Should pediatricians be punished for asking about guns in the home?

Far be it for me, a Bay Area pediatrician, to tell Floridians about how to keep their kids safe. But having spent half of my life in the south (and I don’t mean LA), perhaps I am only partially carpetbagging.

Florida’s Governor Scott has signed a law that penalizes doctors for asking about guns in the home. It shockingly included a $5 million fine and a five year prison sentence if a doctor asked about a patient’s gun ownership, entered gun ownership information into a medical record, or refused to care for patients who declined to answer related questions. An unsatisfying compromise amendment between the NRA and the Florida chapter of the AMA limited the penalty to the possible revocation of a medical license and would allow questions about gun ownership and entry of that information into the medical record only if “medically necessary.”

Similar legislation is making its way through the Alabama legislature.

Particularly bewildering to me were claims made by state legislators that gun safety was outside the scope of a pediatrician’s practice. According to Marion Hammer, a past president of the NRA, “Families take their kids to pediatricians for medical care, not to talk about guns.”

I would beg to differ.

While there are several directions I am very tempted to go with this outrageous bill, I am coming to rest here: my scope of practice is health.

Scope of practice traditionally refers to a license authorized range of a provider’s services. Not surprisingly, the range of a scope is charged with turf battles between specialties and different health professions -like the time your neurosurgeon and orthopedic surgeon wrestled over who got to perform your back surgery.

The scope of practice I am talking about we all can own. I have a responsibility to ask about, diagnose, educate, and treat obstacles to health. For those who see children in their practice, discussing topics such as swimming pool safety and smoke detectors are routine at regular check ups.

But let me take it a step further. I would argue that nutritious food, safe medications, air quality, domestic violence, affordable housing, access to health care, sex trafficking, cultural factors, schools, safe neighborhoods, voting, human rights, international trade agreements, and the state budget, to the extent they impact health of my patients and communities, are also in my scope of practice.

Not only do I feel an obligation to explore these issues, my patients expect it of me. When my infant patient is drinking contaminated Chinese formula or if children can’t play in their front yard for fear of gun fire, it is my problem too.

Commonly called the social determinants of health, addressing only the downstream impacts of unhealthy and violent circumstances in the form of specific diseases (or even death) is addressing a fraction of the problem and woefully insufficient.

So yes, to ask if a device that is associated with over 30,000 deaths a year and over 50% of suicides is unloaded, locked up, and kept out of reach of children is also well within my scope of practice.

At issue is not only whether or not a gun should be in the home, but also the right of physicians, free of legal entanglements, to provide the anticipatory guidance for an environment where their patient can thrive.

Ricky Y. Choi is a pediatrician who blogs at SFGate and reprinted with the author’s permission.

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  • http://www.facebook.com/rob.lindeman1 Rob Lindeman

    It’s a silly law, meant to make a political point, and it is unenforceable in practice.  The point of the law, it seems to me, is to score political points AND to piss off pediatricians.

    Against my best judgment, I’m compelled to say that I find the following statement by my colleague Dr. Choi breathtakingly sanctimonious:

    “I would argue that nutritious food, safe medications, air quality, domestic violence, affordable housing, access to health care, sex trafficking, cultural factors, schools, safe neighborhoods, voting, human rights, international trade agreements, and the state budget, to the extent they impact health of my patients and communities, are also in my scope of practice.”

    Frankly, dear colleague, most of these things are none of our business.

    • http://twitter.com/#!/CloseCall_MD Close Call

      Nutritious food not within a physician’s scope of practice?  Safe medications?  Domestic violence?  I would consider those clearly within a primary care doctor’s scope of practice.  

      If a depressed patient has access to a gun…  yes.  If you suspect a parent or caregiver of violence toward a child and there’s access to a gun….  and the child is your patient… yes.  I hope it’s within our scope of practice.  

      I wouldn’t call the law silly.  I’d call it crappy and dangerous.  5 million dollars and jail time?  Is that what they really wanted for doctors?

      • http://www.facebook.com/rob.lindeman1 Rob Lindeman

        The depressed person (why call him a “patient”?) with a gun is a compelling case, and not as clear-cut as you say, but it’s beyond the scope of this discussion.  

        I hope we can agree that sex trafficking, cultural factors, schools, safe neighborhoods, voting, human rights, international trade agreements, and the state budget do NOT concern the pediatrician qua pediatrician.  If you care about these issues, God bless you, but they should not be a concern of yours in the office.

