By Ajay K. Singh, MBBS, FRCP, MBA
Tuesday, Febraury 7, 2017
A few months back when I saw my primary care physician at one of the Brigham and Women’s Hospital practices, I noticed that there was a question on the pre-visit questionnaire asking about whether I owned a gun. I do not own a gun and never have and so had no problem in answering no to this question.
Recently, however, I noticed an article in Kaiser Health News discussing whether physicians should be allowed under the law to ask about their patients’ gun ownership. Really?
The article states: “Some states have imposed restrictions on gun-related information that patients must provide or that can be collected by providers and state officials. The most notable is Florida, which in 2011 passed the so-called ‘Docs vs. Glocks’ law that generally prohibited doctors from asking patients if they had a gun at home.
The law was found unconstitutional, then that decision was overturned by a divided three-judge panel of the 11th U.S. Circuit Court of Appeals in Atlanta. The full appeals court in turn vacated that decision and heard oral arguments last year, but has yet to rule. In the meantime, the Florida law has not gone into effect.”
So I dug into the literature a bit and came across a comprehensive article on the issue published back in August 2016 in the Annals of Internal Medicine by Wintemute and colleagues.
- In 2014, a total of 33,599 Americans died of gunshot wounds.
- No federal or state statute prohibits physicians from asking about firearms when such information is relevant to the health of the patient or others.
- When to ask? Firearm information would be directly relevant to the health of an individual patient and that patient’s close contacts under three general conditions:
- The first arises when a patient provides information or exhibits behavior suggesting an acutely increased risk for violence, such as explicit or implicit endorsement of suicidal or homicidal intent or ideation.
- The second involves patients who possess other individual-level risk factors for future violence. (A history of violence perpetration, patients hospitalized or treated in emergency departments for violent victimization, history of alcohol and/or drug abuse.)
- Third, questions about firearms would be relevant for patients in demographic groups that are at increased risk for firearm-related injury. Middle-aged and older white men are at high risk for firearm-related suicide (up to 5 times higher than black men of the same age), and young African-American men are 20 times as likely as young white men to die of firearm-related homicide. Children and adolescents may engage in risk behaviors with firearms because their judgment and cognitive skills are not fully developed.”
The article concludes: “Medical specialty societies recommend asking and counseling about firearms during routine patient care or as an element of risk assessment. Neither the law nor the Second Amendment prohibits such activities, and the First Amendment may protect them.
” Quae Sunt Quasi Quaedam Manifesta” (Latin for “Some things seemed obvious.”)
Dr. Ajay K. Singh is the Senior Associate Dean for Global and Continuing Education and Director, Master in Medical Sciences in Clinical Investigation (MMSCI) Program at Harvard Medical School. He is also Director, Continuing Medical Education, Department of Medicine and Renal Division at Brigham and Women’s Hospital in Boston.