Should doctors be required to ask patients about guns?

Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality here.

First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies in Newtown, CT or Aurora, CO. Gun safety should be of paramount importance to all gun owners. However, if I am going to ask all my patients about gun safety and ownership, then there are a few other dangerous things I need to engage them with as well.

“Do you own a pool?” (Quite relevant since we live in Florida.) “If you do, do you have small children at home or as guests? Do the neighborhood children come by? Do you have a pool fence and is it locked at all times? Have you thought about how many accidental drowning of children there are in Florida every year? Have you taken a course in pool safety?”

Or how about this topic: “Do you own a dog? What kind of dog is it? Were there any pit pulls in its family lineage? Do you have small children at home or grandchildren? Has your dog ever bitten anyone? (Okay, the mailman doesn’t count.) Have you taken a course in dog safety ownership?”

You see where I am going with this of course. First of all, I, and most doctors, don’t have the time to engage in this dialogue with my patients, since I am too busy asking about percentage of seat belt use, quitting smoking, updating medicine lists and system reviews, and filling out ridiculous “meaningful use” of EHR forms, just to get paid from Medicare. And even if I did have time, it is really none of my business. And if even if it was my business, asking this would not prevent a mentally aberrant person from finding weapons and using them in a hideous fashion.

The fatal flaw in this logic is that the desire to do good, does not lead to good results. In fact the opposite is often the case. A recent opinion piece in the Wall Street Journal by Jeffery Scott Shapiro highlights this paradox. He was a criminal prosecutor in the District of Columbia from 2007-09. In essence, during the strictest gun ban years, the rate of homicides increased. Ultimately in 2007, the U.S. Court of Appeals in D.C. ruled the city’s gun ban to be unconstitutional. The US Supreme Court also affirmed the ruling the next year. Since the ban was struck down in 2008, the homicide rate dropped from 186 to 88 in 2012, the lowest number since the original ban law was enacted in 1976.

Recent shooting tragedies do launch a knee jerk reaction by well-intentioned politicians, but as usual, the beneficial results of new laws often achieve the opposite, since the criminal, or deviant mind, will always find a way to purchase weapons. So following are my thoughts on what might help.

Loosen the HIPAA laws so deranged individuals can have their psychiatric history quickly accessed by mental health providers. Tighten the “gun show” loopholes, so gun purchases meet the same measures at shows as at a gun store. If the government insists on throwing more money at a problem, (and they excel at always doing so), then invest in more mental health professionals and treatment facilities. Make it easier for teachers, (who want to), learn gun safety and obtain concealed weapons permits. Every adult who supervisors school outings in Israel is trained in weapon use and carry semi-automatic guns on field trips. You never hear about these tragedies in that country.

But mandating doctors to ask patients about gun possession? You can count me out on that one. This is an invasion of privacy, and worse, will do nothing to curtail the periodic catastrophe that occurred at Sandy Hook.

To be prepared for war is one of the most effectual means of   preserving peace. A free people ought not only to be armed, but disciplined.

-George Washington, First Annual Address, January 8, 1790.

David Mokotoff is a cardiologist who blogs at Cardio Author Doc.  He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival.

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  • JonSanders

    You are making sense. That is not allowed.

  • NormRx

    Damn I hate it when I agree with an author, it is much more fun to engage someone when they espouse ridiculous positions.

    I wish a doctor would ask me about guns in my house, I am prepared with a few question for him/her.

    Are you a homosexual?

    Are you HIV positive?

    Do you cheat on your spouse and if you do, do you engage in unprotected sex outside of marriage?

    Do you abuse alcohol or illicit drugs?

    Have you ever been charged with domestic battery?

    Have you ever hit on or had sex with one of your patients.

    Have you ever been charged with insurance or Medicare/Medicaid fraud?

    What is your opinion of doctors that use chelation therapy to treat diabetes, MS, Parkinson’s etc.
    I am sure I would never get past the first question or two before I would be asked to leave.

    • Suzi Q 38

      I would like to ask a psychologist or psychiatrist:
      How many times have you been married?

      Are you still married to your first wife or husband?
      Are you gay, straight, or bisexual?
      Have you ever had a sex change?

      Have you yourself ever been depressed or suicidal?
      Have you ever taken anti-depressants, neuroleptics, or any other mood altering drugs? How abut painkillers like NORCO or Vicodin?

      These questions are personal, but the answers tell me what kind of person you are and help me to determine whether or not you would be the best counselor for myself and family.

      • SBornfeld

        I don’t believe those questions would help you determine whether a counselor is likely to be helpful–not at all.

        • Suzi Q 38

          I agree.
          Although figuring out if a marriage counselor knows how to stay in a marriage may be helpful.