        Domestic violence (defined how?) is a concern of ours as we are compelled by law to report our suspicion.  [NB suspicion is a subjective state of mind, not necessarily connected to objective reality]  

        Of course nutritious food is a concern of ours, to the extent that we ought to recommend that the children who come to our offices eat that way.  But I fear that Dr. Choi means something more than this.

        The federal government, NOT the AAP,  has assumed the responsibility for keeping commercially-available medications safe.  

        • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

          Rob here’s the statute:
          http://preview.tinyurl.com/3ow43dkIt links to the State of Florida.

          (1) A
          health care practitioner licensed under chapter 456 or a health care
          facility licensed under chapter 395 may not intentionally enter any
          disclosed information concerning firearm
          ownership into the patient’s medical record if the practitioner knows
          that such information is not relevant to the patient’s medical care or
          safety, or the safety of others.

          Further down:  “……….a
          health care practitioner or health care facility that in good faith
          believes that this information is relevant to the patient’s medical care
          or safety, or the safety of others, may make such a verbal or written
          inquiry………….”(4) A patient may decline to answer or provide any information regarding ownership of a firearm by the patient or a family member of the patient, or the presence of a firearm
          in the domicile of the patient or a family member of the patient. A
          patient’s decision not to answer a question relating to the presence or
          ownership of a firearm does not alter existing law regarding a physician’s authorization to choose his or her patients.

          You can still choose to terminate the physician-patient relationship consistent with Florida law.
          (5) A
          health care practitioner licensed under chapter 456 or a health care
          facility licensed under chapter 395 may not discriminate against a
          patient based solely upon the patient’s exercise of the constitutional
          right to own and possess firearms or ammunition.

          Would you fire a patient just ’cause they owned guns? If you felt they were being stupid with the guns and the kids were in danger, that’s a different matter, my plain English reading of the statute. Others are entitled to their opinion.
          6) A
          health care practitioner licensed under chapter 456 or a health care
          facility licensed under chapter 395 shall respect a patient’s legal
          right to own or possess a firearm and should refrain from unnecessarily harassing a patient about firearm ownership during an examination.And because there were physicians who DID harass such patients, we ended up with this law. Bad as it may be, it was crafted for a reason.Show me how, under this statute, a doctor is going to face a five million dollar penalty for “asking about guns in the home”.

          • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

            Link doesn’t work.  Try again.

            Florida  Title XLVI  Chapter 790  “Weapons and Firearms”

            790.338 Medical privacy concerning firearms; prohibitions; penalties; exceptions.—

            http://tinyurl.com/3e7tuhv

        • http://twitter.com/#!/CloseCall_MD Close Call

          Agreed, nothing’s clear cut.  Reasonable people can have differing perceptions of risk. Whenever there is an intrusion on the doctor-patient relationship by non-physicians, red flags are raised.  

          A physician should be able to ask.  The patient can refuse to answer.  If the physician deems it to be a legally risky relationship, they should be able to terminate the relationship after a certain amount of time and help them find another physician (or as dictated by their insurance contracts).  Goes for missing appointments, threatening lawsuits, not getting their INR’s checked, not taking medications, lying, whatever.  Some doctors would throw guns in there. If they can fire someone for refusing vaccines, it should be allowable for guns.  

          In terms of everything else that Dr. Choi mentions – I’d say in private practice, it’s all game.  A doctor can market themselves however they want and assume whatever social issues they want to incorporate in their practice.  If they want to offer an “organic” form of doctoring – lets say they only use generics, don’t see drug reps, organize community outreach programs, use acupuncture, and use products that are only made in America (that and using generics would then be mutually exclusive) that’s fine.  Most patients would be turned off, but some might really get a kick out of it.  

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        You think that’s the first time a Legislature has done stupid things because they chose to meddle in physician’s practice?

        When we had flu vaccine shortages a few years ago, many state legislatures decided to meddle into the vaccination process, create a prioritized list, if you vaccinated someone felt to be low priority….in my state it was a licensure action, and a fine…….in Massachusetts there was a provision for jail.

        Vaccinate someone the Commonwealth of Massachusetts felt was not deserving enough, and run the risk of becoming Bruno’s cellmate in prison for felony flu shot? no thanks……..

