The American Medical Association Needs To Be Clear: Guns Are A Risk To Health.

Our friends at The Trace emailed an article yesterday about the decision by the American Medical Association to debate and possibly adopt some gun-control measures when the organization gets together for tor their annual meeting in June. According to the AMA President, David O. Barbe, a family physician out of Missouri, the grand poo bah of all grand medical organization poo bahs will debate a nearly a dozen proposals to reduce gun violence and then put its “considerable lobbying clout behind legislation heading into November’s mid-term elections.”

md-counsel             The AMA is already on record backing such ‘commonsense’ strategies as comprehensive background checks, handgun licensing and waiting periods and ‘mandated penalties’ for gun crimes, whatever ‘mandated’ means. According to Doctor Barbie, this year’s grab-bag of proposals includes banning bump stocks, strengthening the background check system, banning assault rifles and high-cap magazines, and increasing the legal age for gun purchases from 18 to 21. All of these ideas and others stem from a basic notion, says Dr. Barbie, that “gun violence in America today is a public health crisis, one that requires a comprehensive and far-reaching solution.”

I am going to be rather blunt and somewhat descriptive by saying that I think Dr. Barbie and his AMA colleagues are once again reducing the issue of gun violence to just another talking-point which, if debated and adopted at the annual meeting, will accomplish absolutely nothing at all. In other words, it’s a load of crap. God knows we have enough decent, dedicated and devoted gun-control advocates and organizations promoting these same issues all the time. Why should the medical profession, which represents the most objective and science-based approach to how their responsibilities and practices are defined, just get on line behind everyone else who wants to do something about the 125,000 deaths and injuries suffered each year because of guns? What the AMA should be doing is insisting that the issue of gun violence be taken seriously within the practice of medicine itself.

Every medical school curriculum contains teaching modules about violence – how to define it, how to spot it, how to counsel about it and who needs to be contacted if the patient is at immediate risk. Guess what?  You can search all these treatment protocols and you won’t see the word ‘gun’ or the term ‘gun violence’ even once. And gun violence isn’t the same thing as picking up a baseball bat and whacking your younger bother over the head. It’s not the same thing as getting into a fight. It’s a random and highly lethal type of behavior that creates a level of injury which at best requires a significant outlay of medical resources and at worst leaves the victim dead.

What do we get from the medical profession these days when it comes to discussions about what to tell a patient who says that he or she has access to a gun?  We get this nonsensical and ill-advised bromide about safe storage because, after all, we need to ‘understand’ and ‘appreciate’ the culture of patients who believe they are safe if they own a gun.

The studies which show that guns are a risk to safety and health do not distinguish between stored and unstored guns. And as far as I’m concerned, a physician who does not advise patients to get rid of their guns, pari passu, is teetering on the brink of violating the Hippocratic Oath, which does not (read: not) make exceptions for patient ‘culture’ as regards the doctor’s responsibility to reduce harm. Doctors should join and lead the gun-violence discussion by talking about what they know, which is the issue of medical risk. And medical organizations like the AMA should be promoting one very clear message, namely, that guns are a risk to health. This means all guns, no matter how they are stored or how many background checks are required before owning a gun. I know this, and even though I’m also a doctor, I’m just a lowly Ph.D.

 

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What Do Doctors Tell Their Patients What To Do With Their Guns? No Surprise – It Depends On The Doctor.

A new study by Eitan Hersh and Matthew Goldenberg is making waves both in the medical and wider media because it appears to say what Gun-nut Nation has been saying forever about doctors and guns; namely, that doctors don’t like guns.  And since doctors don’t like guns, according to this line of non-thinking, they shouldn’t talk to their patients about guns.  And if they didn’t talk to their patients about guns, to follow this non-thinking line to its absolute conclusion, there wouldn’t be anything known as ‘gun violence,’ because everyone knows that gun violence is a figment of the CDC’s imagination anyway.

docs versus glocks           Okay, let’s get back to reality.  To gather, analyze and understand their data, the authors first created a patient ‘vignette’ which described an initial screening interview between a male or female patient and a primary care provider (PCP.)  During the interview, the patient admits to nine not-atypical health factors (tobacco and alcohol use, depression, etc.) that can cause medical problems, one of them being access to guns.  The roughly 300 physicians who participated in the study were then asked to rate how much they considered each of these health factors to represent medical risk, as well as how they would respond to each one. Their responses were then evaluated based on additional data which matched each respondent with voter registration; a process that was not mentioned to survey respondents so as to avoid the possibility that survey answers would be biased based on how respondents felt their answers might be judged.

To quote the conclusion of the study: “Our findings suggest that Republican and Democratic physicians differently assess the seriousness of patient health issues that are

politically salient. Republican physicians also differ from Democratic physicians in the treatments offered to patients who present with those health issues.” And of the nine issues that comprised the health vignettes, on which particular issue did physicians identified as Republicans versus physicians identified as Democrats differ most widely regarding degree of risk?  You got that one right – access to guns.  Grouped by political affiliation, the two groups more or less agreed on the same degree of risk when it comes to helmets, obesity, tobacco, depression, alcohol and professionally-furnished sex.  Republican-affiliated physicians rated abortion and marijuana use as their greatest concerns, Democratic-affiliated doctors viewed these two issues as having little or no concern at all.  For blue doctors on the other hand, they were most concerned about access to guns, in the case of red doctors gun ownership did not register as a concern.

So far the survey results in terms of the correlation between political affiliations and views about the health risks posed by guns holds no surprise.  After all, most gun owners are Republicans, most gun owners do not consider their guns as a risk to health, so there’s every good chance that many physicians who are affiliated as Republicans will also own guns.  Or at least may share similar views on gun access with their patients who own guns.

Ready?  Here’s the rub.  Recall that the survey not only asked participating doctors to assess the degree of risk, but also asked them to describe a treatment plan for each risk vignette.  And when it comes to firearms, both blue and red doctors would discuss gun risks, but the Democratic-affiliated physicians would counsel patients not to keep firearms, the GOP-affiliated physicians opted for ‘safe storage’ plans.

What this survey reveals is that even though physicians may differ on whether gun ownership poses a health risk, there appears to be across-the-board consensus that patients should be counseled about access to guns.  Where the partisan divide appears is not on the issue of gun-risk per se, but on the most effective strategy for mitigating that risk.  And this is a very important finding because if you listen to Gun-nut Nation, they’ll tell you that guns don’t pose any risk to health at all.  And after all, who really knows more about health – the AMA or the NRA?