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Doctors should be able to ask patients about guns

13 Comments

It is part of my job as a physician to ask patients about behaviors that may affect their health. Examples are smoking, drinking and wearing bicycle helmets.

But if I were practicing in Florida, I might be legally restrained from asking whether they own a gun and, if so, whether it is stored safely. In addition, unlike, say, an embarrassing medical problem, any information regarding gun ownership cannot be entered into the patient's medical record. This law, like recent attempts to block women's access to abortion clinics in Texas, represents misappropriation and misuse of health concerns to advance other political agendas.

In an ongoing case involving a challenge to this law, patient health, the right to bear arms, and free speech crash into each other

The conflict began in June 2011, when Florida Governor Rick Scott signed the Firearm Owners' Privacy Act, which prohibits healthcare providers from inquiring about gun ownership.

Shortly after Scott signed the bill into law, a group of medical professionals filed suit. In Wollschlaeger v. Governor of Florida, known informally as "Docs vs. Glocks," they alleged that the act violated their right to free speech.

First the case went to the U.S. District Court for the Southern District of Florida, where a judge agreed with the doctors and said the law was a violation of their First Amendment rights. She issued an injunction banning application of the law.

The state of Florida appealed, and a three judge panel in the U.S. Court of Appeals for the 11th Circuit reversed the decision of the District Court and upheld the law. (The NRA filed a friend of the court brief stating that the act protected patient privacy and exercise of Second Amendment rights, saying that it "exhorts doctors to stick to practicing medicine when examining patients, rather than pushing their own political agendas.")

The case was then re-appealed by the plaintiffs and went to the entire 11th Circuit Court, which heard oral arguments in June and has not yet made a ruling.

The decisions of the Florida Court of Appeals thus far reflect a rather disturbing ignorance of what doctors actually do. Medicine, particularly primary care medicine, is more than just treatment. As Benjamin Franklin wrote, "An ounce of prevention is worth a pound of cure." Preventive medicine is designed to keep patients healthy and out of the doctor's office, and is central to the primary care practice. It includes discussions of pool safety, childproofing, vaccinating or keeping a gun unloaded and in a locked place that a child can't access. Patient privacy is well protected by HIPPA and doctor-patient confidentiality laws.

The court demeaned patients by writing that "When a patient enters a physician's examination room, the patient is in a position of relative powerlessness." Patients are increasingly well-informed via the internet and often come into the office with a list of questions about everything from vaccines to Zika. They are certainly capable of refusing to answer a question or dismissing a doctor they dislike.

As a physician, the real issue for me is health, and this is where the recent Supreme Court decision in the case of Whole Woman's Health v. Hellerstedt is relevant. In 2013 the Texas legislature passed a bill stating that any physician performing abortions must be affiliated with a hospital within 30 miles, and clinics performing abortions must have facilities at least equivalent to those of an ambulatory surgery center.

The State of Texas maintained that interests in patient health outweighed the fact that many hospitals in Texas and elsewhere find ways to avoid affiliating themselves with doctors who perform abortions, that clinic requirements were unduly stringent and costly relative to those for other more invasive procedures, and that these regulations would result in closure of 75 percent of the abortion clinics in their state.

The Supreme Court ruled that the Texas law created undue burdens for women seeking abortions and did not sufficiently demonstrate the "medical burdens" on patients caused by clinic quality or hospital affiliations. Unlike the Florida Appeals Court, the Supreme Court put the patients first.

The emphasis on health benefits over political gerrymandering should be applied in Florida. In 2015, at least 278 children accidentally shot themselves or someone else with an improperly stored gun. One-tenth of all deaths among children age 5 to 14 years are due to firearms and 3 to 4 times as many children suffer non-fatal gunshot injuries. Furthermore, a recent survey reported that 39 percent of children whose parents thought they had successfully hidden the gun actually knew where it was.

Other non-pediatric populations, such as those suffering from depression or dementia, are clear examples of cases where questions about gun ownership are an important part of good medical care.

In all fairness, the Florida law does allow a doctor who "in good faith believes that this information is relevant to the patient's medical care or safety, or the safety of others" to ask about gun ownership. Since the American Academy of Pediatrics recommends that doctors inquire about gun ownership and safe storage, one might think that pediatricians would be exempt from prosecution for asking about these topics. However, if the injunction is lifted, inquiring doctors may face penalties including substantial fines and loss of their licenses to practice medicine.

In this instance, the Florida judiciary seems indifferent to the health of the state's children, despite the fact that 54 percent of households in the South self-report owning guns, according to a 2012 Gallup poll. The primary legislative and judicial concern seems to be to "protect" Floridians from an inconvenient truth (guns accidentally kill people) that might lead them to question their safety practices or the wisdom of keeping guns in their homes.