        And yes, it’s within your scope of practice to ask the depressed or violent patient about a gun, and the Florida statute expressly allows it. I wish someone would actually read the statute.

        I would imagine the statute would piss off pediatricians…..and every other doc for that matter. Why would anyone think this is unique to pediatrics? Psychiatrists and primary care docs like me encounter far more urgent reasons to inquire about firearm ownership. In any event, I was plenty pissed off about the state meddling into my flu shot practice as well. Seems there was nowhere near the outrage for some reason, compared to what this generated.

        • http://www.facebook.com/rob.lindeman1 Rob Lindeman

          I actually didn’t know about the flu-shot thing.  Yet another Fed regulation I’m expected to know?

          • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

            Not Fed regulation, STATE regulation. The People’s Republic of
            Massachusetts, I don’t have to tell you about that. Shortage that year, I
            think it was 2004, maybe 2005. What was the status of pediatric flu
            vaccine that year, I forget. I don’t think it was as routine as adult in
            those days, so likely didn’t impact you as much as a FP like me, the
            usual infant-to-elderly FP mix.

            Fear whipped up of another 1919 flu epidemic. They’ve been doing that
            since at least the mid-1970′s with Gerry Ford and the swine flu
            Guillain-Barre thing. Many states concocted these priority lists. They
            had to look like We’re Doing Something. I’m not sure I can agree with
            the over-65 thing. My worst flu cases always seem to be young adults,
            and I thought the WW-1 soldiers got the worst of the 1919 epidemic.
            Maybe we should prioritize the young.

            Be that as it may, I could be wrong on that. Thing is, we had the
            recommended priority list, elderly, asthma, COPD, the usual. Rather than
            rely on the professionalism of physician to make an effort to follow
            guidelines, many states got the bright idea to put the force of law
            behind it. My state made it a licensure action with fines. We got a
            couple of cases that made it to the Board as I recall, nothing came of
            it. I don’t think the Board was happy to enforce that stupid law.

            The People’s Republic of Massachusetts went even further with threat of jail. No one was put behind bars.

            I have no idea if the law remains on the books, in my state or yours. If
            still on the books, it’s even more dangerous, like a forgotten land
            mine.

            I was a delegate to my medical association at that time. I spoke out
            about it at the meetings, the effect of the law, if anyone tried to
            enforce it, would be to drive physicians into giving up vaccines.
            Because of the shortage, the state also approached individual docs.
            “Sell us your excess and we’ll redistribute it.”

            For some dumb reason, I happened to be an early shipment that year, got
            my vaccine in August (it was November for me the year before), I had
            already used up nearly all my vaccine when the panic hit. I told the
            association, if I still had vaccine, I’d sell it ALL to the state.
            Threaten my license, threaten fines, jail in Massachusetts, screw you.
            YOU can do the vaccines.

            Oh, and I almost forgot this………in the end, many doctors did sell the state their extra vaccine for redistribution.

            By the time the vaccine was physically shipped to the state, money sent
            to the docs for their product and their trouble, the state figured out
            who was short, of course the community health canters…….

            By the time the vaccine actually reached the perceived “shortage” areas, the flu season was over.

            The vaccine was thrown away. The state threw millions down the drain.

          • http://www.facebook.com/rob.lindeman1 Rob Lindeman

            Thanks, Ninguem (you should be called “Alguem”. Eu agradeco suas palavras boas)  I remember that year well.  Here’s the piece I wrote for it. http://www.natickpediatrics.net/?p=214  It’s kind of milquetoast, but I was a wimp back then.  I remember dumping a ton of vaccine

  • http://www.facebook.com/stephennesmith Steve NeSmith

    It’s way over the line for a physician to ask about guns in a home. Do they ask how much (and type) alcohol is in the home? Booze destroys the health and well being of exponentially more families than a metal device (gun). How about if doctors start asking how fast a child’s parent drives on carpool day? Auto safety is a factor in the health and well being of person. Maybe a doctor should ask how many steak knives are kept in the kitchen drawers and how often they are sharpened. Many injuries result from curious children opening kitchen cabinets and drawers. My point is — it’s a slippery slope to start expanding the definition of a medical doctor’s role with a patient.

