by Mona Mangat, MD
“We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions.”
This quote by an NRA lobbyist troubles me. The statement reveals degradation in a sacred relationship – the physician-patient relationship.
This sentiment was prompted by a Florida pediatrician that refused to continue seeing a child after the parents refused to answer whether they kept firearms in the home. Governor Rick Scott (FL) signed HB-155 into law this month. The law restricts physicians from asking families if they have firearms, prohibits them from discussing firearm safety with families and prohibits them from documenting firearm status in a medical chart.
In a compromise to efforts made by the Florida Medical Association (FMA), physicians may ask about firearm status only if information is relevant to patient’s medical care or safety or safety of others.
The physician-patient relationship is predicated on trust. There must be trust that a patient is being truthful when answering questions. There must also be trust, on a patient’s part, that a physician role is to empower patients to make informed decisions that will ultimately lead to better health.
Last month, in my allergy/immunology practice, a patient presented with acute onset of hives that morning. While hives is not unusual in my office, her presentation seemed odd to me. I asked her about life stress and she answered that she was under some stress but didn’t want to go into details. I then proceeded to ask her about what medications she may have tried to help with the hives. She casually mentioned that her primary care physician had given her a prescription for oral steroids that morning. I was surprised to know that she had seen him just three hours before her arrival in my office and asked how this could be. She then began to retell the events of the past 12 hours. She said that 12 hours prior she had been drinking wine and had drank a bit too much and her husband found her unresponsive. She was transported to the ER and had her stomach ‘pumped’. She was then admitted for observation and her primary care doctor discharged her in the morning after advising her to be more careful when drinking.
I found this story concerning for many reasons. She seemed anxious and tearful. I then asked her if she had tried to kill herself. To my surprise, she answered ‘Yes’. I asked her if she had any intention to harm herself or if she owned a gun. She said ‘Yes’.
Her husband spoke to me in private and recalled that not one health care provider, from EMT to ER nurse, to ER doctor to admitting physician to her own primary care doctor asked her these questions. I don’t know why no one else asked – maybe they were too busy; maybe they didn’t identify the unusual circumstances; or maybe they were afraid that the patient would feel they were making a moral judgment. I simply did what seemed natural. I listened to my patient and I heard a cry for help.
My patient was then escorted to the psychiatric ER for evaluation and treatment. She has since thanked me for taking the time to listen and for having the courage to ask her that simple question. She did not feel that my questions were thinly veiled moral judgments. She recognized that my intent was to help her.
I fear that HB 155 will further stifle this sort of honest communication. The law will cause many providers to take pause before asking difficult questions that impact patient’s lives. The law sets a precedent. As an allergist, I always ask my patients if they smoke and I ask parents of asthmatic children if they smoke. I don’t ask to pass moral judgment. I ask so we can have a dialogue. Parents need to understand that by smoking, their children have an increased risk of developing asthma.
In the course of a patient evaluation, I often ask if my patient has a tattoo or if they have ever used intravenous drugs or if the have ever engaged in high risk sexual activities. I ask these, sometimes uncomfortable, questions not to pass moral judgment but to help guide me when diagnosing and treating patients. And I use this conversation as an opportunity to educate and counsel patients on choices that may help to keep them healthier and safer. When will this line of questioning become illegal? HB 155 places us at the top of a very slippery slope.
This law will hurt Florida’s children and further degrade a fragile physician-patient relationship. I am hopeful that the combined outrage of Florida physicians will be heard by our legislators.
Mona Mangat is an internal medicine-pediatrics physician who blogs at Progress Notes.
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