In the Texas case, the Supreme Court prevented the Machiavellian manipulation of healthcare regulations by pro-life politicians. In Florida, the Court of Appeals has so far sacrificed well-established standards of good healthcare to service their pro-gun views.

© (c) Copyright Thomson Reuters 2016.

©2020 GPlusMedia Inc.

13 Comments
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If a doctor is prescribing SSRIs (anti-depression medication) such as Prozac, Zoloft, etc, then, yes, the doctor should ask about gun ownership. Nearly all mass-shootings in the US were perpetrated by a shooter that had been prescribed SSRIs. The warning labels on anti-depression medication list such possible side-effects as "suicidal thoughts" and "psychosis."

3 ( +4 / -1 )

Wc626JUL. 28, 2016 - 04:02PM JST Doctors should be able to ask patients about guns Okay. Then gun dealers should profile muslims. The FBI should be alerted. And if there are any red flags, no sale.

Let's take a minute to examine the train of logic you just put on display here, because it's fascinating and I think really says a lot about where you're coming from.

A doctor wants to know if you own a gun so they can give you the best advice possible to maximize your safety and the safety of your family. They have no power to take away your gun, no power to discriminate against you in any way for owning a gun. They simply want to make sure you know how to prevent accidents with the gun and help you with that.

You respond with a bargain (as though the right of doctors to practice their expertise properly was up for auction) that gun dealers should be able to discriminate against a religious group you disapprove of.

That really says a lot.

3 ( +4 / -1 )

@DeepForest, they are trying to restrict the right of doctors to ask particular questions, thus it can be construed as restricting free speech as well as violating the professional integrity of doctors.

2 ( +2 / -0 )

When I see a person with a gun in or out of uniform. I assume one of two thoughts. There is a very important need to protect that area from danger at this moment or that this are is very dangerous at this moment. So if I see a cop I stay away because of one fact he has a gun. Meaning he has a need to protect from danger. So not being near a cop or a person with a gun does lower the chance of getting shot. Hence lower the danger. So gun are dangerous weather who has the gun.

1 ( +1 / -0 )

@Reckless What does the "freedom of speech" have to do with asking personal questions?

1 ( +2 / -1 )

This debate isn't new - I remember encountering about this discussion months ago. Heck, they even had time to do a poll already:

http://www.newsmax.com/Health/Health-News/docs-guns-ask-paients/2016/07/25/id/740445/

A majority of U.S. adults say it's at least sometimes appropriate for doctors to discuss guns with patients during check-ups, a nationwide survey finds.

While just 23 percent of people surveyed thought it was always OK for doctors to ask about guns, another 14 percent said this was usually appropriate and an additional 30 percent considered it reasonable in some situations.

1 ( +1 / -0 )

No, they should inform the correct authorities and that person is dangerous to the community and should be cross reference on a data base to detect gun ownership and what works he is involve in. Like he could be a person who is in charge a of town water or drives a train. Yes doctor have a responsible to inform the correct authorities if they have concern of the mentality of their patients.

0 ( +0 / -0 )

first amendment applies to doctors too

0 ( +2 / -2 )

Makes one wonder if American Doctors will be asking about changing your car's oil etc. With the little time they have with patients it makes little sense to be talking about guns and issues they have little education on.

http://www.theblaze.com/stories/2013/01/09/this-is-how-a-secret-gun-provision-made-its-way-into-obamacare-legislation/

Law is fairly clear about Dr's asking about guns.

0 ( +0 / -0 )

Does the good doctor ask if his patients have or carry knives, pocket or otherwise? How about if they light off fireworks, especially on the 4th of July or New Year's Day? Does he ask if they self-serve their cars at the gas station, and fill up at the pump themselves? Does he ask hos patients if they use hairspray? What abut asking his patients if they swim in pools, which have water that is high in chlorine? Does he ask them if they drive a car, ride a bike or take the bus? Does he ask them their choices of occupation (especially if his patients are in construction, car or motorcycle racing, nuclear facilities, the National Guard or Military Reserves, fire fighters, cops, or EMTs)?

How about simply asking medical doctors to do what they're trained to do: practice medicine? Asking someone about their possession of firearms would seem to be a question for an attorney, not a medical doctor.

0 ( +0 / -0 )

If you want to ask people about guns then law enforcement is the career for you!

-3 ( +1 / -4 )

Sorry doc, asking about guns isn't your problem because guns are not nearly as dangerous as other things, like swimming pools, or say, the insufficiently tested drugs you prescribe to your patients.

-3 ( +2 / -5 )

Doctors should be able to ask patients about guns

Okay. Then gun dealers should profile muslims. The FBI should be alerted. And if there are any red flags, no sale.

-6 ( +0 / -6 )

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