    • http://www.facebook.com/rob.lindeman1 Rob Lindeman

      Well said

    • Anonymous

      “It’s way over the line for a physician to ask about guns in a home”

      I would appreciate if a doctor asked about risky behavior on my part-having a dialogue on something I hadn’t considered.  I remember being counselled on keeping my toddler safe and do not think it over the line if my doctor asked about the availability of knives or alcohol or safe driving practices.

    • Anonymous

      “It’s way over the line for a physician to ask about guns in a home”

      I would appreciate if a doctor asked about risky behavior on my part-having a dialogue on something I hadn’t considered.  I remember being counselled on keeping my toddler safe and do not think it over the line if my doctor asked about the availability of knives or alcohol or safe driving practices.

  • http://www.facebook.com/profile.php?id=100000286100535 Diana Echert

    My first job as a physical therapist was in a first class trauma hospital.  Our rehab dept was located adjacent to the ER.  I have seen first hand the many “accidental” gunshot wounds resulting from kids playing at a friend’s house where guns were not stored improperly.  Asking the question does not mean guns should not be allowed in the home.  It does serve to increase an adult’s awareness of the fact the gun is there.  The question ranks right up there with “where do you store your household bleach?  cleaning agents?  scissors and knives?  I have responsible relatives living in Florida who have always taken their gun ownership…….and parenting responsibilities seriously.  We need to give the people of Florida more credit than their state government is giving them. 

  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    It is the patient’s right to choose not to answer a question about guns in the house (or any question), but this in no way gives government the right to fine/punish a physician just for uttering those words.

    • http://www.facebook.com/rob.lindeman1 Rob Lindeman

      Agreed.  What if the pedie asks the question but doesn’t document it?  Does Florida have a claim? BTW, it occurs to me that Florida might consider criminalizing THINKING about asking about guns; George Orwell would have called the offense “crimethink”

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    “Florida’s Governor Scott has signed a law that penalizes doctors for asking about guns in the home.”

    That’s just not true. It’s deliberately misleading.

    Has anybody bothered to read the Florida law?

    http://www.myfloridahouse.gov/sections/Bills/billsdetail.aspx?BillId=44993

    If the question is relevant to patient safety or medical care, or the safety of others, you can ask. Anyone, pro-gun or anti-gun, can easily come up with a medical reason to ask about gun ownership. You want to put it in the usual safety questionnaire at well-child checks, along with seat belts, poisons, fine, and for the same reasons. Offer the usual cautions about securing the weapons out of the hands of curious children. A plain-English reading of the law supports you.

    What’s not allowed is harassment of the patient over gun ownership. That had happened, and the law is a response to that. Bad as the law may be, it did not come out of thin air. You want to blame anyone, blame the radical anti-gun crowd for provoking this legislation.

  • Anonymous

    No, a physician should not be punished for asking about guns in the home.

    Then again, the pediatrician should also accept a polite, but firm “None of your business,” as an answer.

    It’s my understanding that this law came about precisely because some pediatrician didn’t do that, and as usual, politicians got involved and made the issue that much worse.

  • R Gladwin

     If docs can ask about social life, sex life, diet, exercise, they should very well be allowed to ask about guns. The more I read everyday medical blogs the less I’m willing to practice as a physician in the US. *sigh* I think I’ll just go back to India after residency.

  • Anonymous

    “the radical anti-gun crowd ”

    Is this commentary?

    I believe the physician in question refused to treat the child of a parent who refused to answer the question about guns.  Doesn’t the physician have the right to refuse medical care?  What f my doctor asks me if I do cocaine and I refuse to answer.  Does he have the right to terminate our relationship?  What if I refuse to answer questions about my sexual orientation?  This case is not really about guns, but two people with different values.  What precedent does this case set?  If I were a doctor, I would be concerned about this whether or not I owned a gun.

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

      So, what you’re saying is, you haven’t bothered to read the actual statute. Read it, Or have someone read it to you. The doctor is still free to dismiss the patient. The law is silly, but no one is going to be “fined five million dollars for asking about guns”; just try a plain English reading of the law.

      The fact remains, the law didn’t come out of nowhere, it was provoked by people with strong feelings against guns, who tried to impose those feelings in the exam room. I wish both sides would leave the physician alone.

      • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

        The link didn’t work right the first time. Try again. This links to the Florida government. It’s the statute in question.

        http://tinyurl.com/3e7tuhv

      • http://www.facebook.com/rob.lindeman1 Rob Lindeman

        “I wish both sides would leave the physician alone.”
        Here here!