          Asking me if I have a gun is none of the doctor’s business, especially a medical doctor rather than a psych.

          • SBornfeld

            That’s cold–maybe the marriage counselor learned the hard way!

          • Suzi Q 38

            Yes, I always give anyone one chance. Being young and naive is a good excuse as any.
            If you are like my brother and can afford all of the ex’s, well all the power to you. He has been married and divorced 3 times and has 6 children. His track record is not that good, so I finally told him that he wasn’t good at marriage.

            A person like this however nice and brilliant as he is, would not be advising me on my marriage challenges even if he was tops in his class at counseling school.

    • SBornfeld

      You may, of course, ask anything you wish–and if it’s germane to your treatment you SHOULD ask. Of course the doctor is not required by law to answer any of these questions.
      You may not agree with many of the questions on a medical history form–I can think of a couple that I personally think are kind of silly.
      My guess is that your questions are based not on their clinical appropriateness, but your opinion that they’re likely to be found offensive to the doctor.
      For instance, if you’re donating blood, you will be asked if you’ve spent time in the UK in the last few years.
      But silly or not, there is a rationale for asking them related (at least theoretically) with your health or the health of others.
      Dr. Mokatoff rejects the question of guns in the house based on its perceived impracticality, not on its offensiveness.
      We could argue that point, but IMO it would be difficult to maintain that the intent of the question about guns and gun safety is primarily to offend your sensibilities.

  • Suzi Q 38

    How is the doctor going to remember to ask all of these questions?

    Don’t I only have about 10-15 minutes to state my case about my medical problem?

    Most of us don’t have guns.

    If the patient did have a gun, so what.
    What are you supposed to do with that information?

    HIV positive and having sex still???
    Now THAT is a loaded “gun.”

  • drgg

    mental health providers can’t do much about deranged individuals these days as the laws to commit a patient are not adequate. Look at Aurora shooter at batman movie. He did not meet criteria for involuntary commitment and look at what happened there…

  • ninguem

    The reason we ended up with bad laws, like the one in Florida a while back, PROHIBITING doctors from talking about guns, is because it was a reaction to efforts to make it mandatory, the docs MUST talk about guns.

    • http://www.facebook.com/Cheryl.A.Handy Cheryl Handy

      Am I reading your comment wrong? Are you saying docs must talk about guns? Why? Criminals and whacks are going to deny having guns. Then you can screw your appointment schedule up having a heated, lengthy second amendment argument with a completely sane patient.

  • http://www.facebook.com/Cheryl.A.Handy Cheryl Handy

    Of course the best medicine is achieved when the physician and the the patient are in the exam room alone (okay, except for some procedures between male doc and female patient but you get my point).

    Physicians rightfully bemoan the intrusion of insurance companies into the physician-patient relationship. Docs hate those telephone calls from insurance companies recommending a different drug for the patient. It’s easy enough for doc to say “no” to insurance company. Docs know fiduciary duty is to patients.

    Physicians should shutter at thought of the government requiring that docs become agents of the government. Docs are (at least so far) not employees of the federal government and owe the government no fiduciary duty.

    If, however, the patient is a government employee (or even better a politician), I think personal questions are necessary for public safety.

    • SBornfeld

      Of course we owe the government a fiduciary duty–to the State, insofar as license is granted as a privilege by the state. There is a duty to obey federal law too–as employers, as prescribers of controlled substances, and as subject to federal law regarding (among other things) electronic transmission of patient records.

  • Marc

    There are compelling reasons for a healthcare team to discuss overall safety with say with new parents, which could include guns, as well as things like dogs, smoking and window bars, while surely if you resent with depression or other mental health issues it would be a sensible to ask about guns as well drugs kept in the home.

  • buzzkillerjsmith

    In a 2003 article in the Am J Public Health Yarnall et al estimated that it would take 7.4 hours per working day for a primary care physician to provide recommended preventive services to an average patient panel. Even if the number is half that, the job is impossible–if a physician is to diagnose and treat disease.
    Here’s how it should be done. Identify those few screening measures that prevent the greatest amount of sickness and death per second of physician time, as demonstrated by high-quality scientific studies, and have the physician address those. These measures will obviously be a function of the patient population at hand and will likely vary over time. Have someone else address all other screening measures if and only if those other measures have been shown to be effective in a given patient population and if and only if resource limitations allow them to be addressed. Those measures that fail the test should be ignored, no matter what the headlines of the day happen to say.

    Next case.

  • Doris Edwards RN

    Thank you for speaking common sense! In the rush to do good and avoid evil, it seems politically incorrect to raise the likelihood of untoward unintended consequences.

  • SBornfeld

    I feel sorry for you, Doc. Getting a good history is sooooo difficult and time-consuming!