With its push for physicians to discuss gun safety, the AMA once again reveals that it does not truly represent the physicians seeing patients every day.
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.