  • Hexanchus t

    Old News – I believe this is the 4th thread here on this topic.

    Ninguem hit the nail on the head.

    IMHO a physician should not be penalized for asking, but neither should a patient be penalized for refusing to answer. As Ambulance_Driver said, a polite but firm “none of your business” is a valid response, and the physician should accept that, drop the subject and move on.

  • Anonymous

    Yes, they should be taken out and shot.  Sorry, I couldn’t resist.

  • http://www.facebook.com/profile.php?id=604263667 Bram Dolcourt

    I agree this is a silly law, but Dr Choi needs to understand that it is attitudes like his that have driven it. In an time when all information is recorded and shared, individual gun owners have a fear that insurance companies, governmental agencies and who knows who else, may end up getting their medical information. Is it paranoid? Maybe. But then again, people, including doctors, stick their noses into places where they don’t necessarily belong and then spout off all knowing nonsense. 

    Such as this statement: ” I would argue that nutritious food, safe medications, air quality, domestic violence, affordable housing, access to health care, sex trafficking, cultural factors, schools, safe neighborhoods, voting, human rights, international trade agreements, and the state budget, to the extent they impact health of my patients and communities, are also in my scope of practice.”

    This is utter nonsense. I serious doubt Dr. Choi has the requisite  knowledge to discuss these with sufficient understanding that he could advise his patients intelligently. Having worked in an urban, inner city ED for 4 years, I am constantly amazed at how little I actually understand the day to day struggles many of my patients face. While I’d love my patients to have safe neighborhoods, my ability to actually advise them pretty much ends at that thought…good advice requires a far deeper understanding of social dynamics than I, a practicing inner city physician, can actually learn. Scope of practice has to include what a physician actually knows and understands. I’m sure doctor Choi is a fine physician, but understands that there are areas of medicine that are beyond what he knows; I’m sure he isn’t perform routine surgeries, for example. The same goes for most of the topics he lists above: Sex trafficking is clearly bad, but I doubt he knows enough about the topic to say much beyond that.

    Dr Choi demonstrates his lack of understanding when he says: “So yes, to ask if a device that is associated with over 30,000 deaths a year and over 50% of suicides is unloaded, locked up, and kept out of reach of children is also well within my scope of practice.”

    If Dr. Choi had looked a few lines further down his own citation, he would have seen that of those 30000 deaths, only 1200 were non-suicide, non-homicide firearms deaths. Of the remaining, most were not in children. Most of the deaths were suicide. Asking “Is your gun locked up?” isn’t going to make a dent in that. In fact, the US ranks behind Japan, Finland, France, Canada, Iceland, Switzerland, Austria (in no particular order and limited to 1st World Countries) in suicide rates. All of those countries, except Switzerland have more restrictive gun laws than the US. In several of those countries, an individual will have a very difficult time getting a gun at all. Guns don’t cause suicide. Same goes for the homicide rate. It is an issue of crime and not legal gun ownership. Just look at Washington DC and Chicago: High crime rates and almost impossible to legally get a gun, yet one would find some of the highest homicide rates. “Is your gun locked up and unloaded?” isn’t going to stop a teenage gangster from carrying or using a gun illegally.

    Does Dr. Choi ask about swimming pools fencing? Does he spend anytime asking if a child can swim? How about floatation devices? WISQARS data is very clear: From 1999 to 2007, 3.5 times more children age 0-12 died from drowning than from from any firearm (suicide, homicide or accidental). More than 5 times more died from suffocation and more than 2 times more are hit by cars while walking. More kids (0-12) die from poisoning than from accidental gun shot or suicide (by about 2-1). I won’t even include motor vehicles as I hope that Dr. Choi already spends time talking about proper seatbelt use and proper car seat installation (Does he know the test standards so that he can help parents figure out if their car seats are properly installed?). How much time is spent on educating parents on these, far more lethal threats than junior accidentally or intentionally shooting himself. I doubt substantial, if any time is spent on most of them. I suspect the focus of hazard education is misplaced and somewhat colored by political/social views. It is not driven by a rational, evidence based approach to actual hazards.

