Now that the Republican Party has decided the Affordable Care Act will simply ‘implode’ without their help, stories are appearing about out how the majority party in both Houses of Congress and also sitting behind the HMS Resolute desk in the Oval Office couldn’t get it done. This morning David Leonhardt, an op-ed writer for The New York Times, penned a piece in which he celebrated the efforts of a wide swath of citizens who were the activists behind the Republican legislative demise. And one of the groups he singled out for praise were physicians, whose professional organizations really stood up and helped lead the fight.
The idea of doctors being politically in a partisan way is a relatively new thing. Referring to a public statement by the chief of Mass General Hospital decrying Trump’s attack on transgender military troops, a primary care doctor at Mass General said it like this: “Traditionally, health professionals have not commented so boldly on the actions of politicians.” She then went on to say that, “many of the most critical current threats to our health — including poverty, lack of access to affordable health care, gun violence, the opioid epidemic — cannot be eliminated by individuals, no matter how well-meaning.”
I have no expertise in affordable health care or opioids, but I do know a little something about guns. And I have been watching and helping physicians deal with gun violence on the individual, i.e., clinical level for a number of years. And what concerns me about the medical approach to gun violence is that, unfortunately, it doesn’t appear to be rooted in the elimination of a public health issue which kills and injures 125,000+ people every year. Rather, the medical response to gun violence views the problem as one that needs better controls, which is not the same thing as getting rid of it altogether – not the same thing at all.
Last year the Massachusetts Attorney General and the Massachusetts Medical Society collaborated on the production of informational resources that physicians could utilize to become better informed on how to talk to patients about guns. Here’s what is suggested as an approach for counseling patients on gun risks:
Meet patients where they are. Where there is a risk, see if you can brainstorm harm-reduction measures with the patient, as opposed to prescribing one specific solution. For example, rather than advising a patient to get rid of a gun, you could suggest that there are a number of different ways to make guns less accessible, ranging from selling/surrendering the gun, to disposing of ammunition, to temporarily storing the gun outside the home.
This statement embodies what one of the most noted physician researchers, Dr. Garen Wintemute (along with several colleagues) suggested was the proper way for physicians to engage in gun discussions, based on the idea that “conversations should acknowledge local cultural norms,” with the desired outcome being “firearms are stored unloaded and locked, with ammunition stored separately.”
So the bottom line is that the new-found, public advocacy by physicians about gun violence should occur within certain, self-imposed constraints, the chief one being that doctors, unless there is an immediate and verifiable risk, should find ways to communicate with gun-owning patients which avoids the basic issue, namely, that guns, no matter how safely stored, are a serious risk to health. Period. End of story. Enough is really enough.
We have made remarkable strides in reducing smoking, another clear health risk. According to the CDC, the percentage of adult smokers is now less than 20%, when I was a kid, everyone smoked. This didn’t happen because doctors told patients that perhaps they should smoke less. It happened because no physician would ever dare tell a patient that smoking is anything other than a clear threat to health.
You think guns are any different? If someone wants to be ‘safe’ with their guns, they can always take one of those phony safety courses offered by the NRA. Physicians shouldn’t be promoting the idea that a gun isn’t harmful to health.