like I said, I am the type of person you so vehemently hate and despise just because I belong to a certain organization. Your automatic assumption of my deviant and negative behavior by belonging to a certain perceived evil group(NRA), makes me wonder if you harbor the same for other groups like Blacks, Asians, or others....
Rational discussions become difficult when infantile name calling pervades. Degrees behind a name shows how intelligent you are, not how wise one is....
My training with firearms includes (real assault weapons) like the military grade HK MP5 in 10mm and 9mm, M4 , M16A4, M60, M249, M240, M2 BMG, LAW, and a host of LE (Federal, State, and Local Law enforcement). I've lectured about various types of channel injury patterns by different types of rounds and bullets to surgeons in the past. Most homicides are caused by illegal guns in illegal hands of gangs, drugs wars, felons of violent crimes, and others who should not have any firearms.
This is one of the most asinine comments I have ever seen. Who cares what firearms you know about. That is entirely irrelevant. Again, unsupported assertions like your claim about illegal guns will get you know where. That is contrary to fact. PERIOD! You just prove my assertions, you are addicted to guns and could not care less about the harm that guns cause. You simply make unwarranted assumptions and then try to argue based on those unwarranted assumptions. The only argumentum ad hominem is yours when you make a statement like that I am somehow prejudiced against anyone. In any case, that is a laughable assertion which is not deserving of further comment. And if anyone is infantile it is you!
Phillip that is so impressive. During your schooling do you study anything along the line of Liberty? In law school did you cover anything around the Constitution? Freedom works just like novacaine. Works with guns or anything else. We keep going down this road and at sometime you, as my Physician, will be mandated to report on a freedom you do hold sacred and you might feel differently. If guns are a problem, work to get rid of them some other way. This is wrong. Doctors should practice medicine.
Who do you think you are fooling? You produce a pamphlet by some unknown, no attributions of any kind, just somebody named Guy Smith. Both your link and the web site "gunfacts info" lead one to believe that it is simply put out by a member of one of the gun groups -- and the data it shows are are first of all old, not recent and are distorted for the purpose of proving the author's premise. The following is a dose of reality, from the Washington Post: Chart: The U.S. has far more gun-related killings than any other developed country http://www.washingtonpost.com/blogs/worldviews/wp/2012/12/14/chart-the-u...
Published a month ago. The US clearly goes to near the top of the chart and Great Britain where not even the police generally carry guns and which has very strict gun laws is minuscule in comparison.
As I said, just who do you think you are fooling?
Figures don't lie, but they sure as heck can be manipulated. We can do dueling links if you wish, but here is the evidence: NO MASS MURDERS IN AUSTRALIA SINCE THEIR GUN LAWS WERE ENACTED IN 1996. Put in place by a CONSERVATIVE prime minister. http://www.independent.co.uk/voices/iv-drip/in-1996-australia-enacted-gu... What is the need for semi-autos and massive magazines? Are we being invaded? Are we joining up into militias, like Somalia?
Just a disclaimer - M. Young, MD (author of the above) not the same M. Young, MD blogger.
You should be able to ask any questions that your training and experience give you reason to ask. I trust my Dr and appreciate concern. Issue here is what you do with my response. Do you report it to someone because of some mandate or law. Ask about guns, seatbelts, smoking, or briefs/boxers lets just keep between the Doctor and Patient.
Let’s see, the doc has to ask and document in an electronic record under penalty of law. The EMR must be able to export data to the government who requires the patient to register for their constitutional right and then wants to restrict that right. If I were a conspiracy theorist, I would say this sound familiar. Like a modern version of the beginning of past atrocities on citizens by a benevolent government that becomes not so benevolent in it future.
How about I ask those I think I need to ask and give them advice as I feel is needed. Then if I think it was important enough I’ll document it and bill for it. If not I’ll just let it slide and not inflate the cost of healthcare. I recommend docs take a gun safety course before discussing it with patients so they don’t sound as stupid as some of our leaders do.
Great discussion and issue. I agree is part, but personally, I ask patients about seat belt use even though I had nothing to do with licensure. In many ways, I think it is our job to discuss and intervene on health risks - so asking about gun ownership, and their use/storage is within our scope of influence as physicians. I have asked those questions for years. At the same time, though, I am against legislating or forcing physicians to ask those questions.
