Gun Discussions Have Potential to Become a Mandate for Physicians

February 4, 2013

While the president's push is to simply permit physicians to talk with patients about gun safety, my fear is that in the not too distant future, it becomes a mandate.

My last post about physicians talking to their patients about gun safety sparked a lot of online discussion; a lot of very animated discussion. Clearly there are very strong feelings about the right to own guns and physicians’ roles in advising patients about gun use and safety.

For those who did not read the post, it was sparked by the AMA’s letter to President Obama asking for funding for programs that would allow physicians to ask patients about gun ownership. The president in reply said that he supports physicians having this discussion with patients. And in my own conspiracy-theory muddled mind, my thoughts jumped forward to the day that government transitions from “funding” and “supporting” to “regulating” and “mandating.”

Far-fetched? I think not. It was pointed out by some who responded to my post that the AMA is asking for funding for programs that would “allow” us to discuss guns, not programs that would require us to do so. It was also pointed out by some that it should be simple enough to ask the questions, “Do you own a gun?," "Do you keep it locked up?," and "Have you taken a gun safety course?" and that it shouldn’t require funding nor should we charge for it. But think about what happened with asking about smoking. Yes, it important for us to ask about it. Most of us do. But we are now required to not only ask and advise and to document that it has been done, but also to report it.  And as part of meaningful use under CMS' EHR incentive programs, if you don’t do it, you are financially penalized.

I was also accused of being a cash generating machine, I think because I dared to say that we should receive compensation for asking such simple questions. Granted, we don’t get paid specifically for asking about alcohol use or use of seatbelts. My point was that in our current healthcare system, asking the hard questions, advising people on lifestyle modification, education, hand-holding, cajoling, comforting, consoling, analyzing the behavior and finding ways to change it - none of that is valued, at least not in a monetary sense. Our healthcare system places value on procedures. Our poor primary-care doctors are overworked and overwhelmed. And in addition to dealing with patients’ acute problems (the flu, chest pain, nausea) and chronic illness (their hypertension, diabetes, arthritis) and the paperwork (disability forms, prior auths, pre-approvals) and running a business (salaries, insurance, meaningful use), the thought of adding one more thing to the list of things they must ask about and advise the patient on concerns me.

Yes, yes, I know, no one is saying that is going to happen. But why wouldn’t it? It would make for a great political talking point. I haven’t had so many replies to one of my posts before. Can you imagine the response this would get in a political forum? Can you just see some (non-physician) politician standing in front of a camera saying physicians must be in the forefront of this campaign against gun violence?

I will not get into the debate of whether or not it should be legal to own or carry guns of one type or another. Clearly some readers would like to continue that debate, but that is not my purpose.

Should physicians be able to ask patients about gun ownership? I believe so. Is it particularly important that they do so with patients who are depressed, or manic, or in an unsafe home environment? Absolutely. But when the government, the lawyers, and the AMA get their fingers, eyes, and ears in my charts, that is where it becomes a problem.