Now Docs Have The Information They Need To Talk To Patients About Guns.

Back in 2015, eight national medical organizations and the American Bar Association issued a ‘Call to Action,’ promoting the idea that physicians should take a more active and aggressive role in talking to patients about gun violence.  Nobody argues with the fact that more than 115,000 Americans are annually injured or killed with guns, but leave it to Gun-nut Nation and their various sycophantic noisemakers who claim it isn’t a medical issue.  According to these dummies, it’s the ‘person,’ not the ‘gun’ which causes gun injuries, so why worry about the gun?

md-counsel             It wouldn’t matter if the NRA and its toadies would just say what they have to say and leave it at that.  But in Florida they got a law passed which criminalizes physicians who counsel patients about guns, and there’s even a physician in the U.S. Senate who (briefly) ran for President and chased the NRA vote by telling everyone that he didn’t think that guns were a public health issue at all.

The good news is that the medical community has refused to be cowed by this distemperate demonstration of stupidity and has begun asserting its authority to put the discussion about gun violence exactly where it belongs, namely, in face-to-face meetings between patients and their doctors which happen every day. And the news is that last week the 11th Circuit told the State of Florida to take its pernicious attempt to gag doctors and shove it you know where.

But while most people have no issue with a doctor talking to them about guns (after all, there’s no law that requires a patient to follow a doctor’s advice) many physicians don’t know what to say to their patients in discussions about guns. It’s not part of the medical school curriculum, there’s no medical academy that has yet to publish a treatment protocol on the subject, and many physicians don’t own guns.  So how to proceed?

Now there’s an answer and it has been provided by a collaboration in Massachusetts by the Massachusetts Attorney General and the Massachusetts Medical Society which has now posted informational pamphlets on gun safety both for patients and physicians, as well as a Continuing Medical Education (CME) course on counseling patients about guns.  Together, these resources constitute the most comprehensive effort yet developed to help physicians both identify patients who might be at risk for gun violence, as well as specific counseling strategies that might be employed in a clinical setting.

The CME course, available to the public either as a video or viewable slides, includes a section on how to initiate a conversation about gun safety which recognizes the fact that most gun owners are very conscious of the necessity to be careful with their firearms, so reminding them of the need for safety should not be done in a judgmental or accusatory way.  Even more important is the presentation of five clinical scenarios, each describing a different situation involving potential gun violence risk (possible suicide, intimate partner violence, child playing with a real gun, etc.) and recommendations on how to effectively communicate risk-mitigating options to the patient and family members.  Perhaps the most instructive scenario covers how to respond to the patient who is reluctant to talk about the existence of firearms in the home, and the guidance offered for this scenario might also ease the concerns of patients who would rather not discuss the gun issue at all.

This effort marks a significant step forward in the medical response to gun violence because we now have a substantive resource that can be used to make physicians feel more confident in talking to patients about guns and give patients reassurance that their physician is interested in their health and not trying to promote a particular point of view. An effective doctor-patient relationship assumes that any subject which arises during a medical consultation can be treated in a compassionate, honest and medically-proper way. It also assumes that the physician will give the patient evidence-based information about any risk to health. These new resources do both – it’s a big win-win.

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7 thoughts on “Now Docs Have The Information They Need To Talk To Patients About Guns.

  1. I read the pamphlets. They are not completely awful.
    Although folks often struggle to explain their concerns about the issues of privacy, there is more than paranoia here. Electronic medical records are anything but secure to hacking and many systems are designed by Government actors from the start to give them access to whatever they want. In other words, if someone affirms to their MD that they own firearms that information will be potentially available to multiple government entities without their consent.
    Here is something to ponder: Mental health providers are generally refusing to digitalize their private talks with their patients. The feeling is that trust and openess would vanish forever with the first data breach or evidence of governmental use of private, sensitive information.

    • What you are saying is simply not true. Mental health providers are not required to keep any record of what a patient says to them. They are required to keep records on diagnoses like any other physician. As for the security of medical records in general, what are yo saying? That we shouldn’t have an y medical records on digital venues? Why not get rid of all VISA cards, bank accounts and every other form of electronic record-keeping.