I will be happy to discuss guns with patients as long as Obamacare ( scare) pays for it.
Physicians ask their patients about safety in the home, automobile safety, safety on the job, but they are to put a circle around discussions about guns and not talk about them? Guns are the number one cause of injuries and the number two cause of traumatic deaths (soon to be number one), but physicians are not supposed to ask their patients about gun ownership and gun safety? This is simply more nonsense from the NRA and other gun lobbies. The analogy to lint is pathetic garbage. And the only thing you are worried about is whether you might be sued? What a sad commentary on this society!
I agree. What a bunch of no-nothings we have in medicine now. MORE guns? The only research, done before NRA and republicans put a muzzle on further research, is that guns for defense in the home make it more likely that you'll kill a loved one, a friend or relation, or yourself. Doubt it? Allow research.
It seems intuitively obvious that the idea the NRA and other gun lobbyists have promulgated that the answer to gun violence is more guns is simply hideous barbarianism. I recognize that we live in a broken world and that we are all imperfect. Because of that evil exists in this world, yes, but the answer to that is simply NOT to create even more evil wherever possible! I am not advocating that we stand meekly and cowering before those who would do us harm. Nor am I saying that those who enjoy the sport of hunting or target shooting should give up those activities -- although hunters clearly go overboard sometimes and often do so incautiously in the use of their guns -- but the insane proliferation of guns beyond all reason to where there are more than 90 guns per 100 people in this country contributes to the problem. Alcoholics have all kinds of excuses and rationalizations why they should be allowed to continue to drink despite the obvious harms they do to themselves, their families, their coworkers, their friends, and everything and everybody around them. They find all kinds of reasons why it is OK if they drive and do all kinds of other dangerous things. The excuses and rationalizations of all too many gun nuts sound all too similar! The NRA has blocked not only research such as you suggest but has also blocked even research into better methods for treating gunshot wounds! It is time to stop the insanity and for physicians to work toward that goal.
"It seems intuitively obvious that the idea the NRA and other gun lobbyists have promulgated that the answer to gun violence is more guns is simply hideous barbarianism."
Let's test that theory:
Where are the most stringent gun-control laws in the land? Chicago (my adopted home town) is the correct answer, and it has one of the highest murder rates in the land. Criminals - by definition - don't follow society's rules. Murder is further down the line of offenses than gun registration, and they don't seem to have much of a problem with that.
What happens when concealed carry laws are enacted? Violent crime (including rape) have dropped dramatically. (78 Multiple Victim Public Shootings, Bombings, and Right-to-Carry Concealed Handgun Laws: Contrasting Private and Public Law Enforcement, Lott John R., Landes William M.; University of Chicago – covers years 1977 to 1995)
The logical conclusion of your thesis is that because alcoholics drink alcohol, it too should be banned. Being a tea-totaller, I personally have no problem with alcohol in my life, but to restrict other's rights to drink would be a concern. Like alcohol, firearms can be abused, but to restrict law-abiding citizens the right to possess them is a dangerous thing.
The NRA blocking research on treatment of gunshot wounds? Never heard that one, and knowing the NRA's history, this is opposite their mission. Safety is ALWAYS first - they originated the first gun-safety classes. Heck - they were the ones supporting the blacks' rights to own firearms when the KKK and their ilk were pressing to have those rights suppressed.
Political talking points are fun at cocktail parties, but this forum is best served with honest discussion.
First, after does not EVER mean because of. Crime has decreased slightly over the last decade nationally, but if you look at crime statistics there are ups and downs. There is no way to come to such a conclusion regarding concealed carry. And in any case, concealed carry is based on little boys' fantasies that somehow they are going to get the drop on someone and be a hero. It DOES NOT HAPPEN THAT WAY. Many of the shootings that have been publicized recently are actually murders, in some cases the shooter has been allowed to escape prosecution, but that does not change the facts: too many of the gun nuts do not understand the laws of self-defense. And the police would use restraint where these people just shoot. How does that solve the problem of gun violence. The theory that more guns decreases gun violence is simply silly.
