Did any doctor ask Nancy Lanza about guns?

Suppose 20 children and 6 adults died at a school in a very short time period. And suppose there were clusters of similar deaths, many of young healthy people, around the country: at a movie theater, a shopping mall, a high school, a house of worship. Would you expect the Center for Disease Control to get involved in trying to figure out why these people died and how to prevent similar deaths? Would you want your own doctor to do all he or she could do to prevent similar “outbreaks” from occurring in your community? Even if the cause of the deaths turned out to be complex, multi-factorial, and overlapped non-medical arenas, such as the law?

I would not have thought that such suppositions would be controversial, but they are.

When I wrote this blog after the Aurora, CO movie theater shootings last summer, I received more comments and mail than I’ve gotten on just about anything I’ve written. My point in the blog was that doctors and other health professionals can play a role in preventing gun violence by asking patients if they own firearms, if they are kept locked separately from ammunition, and if anyone else has access to them, especially children and the mentally ill.

Many of the responses suggested that a doctor has no business asking a patient about guns. Some commenters said they would simply lie to the doctor if such questions were asked, and some said they’d find a new doctor. One wrote that it’s no more appropriate for a doctor to ask about firearms than for someone to get their strep throat treated at a gun club.

I was surprised by these arguments, and have reflected on them again in the last few days. Did any doctor ask Nancy Lanza: Do you have guns at home? Are they kept locked separately from ammunition? Are they accessible to anyone else, especially children and the mentally ill? Would it have helped? Or, at least, how would it have hurt?

Perhaps health professionals aren’t, on average, as knowledgeable about guns as many gun owners, or as versed in constitutional law as many lawyers. But we treat victims of gun violence: their wounds, paralysis, colostomies, brain injuries, depression, chronic infections, and PTSD. Several members of our profession just performed autopsies on 20 first graders.

Doesn’t this earn us a place in the national discussion on prevention of gun violence?

Doesn’t this justify our asking our patients three simple questions?

Suzanne Koven is an internal medicine physician who blogs at In Practice at Boston.com, where this article originally appeared. She is the author of Say Hello To A Better Body: Weight Loss and Fitness For Women Over 50

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  • http://twitter.com/hurthefeelings Xi Mingze 习明泽

    Of course you should ask.

  • http://www.facebook.com/glen.harness Glen E Harness Jr.

    It’s not the doctor’s business. If my doctor asks me about guns, then I’ll find another doctor. Equating gun ownership with some sort of disease is despicable.

    • Marc

      Guns are a very serious public health issue. You have no business saying that doctors and government must not seek ways to reduce harm.

      • buzzkillersmith

        I am a doc, not a public health officer. You want gun control? For the record I do. Lobby, organize. But I know no more about this than you do.

        • Marc

          In most countries the health system is a continuum where doctors play pivotal roles in injury and harm prevention. If you can advise on putting say locks on high-rise windows with a new child, you can equally enquire about unsecured guns in a house with a disturbed teenager or a depressed adult.

          • buzzkillersmith

            This ain’t most countries. How ’bout you get to work on changing the structure of medical delivery in this country and giving us docs all the time in the world to ask you about every little thing? Perhaps I should come clean your house, maybe cook you dinner?

            What rubbish. I do diagnosis and treatment, not social work.

          • Marc

            You sound like a lousy doctor. Reminds me of Tom Lehrer’s song about Wernher von Braun:

            “Once the rockets are up, who cares where they come down?
            That’s not my department,” says Wernher von Braun.

        • Docbart

          Apparently you don’t. If you were a public health officer, you would.

  • Bob

    Agreed that this is a controversial topic and would add a fourth question: What would the health professional do with the answers to those three questions to prevent gun violence?

    • JonSanders

      Report you to the authorities. Your doctor is your new probation officer.

      • Bob

        That sounds like quite an expanded role for accountable care.

    • Docbart

      Stress gun safety, perhaps steer someone in need of counseling. Many people actually respond to a doctor’s advice and won’t do something as obvious as stopping smoking or making other lifestyle changes until their doctor advises them to do so.

      • Bob

        I agree that a doctor’s advice can carry an important level of influence with regard to a change in behaviors. But change is hard and, in its own way, so is healthcare. Sustaining the effort in either case requires the person to accept some responsibility too, and maybe even engage a few more people in their community whether it be family or friends. We all can be a caregiver of some kind, and maybe in a certain household the important decision to do something more than lock up the gun has to be made by the head of that household.

