Doctors should talk to patients about guns
Long known for its efforts to quash research on the dangers of guns in the home, the National Rifle Association is now attempting to intrude into the doctor’s office itself. Although the case before a Florida appeals court might seem far removed from Massachusetts, it’s part of a broad-based campaign by NRA lobbyists to block any discussion of gun violence as a pervasive public health problem that transcends questions about Second Amendment rights.
The NRA successfully campaigned for the passage of legislation in Florida that restricts doctors from broaching the subject of household gun safety. The so-called “docs vs. Glocks” law was upheld in December by a three-judge federal appeals court panel, and the full court will take up the matter in June. The Florida law clearly violates doctors’ right to free speech, and should be overturned.
The NRA argues otherwise, of course. “People go to the doctor when they’re sick and the last thing they need are gun control advocates trying to politicize their care,” says NRA spokesman Lars Dalseide. But the claim that safety screening amounts to a form of gun control is an absurd notion that ignores concerns about basic health and safety in the home. “The fear that this is going to be used to take people’s guns away is unfounded,” says Dennis M. Dimitri, president of the Massachusetts Medical Society.
Massachusetts’ gun ownership rate of 22.6 percent is below the national average of 29.1 percent, according to a study published by the journal Injury Prevention, but too many shooting tragedies still occur in homes across the state. Contrary to the belief that having a weapon handy offers protection, studies have shown the practice actually raises the risk of violence. A 2014 report published in the Annals of Internal Medicine found that a gun in the home makes it more likely for someone to commit suicide, or to shoot someone else.
That’s why Massachusetts physicians should make it part of their routine to ask patients — or, in the case of young children, their parents — questions about guns in the household. How many? Where are they stored? Are they kept loaded?
Some doctors already make gun safety a regular part of their conversations with patients, the same way they discuss smoking, excessive drinking, depression, sexual behavior, and concerns about domestic abuse. For pediatricians, it can be an extension of the guidance they offer parents on such matters as car seats and backyard swimming pools.
The practice of voluntary gun-safety screening is supported by the Massachusetts Medical Society, the state chapter of the American Academy of Pediatrics, and other professional groups. But it’s unclear how many Massachusetts doctors incorporate such a discussion into their exams. A 2013 national survey by the American Academy of Pediatrics found that about half of pediatricians sometimes ask patients about guns, and one in five always do.
While the topic of doctors, patients, and guns is on the agenda for a Massachusetts Medical Society public health leadership forum on firearm violence scheduled for April 5, Attorney General Maura Healey is right to suggest that the issue needs a higher profile in the Commonwealth. “Guns are inherently dangerous,” Healey said. “Why wouldn’t we take advantage of every forum and opportunity to talk to people about a public safety issue?” She has offered to bring together medical professionals, gun groups, and others to develop guidelines for Massachusetts doctors on asking patients about guns, and to give advice about how the information might be used. The medical society and other physician groups should take Healey up on her willingness to help, and convene a more comprehensive discussion – resulting in concrete guidelines for physicians.
If guidelines are implemented, they could eventually provide useful data for statistical studies — while preserving patients’ anonymity — and lay the groundwork for breakthrough research on the effect of gun ownership and the roots of gun violence. Massachusetts has long been a leader in public health. Although there are plenty time pressures on the office visit, the medical establishment should jump at the chance to lead the way nationally on gun research by adding a few quick questions to doctors’ discussions with patients. That alone could bring rigor and rationality to a rancorous debate.