Chicago, and I was born there, simply does not have the most stringent gun laws in the country, they are virtually unenforceable. Ask a Chicago Cop. The rest of Cook County, the collar counties, for that matter downstate Illinois, Wisconsin, and Indiana do not have the same laws. It is so easy to get guns into Chicago that they might as well not have passed any such laws at all! The We should be more civilized than the Old West where shoot 'em ups but too many think in the same way -- just shoot it out.
There is NO such thing as an absolute right. In Heller, the Supreme Court, in dicta indicated that there could be laws restricting the right to keep and bear arms just as there are legal time, place, and manner restrictions on free speech. You don't like it too bad.
And sorry, but as far as research is concerned you really are misinformed. I was part of a team that was going to study ballistic missile wounds (that's bullet wounds to you) and the grant was blocked! Yes, the NRA and other gun groups are not interested in what happens to the human body when a bullet goes through it!
And as far as gun safety, your statement comes right out of the NRA handbook, the only thing is that it is not the truth. If Adam Lanza's mother had not owned all of those guns, she would still be alive along with all of those children and their principal, school psychologist, and teachers! I can even go way back more than sixty years ago when my aunt's first husband who was an FBI agent left his service revolver on the coffee table where their children could readily get at it. Nothing much has changed and gun owners refuse to adopt simple measures like trigger locks or gun safes. Safety, no way -- gun owners are often very sloppy about safety!
The only one making political talking points is you! Honest discussion? When you cite bogus data, use logical fallacies in your arguments, insult people that you disagree with, AGAIN, who are you kidding? And yes, alcoholics have to have their substance of abuse taken away from them. In this society there are over 90 guns per 100 people. Since that 100 people includes children and the many adults who do not own even one weapon, that is an absolutely hideous number. As a physician, I have to say that your comments only prove my point: your false information, rationalizations, excuses, etc. are exactly the kind of thing that an alcoholic produces to justify his or her drinking behavior! Sorry, but I am not impressed by any of your arguments. And it is people like you who convince me that no changes will take place --- we will continue to have our epidemic of gun violence!
So Phillip when a patient says i own guns and asks u about gun safety what are u going to tell them?
Will u refer to an NRA gun safety course?
If not then why ask the Q? You clearly have little training with guns so what could you say. Most docs against gun ownership have know experience with guns. So how can you advise on safety?
Correct Mark. Violent crimes in UK and Australia rose significantly after firearm confiscation occurred there. See my other posts.
And yet what have you done to get alcohol banned? I have friends and coworkers that have had guns around me for years and I have yet to see anyone rationalize why they keep shooting people with their firearms. Granted I might be hanging with the wrong crowd. Thankfully we have geniuses such as yourself to ensure we know how to conduct our lives.
"Guns are the number one cause of injuries and the number two cause of traumatic deaths (soon to be number one)"
Just plain ridiculous.
In 2007, there were 999 drowning victims and 137 firearm-related accidental deaths from ages 1-19. Firearms outnumber pools by a factor of over 30:1. Thus, the risk of drowning in a pool is nearly 100 times higher than from a firearm-related accident for everyone, and nearly 500 times for children ages 0-5.191 (2007 WISQARS (Centers for Disease Control)) There is also some poor statistical analysis is revealed when comparing other countries gun stats to ours. In our stats 'children' in some studies include the gangbangers up to age 24.
Firearm misuse causes only a small number of accidental deaths in the U.S.189 For example, compared to being accidentally killed by a firearm, you are:
• Five times more likely to burn to death
• Five times more likely to drown
• 17 times more likely to be poisoned
• 17 times more likely to fall
• And 68 times more likely to die in an automobile accident
(Also from WISQARS CDC study from 2007)
The rate of gun accidents is so low that the U.S. Consumer Product Safety Commission doesn't even mention them in their annual safety reports.
You my friend have been drinking the Kool Aid.