    Dr Choi: Do you know anything beyond your buzzwords. Can you rationally discuss the best ways to secure a firearm? Can you discuss the pros and cons of different methods? Do you even know how to lock up a gun? How about ways to secure a loaded firearm to make them safer since many people want actually want a loaded gun in the house? Anything besides “Don’t do it,” I mean, since that advise will be ignored. Do you discuss educating children about gun safety? (Beyond the head in the sand “don’t touch it” approach, I mean. It doesn’t work for sex ed, why would it suddenly work for gun ed?)

    So yes, the Florida law is a silly, reactionary law. However it was born out of statements and policies by a bunch of know it all doctors who don’t actually know or understand much at all. 

    (As a note, before anyone quotes the “A gun in the home is 43 times more likely to kill a family member…” nonsense I suggest you critically read Arthur Kellermann’s paper.” The results fall apart when it is realized that accidental death was exceeded by the number of people killed in self defense. Moreover, a person need not be killed in a self defense shooting for it to be a successful use of a firearm for self defense.)

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

      “…..I agree this is a silly law, but Dr Choi needs to understand that it is attitudes like his that have driven it…..”

      Thank you. I was starting to feel alone here.

      The chance of Dr. Choi coming to understand it, I’m sorry to say, is about zero.

      I think it comes with the MPH.

  • Anonymous

    The statute is narrow in that it addresses gun OWNERSHIP.  How about formulating inquiries that address gun ACCESS and gun SAFETY? The letter of the law is upheld (no reference to ownership), and the patient safety issues are addressed. Moreover, firearm safety is pertinent to all age groups.

    • http://profiles.google.com/molly.ciliberti Molly Ciliberti

      Ask the NRA why the statute is so specific, duh.

  • http://www.facebook.com/people/Maggie-Keavey-Kozel/1383572933 Maggie Keavey Kozel

    Parents can refuse to answer questions, but they can’t tell a pediatrician “Its none of your business.” Safety is at the core of pediatric business.  What if the child were depressed?  The presence of a gun in a home of a depressed child increases the suicide risk – even if it is kept locked away.  Is that any of my business?  If parents don’t like the way I conduct myself at a visit, then they can find a pediatrician they feel comfortable with.  That is their right.  Telling me how to practice medicine is not.

    • http://www.facebook.com/rob.lindeman1 Rob Lindeman

      Forgive me, Dr. Kozel, I’m stunned.  Has the culture of coercion totally taken over at Georgetown?  The physician-client relationship OUGHT to be a contractual and consensual.  To the extent that it is not, the reason is probably because physician expects that the client will answer all his/her questions completely and truthfully, and follow all his/her recommendations or get the hell out of his/her office.  Fortunately for the people, they can still find physicians who understand that a doctor doesn’t own the “patient” and can’t make the latter do whatever he/she commands.

    • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

      Sigh……read the Florida statute. The case you described, the law specifically allows the doctor to ask.

      Actually, I can medically justify asking the question of anyone, for all the usual good reasons.

      If I, as the physician, think there is a medical or safety reason for asking about guns, I can ask.

      I feel like I’m talking to the wall.

      • Hexanchus t

        “I feel like I’m talking to the wall.”

        I feel your pain.

        What I can’t figure out is why this topic keeps floating to the surface like a dead fish. As I said earlier it’s old news – I think this is the 4th OP here on this topic. I guess some folks just can’t quit pushing their agenda…..

        As you said when it was first posted weeks ago, both the pro/anti gun factions need to stay the hell out of the physician/patient relationship.

        Common sense should dictate that if it is immediately pertinent due to a specific situational risk, ask.  If not, don’t go on a witch hunt. IMHO the limited time physicians have with their patients is better spent focusing on things like current health issues, immunizations, allergies, etc. than going on an unfounded witch hunt.

    • Hexanchus t

      Yes Dr. Kozel, unless it is immediately pertinent due to a specific situational risk, it is none of your business. The only information you have any right to is that which the patient chooses to share. My advice to a patient that encounters a physician with such an obviously judgmental and paternalistic attitude is to look them straight in the eye and lie through their teeth.

      I submit that the vast majority of physicians are not qualified to give advice on firearms safety. Instead of going on a witch hunt by asking unfounded questions and thereby wasting the valuable and limited time with the patient that could be better spent on more meaningful things, why not just hand every patient a brochure on firearm safety in the home and ask them to read it at their leisure.  If they have any questions and you are a qualified firearms safety instructor, feel free to answer them – if you’re not, refer them to someone that is qualified to provide accurate answers.