    • LastoftheZucchiniFlowers

      bob – in my (past) experiences as a provider, anyone who answered ‘yes’ to the question about wanting to kill themselves (or harm others) AND answered affirmatively about having ‘access to guns) was always referred immediately to the local PESS (psychiatric emergency services section) which was a great group of trained psych/mental health RNs working in a larger ER at that time. They did fantastic work with patients in crises and sometimes this required an emergency holdover/admission to the psych/mh inpatient unit. Today many of these units are closed, or worse – COMBINED with other inpatient settings (even pediatrics!). Funding for mental health is the lowest priority in health care apportionment of dollars today – even while platitudes are being flung freely about how important it is to ‘screen’. Go figure. It’s easy to be verbal when it comes to what we would like to see by way of change – but the reality and the economics of what we want is another story altogether.

  • http://twitter.com/Sharpestick Don Sharpe

    Why not have teachers ask? Or the mailman, or the electric meter reader? Hey, why not have neighbors ask, and then phone a special ‘hot line’ to report the answers they don’t like . . … like in 1930′s Germany. Yeah, that’s a great idea. Tomorrow I’m going to find a doctor who’s a gun owner. #DoNoHarm

    • buzzkillersmith

      Yup, you got it right. See my post.

      • http://www.facebook.com/jane.peterson.5832 Jane Peterson

        Why do you waste your precious spare time posting about topics that you feel are totally out of your domain? Let those doctors who wish to serve in this area do it, and go relax somewhere since you are such a hard working diagnostician who clearly knows the limits of your duties.

    • Docbart

      What will you do if that doctor asks about your guns?

    • Ginger

      “Hey Nancy, I know your kid isn’t mentally ill, he’s just got a developmental disability, but he sure has intense reactions, maybe it’s not such a good idea to keep those guns around the house. How about you store them in my garage or at the shooting range? If Adam has a meltdown they won’t be a temptation. It’d be a shame to have a problem like that nutcase in Colorado.”
      I call that kind of asking the hand of friendship and concern.

    • http://twitter.com/sarasteinmd Sara Stein MD

      Physicians are entrusted with saving lives. If I can ask you about what you’re eating that will kill you, I can ask you about what you’re holding in your house that can kill you. The decision is yours to make, but I’m a better doctor because I raised the question.

  • buzzkillersmith

    No, it does not earn you a place, except insofar as everyone in this society has a place.

    You have to realize your limits. You have to realize that you might or might not be expert in diagnosis and treatment. Likely you are. That is as far as it goes, doctor. The rules of this society are set mostly by others, and we live with them.

    We are the shamans and we inhabit a special and privileged place in this society. Look at your salary. Look at how you enjoy instant acceptance and credibility. Don’t abuse it, doctor. For all the problems we face, people respect us more than they respect lawyers, judges, politicians, businessmen, college professors. Perhaps not as much as clergy. Don’t throw that away pretending to be an expert on things you don’t understand any better than anyone else.

    • Guest

      I agree somewhat with the points you are trying to make about knowing boundaries and things to ask, but be careful when you assume “people respect us more than they respect lawyers, judges, politicians, businessmen, college professors” – that’s your opinion. Be careful about “glorifying one’s job”.

      • buzzkillersmith

        Fair enough.

    • Docbart

      As doctors, we ask all sorts of intimate questions, and sometimes our input saves a life. Offending a patient vs saving a life- not hard to figure out where the priority should be.

      • buzzkillersmith

        It’s da time, doc, as you well know if you’re primary care. You don’t need 7 years of post-college education to ask about guns, or tell people to watch their weight, or tell them to use sunscreen, or tell them, gee whiz, all that food and no exericse can hurt a guy. Let the nurses do it, or the healyh coaches.

        If you’re a busy doc, as I am, you know that well people are not our responsibility. We’ve got our hands full with the sick.

  • http://www.dpsinfo.com LaurieMann

    In Pennsylvania a few years ago, it was common for a doctor to ask if you felt safe in your home (and this might have just been a question for women). I haven’t heard that as much recently.

    • SarahJ89

      That’s because these kinds of questions are generated by the accrediting bodies in the US. They’re basically fads. That “rate your pain on a scale of 1 to 10″ question is designed to prove you’ve been screened for pain.

      I broke my arm recently. As I sat in a wheelchair (fainted from the pain) in a room with three strangers and my husband’s hands on my shoulders, I was dumbfounded to be asked “Do you have any concerns about drugs, alcohol or domestic violence?” This is not a question that comes from any concern about my well being. It’s merely a check-off box to prove to the hospital accreditors that “We asked.” No one who gave a rat’s patootie about a person’s health, safety or well being would ask that question in a room with three strangers and the most likely perpetrator of domestic violence. But they’ll move on to some new fad question in a couple of years.

  • NormRx

    300 children drown each year in swimming pools, maybe you should ask your patients whether they have a pool or not. Doctor, if you really want to use your skills, why don’t you research whether there is a correlation between drugging our young males with Ritalin and other psychotropic meds and violence? When being male is treated as a pathology something is seriously wrong with medicine.

  • ninguem

    It’s fair to ask about guns in the house, swimming pools, fire extinguishers, seat belts, and a whole bunch of other things more likely to kill than guns.