Excuse me, what is ridiculous is someone who cites half the facts and then calls someone else ridiculous. Suicides, murders, and manslaughters -- all the forms of homicides -- count as firearm deaths. Who said anything about misuse? JUST WHO DO YOU THINK YOU ARE FOOLING. THE ONLY ONE DRINKING KOOL AID IS A FOOL WHO WOULD MISUSE STATISTICS LIKE THAT!!!!!!
First - please stop shouting. Second - please cite how firearms kill more people than automobiles (your original premise). Screaming is not a substitute for discussion.
When these sites allow italics or bold fonts, I will stop using caps! You are the one who left out homicides, suicides, and other gun deaths and cited only accidents. That is how you come to the conclusion that guns kill nearly as many people as automobiles do, and it has been predicted that it will be the number one cause of traumatic death by 2014. That's how! And the deaths are disproportionately younger individuals, so they are years of productivity lost. Those statistics are available from the National Center for Health Statistics. You cannot leave out half of the numbers and expect anyone to believe you!
Amen.
I cancelled my AMA membership with the blanket support of "Obamacare"
Many if not most doctors are not well versed in the use of firearms. Many confuse "assault weapons" with non assault ones and the controversies continue on with false pretenses and assumptions. I do not ask if a family has guns in the home. In my rural area, most do. I just go into my short lecture on gun safety in the home, just as I do not ask if they have a car, I just go into my carseat and car safety monologue.
Its hard for those not well informed about firearms to lecture about firearms.
Exactly!! Couldn't agree more! The point is to encourage people to evaluate (or re-evaluate) their safety procedures, not get into a constitutional argument. As a pediatrician, much of what I do is safety education to parents, and although I like to assume most people have common sense in terms of safety practices, I see situations every day where it flies out the window. This all falls under the umbrella of "anticipatory guidance" that's part of every well visit. If someone asks specifically about gun safety procedures, I can discuss it further, or (preferably) refer them to where they can get more accurate and knowledgeable information. Otherwise, a simple reminder to keep guns (if they have them) where kids can't get to them is more than enough. There aren't enough hours in the day to do all the "recommended" guidance for each well check! I feel the new executive orders placed an unnecessary emphasis on something that is already done by most doctors when they feel it's needed. The effect of this EO seemed intended to incite inflammatory rhetoric on both sides. And although it may be a stretch to imagine a doctors may be sued for a patient's gun-related death, the way this country is headed in terms of lack of personal responsibility & uninformed regulations, I fear that could very well become a reality.
Well said.
If you need funding to ask essential questions such as
*do you own a gun?
*do you keep it locked up?
*have you taken a gun safety course?
you are no longer a doctor, you are a cash generating machine. You all have lost sight of what it means to care, regardless of your politics, about everyone. I'm glad I do not work with you.
I didn't mean to make it sound like it shoud be a cash generating project. It is more of my commentary on the system in which we work. Advice and counselling, hand-holding, teaching, consoling - all the stuff that does show that we care - is not valued. No offense to the surgeons and procedure-based practices - but "carpentry", procedures - that is what is valued. I would happily sit for an hour asking a patient about his health practices and advising him if I could make a living off of that. But a primary care physician makes less in a week's worth of office visits than a cardiac surgeon makes in one CABG.
And given your propensity to pass judgement, I'm glad you don't work with me too.
Well Said
Dr. Young:
Thank you for so eliquently presenting the concerns many physicians and mid-level providers have regarding gun control and counseling. Where does the ultimate responsibility lie and what is the best solution? After reading other comments, this has the potential to become a very hot and debated topic. Again, thank you and I support your stance.
I practice family medicine in Maine, and there are a lot of gun owners here. I make it a part of my preventative screening to ask parents if they have guns and if they keep them locked up. I also ask any patient that has issues with depression whether or not they have access to a gun.
I feel it would be irresponsible not to ask these questions.
Well, this certainly sparked a lot of debate! I had not intended my post to incite argument for/against gun ownership, although I suppose I should have foreseen that as a possible consequence.
