HealthZette

Gun Ownership: A New Medical Illness?

Why your physician is asking this 'loaded' question

When Dr. Rosemary Fernandez Stein sees patients at her pediatric practice in Burlington, North Carolina, she asks parents the usual run of questions. There’s one she would prefer not to have to ask, though: “Do you have a gun in your home?”

“It’s a Catch 22: You want your patients to be safe, but you don’t want to invade their privacy.”

She gets a lot of peculiar looks, especially since a good number of people in her state carry guns.

“It does feel rather invasive when I’m asking the question,” Stein told LifeZette. She said the American Academy of Pediatrics requests that doctors ask the question, which is on intake forms for new patients and regular checkups. She does so in order to comply.

“It has become more prevalent,” she said. “You feel uncomfortable whether you do it or not. It truly feels like you’re getting into the parents’ business.”

Stein says it’s a Catch 22: She wants her patients to be safe, but she doesn’t want to invade their privacy. The information she collects is not shared outside of her practice. If she has to ask about guns, she would rather be able to distribute information on gun safety for kids — instead of just being forced to check off a box.

“That’s not what we’re doing, but we should be,” she added.

Stein, like most doctors, is under pressure from industry associations to inquire about whether or not Americans own guns.

Broaching the Subject
This week, Dr. Garen Wintemute, director of the violence prevention research program at the University of California, Davis, published an article in the Annals of Internal Medicine that recommends inquiring about gun access to patients in three categories. The first is patients who share that they are planning to shoot themselves or others; the second is patients who have a mental illness, abuse drugs or alcohol, have prior violence history, were a victim of violence, or have a brain disorder such as Alzheimer’s; and the third is patients in at-risk demographic groups such as middle-aged older white men, young African-American men, and children.

There are no federal or state laws to prevent doctors from asking their patients if they have guns in their homes.

Wintemute says there are no federal or state laws to prevent doctors from asking their patients if they have guns in their homes — and says they shouldn’t be afraid to ask.

Florida, however, has passed legislation stating doctors cannot inquire about gun ownership unless the patient poses a health threat to himself or others. In his paper, Wintemute notes that Minnesota, Missouri, and Montana have passed laws that are not “gag laws” like Florida’s. Minnesota’s legislation stops the state from collecting data on firearm ownership; Missouri’s law makes it illegal to require physicians to inquire about guns or share information without a court order. In Montana, doctors cannot refuse to give a patient treatment depending on how they respond to personal questions.

A 2014 survey on 573 members of the American College of Physicians found that 58 percent don’t ask patients about guns, yet 86 percent said firearm injury is a public health issue.

Dr. Eric Fleegler, a pediatric emergency pediatrician at Boston’s Children’s Hospital, said doctors are not required to ask about guns, but some organizations encourage it.

“These are delicate conversations,” Fleegler said. He believes the subject should be broached carefully if a patient has screened positive for depressive or suicidal behavior. He sees about two to four patients a day that fall into that category. When that happens, he has a thorough conversation with the patients and their parents. He discusses what harms may be in the house, and that can include guns — so he asks.

“Regardless of what they tell me … I provide the same advice,” he said, adding the discussion isn’t centered around getting rid of the gun, only ensuring the child cannot get to it. “I’m not passing judgment; I’m not telling them they have to sell or get rid of their guns.”

Recently, he was treating a teen girl who reported a firearm in her house — it was her brother’s gun, and he is a police offer. When asked, the girl’s mother said they didn’t have a gun, then remembered her son’s service weapon. Fleegler said the mother was grateful he brought it up.

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When he inquiries about guns, or when a patient reports having access, he does not specify it in the records. Instead, he uses a code to indicate that a social concerns screening was performed. Unless a patient said they wanted to use a gun to kill themselves or others, he would not mention a firearm.

Fleegler does not believe Wintemute’s suggestions should be a requirement, since there is not enough data to say whether or not asking a patient about having a gun results in fewer incidents.

He does believe, however, that all patients should undergo mental health screenings. If they are positive, doctors should approach the topic in a sensitive fashion so the patient doesn’t feel harassed for having access to a weapon. And patients should never be refused care based on how they respond, Fleegler added.

Setting Boundaries
Dr. Arthur Przebinda, a diagnostic imaging physician in Southern California and member of Doctors for Responsible Gun Ownership, believes asking all patients whether or not they have a gun infringes on their Second Amendment rights. The only time a patient should be approached about having a gun is if they show signs of mental illness — then it’s okay to open up discussion.

He believes Wintemute’s report is misleading because several of the citations — and the figures drawn from them — are based on his own research. Just because people have guns doesn’t put them at risk for death, but medical organizations are forcing their stance on doctors; that’s something that opens the doors for them to encourage getting rid of guns, Przebinda said.

“They’re trying to identify gun ownership as a risk factor, the same way they would define smoking inside the house,” he said.

If inquiries are used to prejudice patients against gun ownership or to persuade them to give up their guns, that constitutes unethical conduct, the DRGO website states.

“It’s not appropriate to do a blanket questionnaire,” Przebinda said. “It’s none of their business.”