Why HB 155 undermines the trust doctors have with patients

Do doctors have any business asking patients about whether or not they own a handgun?

Like many other paternalistic inquiries with which doctors routinely harass their patients (car seats, bicycle helmets, smoke alarms, etc), my answer to this question is “no.’”

There is a fairly well delineated sphere of knowledge which is medical in nature and in which I have some expertise and other topics which are purely personal, moral, or lifestyle considerations and in which I have no particular expertise.  I was taught that my job as a provider is to give medical advice to my patients and to share in the decision-making process with regard to their medical care.

If a patient were to ask me, “Should I wear a helmet when I ride my bicycle?” I would tell her, “Yes, I think you should.”  I could quote her some statistics, but she knows just as well as I do that she’s much less likely to sustain a serious injury to her brain if she hits her head while wearing the helmet as opposed to without it.  In other words, her opinion on this issue is only minimally less informed than my “expert” opinion.

With regard to gun ownership, my opinion is even less meaningful than for wearing of bicycle helmets.  I’ve never held a gun in my life, let alone fired one.  I haven’t the faintest clue about proper gun safety, nor do I intend to learn.  Just as I wouldn’t presume to ask a pilot whether he follows all proper safety procedures and inspections before take-off, or whether a scuba diver properly checks out his gear before diving, I have no business asking about gun ownership.  Sure, the AAP is fond of quoting the higher incidence of gun-related deaths among gun-owners (hence, my personal decision not to own one).  Similarly, I could quote the higher rate of airplane related deaths among those who fly vs those who don’t.  Or the higher incidence of scuba diving related accidents among those who scuba dive vs those who don’t.  The list goes on.  My point is, that these are personal, life-style decisions.  They’re not medical decisions and, as such, my opinion is really irrelevant.

All that being said, a bill which holds doctors criminally accountable for discussing guns during a patient visit, as Florida law HB 155 does, is simply outrageous.  Mona Mangat argues that this type of legislation places us at the top of a “slippery slope” at the bottom of which it may become illegal to ask patients about smoking.  I would go even further and say that we’re already well on our way down the slope with this legislation, the issue is no longer slippery.

One can have a rational, academic discussion about which types of behaviors and decisions doctors should and should not be asking their patients about.  But to make a particular line of questioning illegal is an unprecedented step which clearly undermines doctors’ ability to establish trust with their patients.  The issue is not, as some have argued, that this law prevents doctors from their duty to identify a particular risk to patient safety.  Whether or not doctors have a duty to ask about gun ownership as a patient safety concern is a matter of opinion (I’ve expressed mine very strongly above).  The issue here is that making any topic of discussion with your patients illegal, in addition to being a likely 1st amendment violation, represents an attack on the heretofore highly protected and privileged doctor-patient relationship.

As Virginia Hood, president of the American College of Physicians put it,  ”This issue is much bigger than guns, it is about whether the government or any other body should be allowed to tell physicians what they can and can’t discuss with their patients.”

James Logan is a resident in family medicine who blogs at his self-titled site, James Logan, M.D.


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