I believe physicians should have the right to advise patients about safe gun ownership. My concern is that this political move will lead to a heavy responsibility upon physicians' shoulders. Patients already do not take responsibility for their own actions - their weight is because of their diabetes medications, their blindness is because they were never told to go to the eye doctor, their cough is because of the new inhaler - not the Big Mac, the lack of follow through or the cigarettes. My concern (yes, from a purely selfish standpoint) is that some fool who shouldn't have been sold a gun in the first place, will pop somebody in the head, his doctor will be blamed, and then the regulation will set in. Far-fetched? Maybe.
Oh, and somebody made a comment about my lint analogy being garbage. Dirty lint traps can lead to fires. It's a home safety issue. Had a nurse's house burn down not too long ago. Maybe if her doctor asked her when she last cleaned it, it wouldn't have happened.
Duct taping Jenny McCarthy's mouth shut and sending her to Siberia would save more children's lives than any gun control measure being proposed. Her anti-vaccine rants are responsible for thousands of deaths. (There is even a web site that documents this.) Yet we don't do such things in a civilized society because it is a violation of her right to free speech and to be stupid. We could also pass a law limiting the speed limit to 20 mph except for ambulances and police and save thousands of lives. If saving lives were the only goal in a free society.
The AMA option is even dumber than this idea because it wouldn't have stopped any mass murders. At least the Jenny McCarthy muzzle and slow speed limit would have. The point is we could actually be effective in life saving if we passed dumber laws than the ones being proposed.
I didn't realize that being a physician meant I was an unpaid deputy of the ATF.
The result of all of this is that psychiatrists will now gravitate more than ever away from patient care, especially in potentially groups such as adolescents, drug users, or felons.
Why does anyone even pay attention to the idea of an organization that only represents about 15% of physicians?
We are now unpaid ATF deputies. Great job, AMA. You don't speak for me and 85% of physicians.
I have yet to see any evidence that psychiatrists are better than other professionals, or even the general public, at predicting "dangerousness" to others (whatever that is). In particular, I have yet to see any evidence that psychiatrists have any expertise in predicting mass murders. The number of mass murders cannot be all that great, and the number where the murderer is under a psychiatrist's care must be even smaller.How is it possible to draw any conclusions from these small numbers? The general public wants "something to be done" about mass murders, and since they believe (without evidence) that a mass murderer must ipso facto have a psychiatric illness, the obvious people to "do something" are psychiatrists.I suggest that we all calm down and consider carefully the role of mental illness, psychiatrists, and gun possession in all of this.Above all, we need evidence, not anecdotes or impressions, lest we engage in rash actions and enact frivolous and useless laws and regulations.
I work for a psychiatrist and we routinely ask patients who have the potential for violence and/or suicidality about their access to guns/weapons. It is not a violation of doctor/patient confidentiality to report to appropriate authorities when there is a patient who has the potential to harm themselves or others, and we have done so on occasion. This is in the Pennsylvania law code. Common sense would tell any doctor who has a patient with potential for violence to ask about whether they have access to a weapon they could use to perpetrate that violence. Not asking is negligence.
Physicians need their guns taken away too.
http://abcnews.go.com/US/buffalo-hospital-shooting-police-search-surgeon...
Personally, I am concerned with the fact that a psychiatrist or other health care professional would be responsible , most likely based on one lone patient visit, to approve or disapprove a gun license. Would this mean physicians would need regular access to a national medical record library (so as to identify individuals with any significant personal or family mental history), access to all pharmacy records (noting any use of mind altering medication and dosages of medications), not to mention access to patient's personal criminal/legal records. This is a great burden to take on for one singular visit, let alone , to place such responsibility on a medical provider without a substantial support system in place. such as deferring all results and reports toa committee that would based upon all information previously mentioned, would then proceed to provide the final approval/disapproval of a gun license. ,
Perhaps one of the important tenets of reducing medical costs is to focus on prevention as a cornerstone to providing appropriate care that helps patients reach optimal health. Assessing risk for disease and disabling conditions is key to counseling and treatment in a prevention model. For years, pediatricians and many family physicians have included questions about firearms in the home as part of risk assessment for accidental injury and suicide. The State of Florida enacted a bill will bans physicians from posing the question. Many find this to be an interference in the patient-doctor relationship as well as decreasing te effectiveness of an overall risk assessment.