  2. Let me put it this way: I would not put any transaction that I wanted to remain securely private on a Bank Card or any digital medium. Such information is discoverable by various means legal or otherwise. If I want to buy something (like a gun) that I desired to keep private and out of the public domain, I pay cash for it from a non FFL source. Everybody does. That includes ammo or anything that can potentially be connected to it.
    The purpose of the 4th and 5th amendments were to protect privacy. The founders understood that there can be no freedom without zones of privacy. Without privacy, everyone is vulnerable; certainly too vulnerable to participate in public life. Everyone can potentially be pressured or blackmailed over something. Or, the bad guys will just know how best to threaten you. The Founders were what you could call “Realists”.
    Disclosure: I am an MD who now works in healthcare IT. I happen to know a lot about the porosity of electronic medical records and one of the things they were deliberately designed to do (reduce citizen privacy). Am I paranoid? Yes. Were they designed that way? If you think otherwise, well, I wish you luck. The disclosures of widespread government snooping made by various whistlebowers like Snowden and Assange should surprize no-one. Who designed the effing internet in the first place? Do you think they forgot to give themselves a backdoor entrance?
    I talk to Psychiatrists as peers and drinking buddies. Their “records and diagnoses” are often concerning the most private details of their patients lives. They tell me that if the patient saw them typing into a computer as they were telling their most private facts, their patients would run away.
    And they would not blame them.

  3. I appreciate your comments because although we obviously disagree, at least the conversations are civil and I am happy to trade opinions with anyone as long as a basic respect for other points of view are exhibited. So by all means please feel free to continue posting to my site.

    I should tell you that prior to my retirement, I was an IT Vice President for a Fortune 100 company, my accountability was web and I was responsible for the web portals that the enterprise maintained for 35,000 customers, 7,000 field salesmen and 4,500 home office employees. And this obviously included infosec. So I think I know a little bit about whether information is protected or not.

    Occasionally, your paranoia gets the better of you. The internet was invented by the U.S. Army, not by some government people who wanted to find a way to get citizens to give up private information. IT became proprietary technology in the early 90s because the commercial possibilities were too attractive to the private sector. Your statement that ‘everyone’ pays cash for their guns and buys them privately is absurd and simply not true. You can believe it if you like but what you are saying has no basis in facts whatsoever, even if you know some guys who do it that way. I also buy guns privately for myself from time to time. So what?

    As for your knowledge of Constitutional law, the 4th and 5th amendments have nothing to do with privacy. And if you are convince they are, then I suggest that instead of just making up whatever you think sounds good, you take the trouble to read the debates about those Amendments while they were being drafted. In fact, both amendments were put into the Constitution as a response to warrantless searches by British troops and the practice of forcing colonials to let British troops live in their houses. Of course you can say that this was an ‘invasion of privacy,’ but don’t stick 20th century words into the mouths of 18th-century thinkers. For someone who no doubt believes that the Constitution should be interpreted literally, you certainly have no trouble taking the text out of context when it suits your argument.

  4. Fair enough.
    90% of the firearms I own are fully documented. I just assume I could not keep those if the authorities decided so. Would they kick down my door to seize them? No. I would just be informed that if I did not turn them in, my cell phone would stop working and my digital cash would be frozen.
    I know this is not quite true today. I am pretty sure there are folks who are salivating at the prospects for the future.
    I have on my desk a terminal that, with the right passwords, I can look at any of the digital medical records of millions of people in real time if I have their real name and date of birth. And I am not even in government.
    The basis of the Roe v Wade decision on abortion rights was built on the “emanations from the pneumbra” of the Constitution regarding the essentiality of privacy to all other rights. I think that went 7-2.

  5. Roe versus Wade was the first time that any case was based on a Constitutional right to privacy. There was never any previous recognition that the Constitution gave anyone a privacy ‘right’ at all. Please don’t try to stretch a meaning when there’s no meaning or mention of it. Sorry, that’s not how we analyze legal texts. And if you don’t turn in your gun you’ll lose your cell phone account? What kind of dope are you smoking? Please send me some – then I can get as high as you obviously get when you post something for my website.

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