  • http://pulse.yahoo.com/_KC5TGWSSBBYCIPHLVT6XVZUZQE Goobler Mcgee

    I don’t go to a firearms instructor to get medical advice and I don’t go to a doctor to get firearms advice.  Unless the doctor is an NRA certified instructor they need to stick with what they know and leave everything else to other professionals.  Otherwise, what they are doing reeks too much of police state intrusion.  There is no legitimate reason to be asking about firearms.

    Do the doctors also ask about cars (the #1 killer in the U.S.)? Do they ask about knives? Pools? Household cleaners? Baseball bats? You see where I’m going with this?

    Statistically, you are more likely to be killed by a doctor than by a firearm, do they not ask about why you are visiting them in the first place knowing the potential danger it places you in?

    • http://profiles.google.com/molly.ciliberti Molly Ciliberti

      I know pediatricians that ask about seat belts, car seats etc. as well as pool safety and keeping household cleaners where children cannot get them. They need a dislike button for your comments.

    • http://www.facebook.com/profile.php?id=100000977601479 Melissa Gastorf

      I do ask about pools, household cleaners and other potentially dangerous situations in the house, such as stairs.  I ask about seat belts, and how the child sleeps.  Where I live, I assume 90% of my patients or their parents own a gun.  So I would argue that it is a justifiable question.  However, the reason this case was inspired sounds to have handled the situation poorly.  If a parent in my office does not want to answer the question if they have a gun, I merely respond that my concern is that it is locked up safely out of reach of the child, and if they don’t want to answer, that is fine, but I ask that they take care for their child’s safety.

      Everyone upon hearing the law seems to believe that doctors are trying to find out who owns guns for the state.  I don’t report that information to anyone, other than to mark it down in the chart.  The only other patients that routinely get questioned about firearms are those that are depressed, especially suicidal or homicidal.  Part of the job of a physician, especially those that take care of children is to educate the parents to help avoid potential dangers in the home.  I don’t have to be an expert in the storage of firearms to discuss the need to keep it up and out of reach of your 4 year old.  

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    What if the child has mental illness and there is an accessible gun in the house and they use it to kill themself or others? Wouldn’t having the physician ascertaining the existence of the gun and warning the parent of the issues be appropriate. I sure think so. It is called preventative medicine.

    • http://www.facebook.com/rob.lindeman1 Rob Lindeman

      There’s another fact that needs to be stipulated in your scenario, Molly: “… and if the parent doesn’t already know already how to store a gun safely”  

      FWIW, I’m a board-certified pediatrician and I don’t know how to store a gun.  Anybody know where I can find a CME on this?

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Obrigado, mas não, eu não sou ninguém.

    The drumbeat of “the next 1918 swine flu epidemic” has come up flu season after flu season. It dates me, I suppose, but I remember it being a big thing as least as far back as 1976. Gerald Ford was advised by his medical/public health experts that the next 1918 was coming in 1976, and we had to get the vaccine out immediately. President Ford did what he was advised by the best and the brightest, in good faith. Here’s Gerald Ford getting his swine flu shot in 1976.

    http://upload.wikimedia.org/wikipedia/commons/6/6e/FordSwineFluShot1.jpg

    Check out the nurse white outfit and cap. Seems like a million years ago. Everyone’s getting older, except me.

    As I understand it, in 1976 the swine flu itself killed one person and hospitalized 13.

    Side-effects from the vaccine that year, caused five hundred cases of  Guillain–Barré syndrome and 25 deaths.

  • salena anderson

    I don’t have a problem with an MD asking basically if there are guns in the house and if so, are they secure from children. Appropriate question similar to pool safety. I would believe much of the issue here is that insurance companies can get access to health records. Right now, some insurance companies will deny coverage to people who own specific breeds of dogs- whether that dog has done anything or not. Those distinctions also don’t identify known ‘biters’ from breeds not in the ‘do not own’ lists. I fully believe it is only a matter of time that either a homeowner’s, life, or medical insurance policy will deny coverage or specific care if a gun is in a home regardless of how stored. There is the bigger threat.

  • Anonymous

    Like to know where you got you numbers (stats) or are you like the gov’t, just make them up to suit yourself.

  • Anonymous

    I would like to know where your erroneous statistics come from, just like the Gov’t, make them up to suit yourself.