This is no mandate that physicians must ask the question only an attempt to secure the right of physicians who see it as part of a complete assessment and the ability to provide knowledgeable guidance to do that. There is no governmental move to force you or others to include these kinds of questions if you do find it necessary. If an EHR system includes it as a prompt, consider just that and if that is a problem then it seems te most effective way to deal with it is the vendor and/or employer.
Unfortunately, doctors have become the frontline people facing many "social" issues because as a biopsychosocial model of disease is supported by lifestyle and behavioral research, we understand the impact on health. We look at the health of our individual patients but use population-based evidence as part of decision making. A web of interdependence of patient, family, friends, and community means care for a single patient reverberates and we inevitably practice "population" medicine.
Whether asking about gun ownership in te exam room or screening for sometimes elusive mental illness, our profession will be required to grapple with the issue of our role in reducing all kids of firearm morbidity and mortality.
We all irrationally embrace antedoctal experience over research findings especially if is a controversial, emotionally charged subject or if findings challenge our current practice. The gun violence debate in erms of individual rights and behavior is perhaps at the same point that the debate over the use of tobacco was 40-50 years ago. It will continue to unfold.
Perhaps one of the important tenets of reducing medical costs is to focus on prevention as a cornerstone to providing appropriate care that helps patients reach optimal health. Assessing risk for disease and disabling conditions is key to counseling and treatment in a prevention model. For years, pediatricians and many family physicians have included questions about firearms in the home as part of risk assessment for accidental injury and suicide. The State of Florida enacted a bill will bans physicians from posing the question. Many find this to be an interference in the patient-doctor relationship as well as decreasing te effectiveness of an overall risk assessment.
This is no mandate that physicians must ask the question only an attempt to secure the right of physicians who see it as part of a complete assessment and the ability to provide knowledgeable guidance to do that. There is no governmental move to force you or others to include these kinds of questions if you do not find it necessary. If an EHR system includes it as a prompt, consider just that and if that is a problem then it seems te most effective way to deal with it is to discuss it with the vendor and/or employer.
Unfortunately, doctors have become the frontline people facing many "social" issues because as a biopsychosocial model of disease is supported by lifestyle and behavioral research, we understand the impact on health. We look at the health of our individual patients but use population-based evidence as part of decision making. A web of interdependence of patient, family, friends, and community means care for a single patient reverberates and we inevitably practice "population" medicine.
Whether asking about gun ownership in the exam room or screening for sometimes elusive mental illness, our profession will be required to grapple with the issue of our role in reducing all kinds of firearm morbidity and mortality.
We all irrationally embrace antedoctal experience over research findings especially if is a controversial, emotionally charged subject or if findings challenge our current practice. The gun violence debate in erms of individual rights and behavior is perhaps at the same point that the debate over the use of tobacco was 40-50 years ago. It will continue to unfold.
I don't make guns. I don't sell guns. I don't use guns. I am a physician and I do not think it is my responsibility to enforce gun control legislation. I am willing to discuss gun violence or other self destructive behaviours and encourage good choices. By no means should I be held accountable for enforcing poor reactive legislation.
If you want real change, change to law to punish those with self destructive behaviour. I think it is called personal responsibility. This is a concept which has almost disappeared. Since, I have never purchased a gun, I am not sure of the specifics , but I would suggest that each purchase be tracked in a data base and titled similar to a car purchase. If a gun is lost, stolen or sold, the last person on the list would be reponsible for the crime. There fore it would be then up to those who "lose" their guns to bear responsibilty. It would be also up to the seller to do a proper background check. Passing the buck on responsibilty , seems to be the American way.
Government, through the new deal, and " the great society" was going to solve all the ills of the human condition. They were unsuccessful. Now, healthcare, in the name of cost control and patient health, is being asked to solve all these infirmities of poverty, poor health choices, poor education, risky behavior, poor diets, gun violence. We won't be able to fix all the problems of the human condition either. Asking patients if they have guns during a fifteen minute office exam will have no effect on random acts of violence done mainly by people who never access the health care system till after they are victims. Most patients think this is none of our business. All it will do is drive a wedge between us and our patients and make them less likely to share something that might really matter.