    But still……fine. They should be secured properly. Same with narcotic medicines for that matter.

    Still, the kid killed his mother and stole the weapons.

    And…..the whole story is not out yet, of course………the mother sought treatment for her son’s mental illness, and got nowhere.

    Just as with the school shootings, when a story pops up about a mentally disturbed person pushing someone on a subway platform, there’s talk of mandatory psychiatric confinement of certain disturbed individuals.

    And nothing happens, wanting to protect the “rights” of the mentally ill. Same as the “rights” under the Second Amendment.

  • FinnHaddie

    Good lord, what a load of swill and fertilizer at that link! Anyone who refers to all gun control advocates as “advocates of victim disarmament” is as worth reading as the kind of gun control advocates who refer to all gun owners as “gun nuts.” And anyone who thinks their doctor is asking them about guns in the house to report them–to whom? for what?–is so paranoid that they think doctors want MORE paperwork. Asking about guns in the house is no different from asking me whether I use a helmet when I bike or my sister if she keeps prescription meds out of her kids’ reach: the point of the question is to find out whether they need to talk about injury prevention on that particular topic, not to call in the imaginary “jackbooted thugs” to confiscate legally owned firearms.

  • SarahJ89

    I’m always amazed that people think separating guns and ammo and locking them up somehow makes them inaccessible to teenagers. What kind of kids do you have out there? Ones minus opposable thumbs? It’s not terribly hard to break into a gun cabinet and any kid who found the stash of Santa’s presents as a kid will tell you, hiding stuff really doesn’t work.

    I’m not against guns, but they don’t mix well with delusion.

  • LastoftheZucchiniFlowers

    We should all recall our psych/mental health training wherein we were taught to screen for potential suicides via the blunt question: ‘have you ever thought of killing yourself?’ If the answer was ‘Yes’, the algorithm proceeded logically to: ‘do you have access to weapons/guns’? No one ever thought this was PC/non-PC back then. It was simply good medicine. Now – the very IDEA is fraught with wringing of hands and fretting by anyone who fears offending……complete and total bulls##! If we just get back to good medicine which is often PREVENTION, no one can be faulted

  • http://twitter.com/sarasteinmd Sara Stein MD

    Oh puhleeze. She left out rationalization and intellectualization, or as I saw it…drivel.

  • http://twitter.com/sarasteinmd Sara Stein MD

    I ask, but I’m a psychiatrist. Considering that 50% of the prescriptions that PCPs write are for psychotropics, I would urge everyone to jump right in. It goes like this… “Do you have guns in your house?” And if they say yes…”Do you think that’s a good idea considering what’s going on right now?” (meaning in their lives, not the news). They say “I’m okay, I’m not going to do anything” (kill themselves or someone else). And I say “you say that now, but what happens when you get drunk? (or the other person gets drunk” (or hear voices, or go into a rage, or your son the drug addict gets hold of it, etc). And I’ve had a number of people say they would secure them better, or have someone else watch over them. Other people say, “I have to, my neighborhood isn’t safe”. I’ve NEVER had anyone be offended that I asked. Unfortunately, I’ve also never had anyone say they are going to turn them in to the police for gun buyback.

  • L. Scofield

    How about patients start asking gun illiterate phisycians, how many patients have they directly or indirectly injured, impaired or kiled by the medical errors that occur every day in the health care industry? Statistics for medical errors are greater than injuries and deaths caused by law abiding fire arms owners.

    The medical profession has done a very poor job in ensuring that mentaly ill patients are diagnosed, treated and kept away from gun ownership. Perhaps it is because mental health provides less reinbursement than doing unnecessary lab tests and procedures.

  • http://www.facebook.com/jane.peterson.5832 Jane Peterson

    Hell yes it justifies doctors asking patients 3 simples questions. Thanks for speaking out and don’t let anyone tell you otherwise.

  • Faxon

    My Internist asks me a standard list of questions during my annual physical. I consider his asking me if I own guns (by now he knows I don’t) to be on a par with asking me if I wear a seat belt, motorcycle helmet, and telling me if I drink do not drive. This year when he mentioned guns, I commented on the Newtown massacre. We briefly spoke of the horror. Of course doctors should talk about anything that that impacts their patient’s health. That includes gun ownership.

  • Lisa Cunningham

    Keep on asking! Psychiatrists and psychologists should be asking, too. It never hurts to ask. The more education people get about locking up their guns and being responsible, the less accidental murders we’ll have.

  • http://twitter.com/AnnFriedmann Ann Friedmann MD

    Of course we should ask these questions. There have been many posts on this topic by physicians and all of them receive the same comments by posters who look for this content ( I believe you call them trolls). I say “Whatever”! If one person that I talk to changes how they secure their firearms it’s worth the conversation.

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