Last week I attended a conference on medicine and gun violence in which a cross-section of researchers and clinicians focused on how to figure out if patients are at risk for gun violence and how to intervene appropriately when such a clinical situation appears to exist. The problem raises medical, legal and ethical issues involving proper patient care, privacy, liability and other questions that the medical profession has been wrestling with for a long time but have really come home to roost this year. Three states have now passed laws limiting the degree to which physicians can ask patients about guns and only a last-minute surge of votes from Democratic Senators who will shortly be replaced by Republicans allowed a Surgeon General to be confirmed whose views are decidedly anti-gun.
Throughout the conference I kept listening to presentations which were based on an assumption about medicine and guns which I’m not sure is really true. And the assumption goes like this: in order to effectively raise the issue of gun risk, the physician must first determine whether a patient is, indeed, a risk to himself or others if he has access to a gun. And if the physician determines that the patient is, in fact, a health risk if there’s a gun around, how do you determine the degree of gun access without invading the patient’s right to privacy or infringing on his right to own a gun whether he’s a risk for gun violence or not?
The reason I’m not comfortable with this assumption is because I happen to believe one simple thing about guns, namely, that if there is a gun lying around, locked or unlocked, the risk of gun injury is simply much greater than if the gun doesn’t exist. To borrow a phrase from the late Elmore Leonard, “Don’t fool with guns in here, okay? The goddamn piece’s liable to go off.” Now researchers can parse all the data with a fine-tooth comb from today until next year, but the bottom line is exactly what Leonard says: if it’s around sooner or later it’s going to go off.
Now don’t get me wrong. I’m not anti-gun, no matter what many people who read this blog and others will choose to believe. I currently own two black guns, a Colt H-Bar and a Ruger Mini-14, along with a Mossberg tactical shotgun, a Marlin 30-30, without doubt the single best deer gun ever made, and one of those Remington 700s in 270 Winchester which might go off even if the trigger isn’t pulled. Not that I’m against handguns, for that matter, because I also own every Glock in 9, the two John Browning masterpieces, a Colt 1911 and a P-35, a Walther PP in 22, another Walther PP in 32, a little TPH for when I’m out walking in shorts, three or four K-frame Smiths and just for good measure, a S&W Model 39. And I almost forgot the two Sigs I own, the new little guys in 380 and 9. But I know one thing about all my toys – put a round in the chamber, pull the trigger and if someone’s standing in the direction in which the gun is pointed, they’re going down.
It’s all well and good that physicians are concerned about how to make guns safer, how to keep them out of the “wrong” hands, how to lock them up or lock them away. But I think what doctors should do is always tell all their patients that a gun can cause real harm. And they should say it again and again. My internist doesn’t ask whether I smoke before cautioning me not to light up a cigarette. Pediatricians don’t ask parents whether they fasten the child’s seatbelt before reminding them to make sure the kids ride safe. The role of the physician, every physician, is to reduce harm. Not having a gun reduces harm. The patient doesn’t agree with you, that’s fine. But you did what is required and expected of you, which was to say something true about risk from guns.