Melissa I love everything about this blog with the exception of your "Option". Instead of looking elsewhere for someone to blame like gun dealers, or down the road, as you so eloquently stated, the Doctors we blame the person responsible. A sick coward. All the laws in the world aren't going to keep sick cowards from doing gutless cowardly acts. Current laws do all of the things that you recommend in your option. I don't care about guns specifically in my views just freedom and everywhere I look I see us trading "security(so called)" for liberty. God bless those families. Lets let Doctors Practice medicine not report to the government. Very slippery slope for all concerned. Great Blog.
The problem was the mom. If she was going to have him committed she should have had her guns locked up and probably out of the house. Doctors have nothing to do with it. I wouldn't even have a sharp knife out let alone guns. And psych screen would no have stopped this either- it was the mom who had the guns. These suggestions are worse than useless because they direct thought away from anything that might help. Smaller clips wouldn't help either cause no one had a weapon there to stop him with (and changing clips is fast only makes a difference if you r facing another armed man and trying to keep suppressive fire
I prefer not to ask about gun ownership. Instead I assume my patients have a gun and discuss gun safety (training, proper storage and handling) .
I think it's extremely important to keep these discussions based on facts and not go off on tangents about some slippery slope of government intrusion into the patient/health care provider relationship or exaggerated ideas of what will be "required" next. According to FactCheck.org:
"Rep. John Fleming, a family physician, issued a statement condemning the president’s plan to “push” doctors to ask patients if there are guns in their homes. But Obama made no such proposal. Rather, Obama said that he would seek to “clarify” that the Patient Protection and Affordable Care Act does not prohibit doctors from asking patients about guns in their homes."
This clarification was necessary because (again according to FactCheck.org): "Specifically, the law (page 19) makes clear that wellness programs “may not require the disclosure or collection of any information relating to … the lawful use, possession, or storage of a firearm or ammunition by an individual.” Further, the law states that it does not authorize the collection of data or maintenance of records related to gun ownership. And the law spells out that insurance companies may not increase premium rates based on whether someone owns a firearm."
Although it seems reasonable that providers should not take this prohibition of REQUIRING disclosure about guns in a home as a disincentive to doing so, there has been concern that this would be the case, thus the clarification that these provisions don't PROHIBIT providers from asking about guns.
While I personally think inquiring about the presence of guns in a home (and appropriate counseling if there are) is good practice, what each of us believes and practices regarding health and safety assessment and counseling with our patients is an individual choice. However, none of should be suggesting the proposed law either requires or prohibits us from practicing in a manner we believe is in the best interests of our patients.
I don't own a gun but I am fully supportive of law abiding citizens exercising their rights to own a gun. As a physician my main concerns are that the owners know how to properly use them and keep them secure from children and for those who have a behavioral problem (severe depression, agitation, dementia) to do what I can to make sure that their family members (within the privacy regulations) are fully informed to keep their loved one and themselves safe from the potential inappropriate use of a weapon. I would oppose any attempt to limit the constitutional rights of law abiding citizens to own guns otherwise, or put patients in a database regarding gun ownership. That is tyranny.
The time physicians have with a patient the way present day "practice" is conducted is limited. There are literally thousands of questions that could be ask of any patient, if one only had the time. The primary questions that should be ask are those relevant to the reason the patient is consulting the physician. There is no reason for a physician to get on a "soap-box" unless that is what he/she desires to do. Asking questions is strictly a personal matter and should not be dicatated by someone who has a paricular "axe to grind"
Did the Fort Hood psychiatrist ask all his victims about guns before he shot them?????????? Sure it's an exception, but--------.
AS a psychiatrist the presence of guns especially for someone at risk is always a question that enters into the discussion. There are also measures of gun safety in such situations that need to be explored including use of lock box and donating the gun in such times to a relative. It is not out of the question to ask such a question. It is good standard of care.
And can physicians then be sued for malpractice if one of their patients commits violence with a gun?
From what I understand, the AMA asked for funding for programs that would "allow" (not "require") physicians to ask about gun safety. The NRA has supported legislation that makes it illegal for physicians to even ask. Physicians shouldn't be restricted from asking almost anything.