Should Doctors Talk To Patients About Guns? They Talk About Other Risks, Don’t They?

This week Dr. Garen Wintemiute and several colleagues published an article that detailed both the legal and clinical issues involved in counseling patients about guns. Not only did the article summarize the current legal environment surrounding doctor-patient communications, but it also presented a schema for helping doctors to determine how to respond to a patient’s access to guns based on factors such as depression, substance abuse and other known causes for violence against oneself or others.

docs versus glocks           The article received significant exposure both within and without the medical community, so it didn’t take long for a few physicians whose self-appointed task is to defend gun-owning America against the evil intrusions of gun-grabbing physicians to respond.  The first response was by a physician in California who claims that asking patients about gun ownership infringes on their 2nd-Amendment rights.  So, according to this logic, the 2nd Amendment only allows Americans to own guns, it prevents any discussion about guns.

This gun-loving doctor, Arthur Przebinda, agrees with Wintemute that doctors should be allowed to engage in gun counseling if the patient “shows signs of mental illness,” but he nevertheless finds Wintemute’s report ‘misleading’ because – are you ready for this one? – it is based on Wintemute’s own research. [My italics.]

Is this guy serious?  Does he expect a single medical professional to take him seriously because he claims that Wintemute’s article is in error because it is based on Wintemute’s own research?  What should a peer-reviewed article in a medical journal be based on?  No research?

But the truth is that Przebinda isn’t interested in communicating his nonsense to the medical community; his sole agenda is to try and influence the thoughts of gun owners, some of whom might otherwise be tempted to actually take seriously what medicine believes to be the problem with guns.  And the problem with guns is very simple: they constitute a risk.  How much of a risk?  This remains a subject of debate because thanks to the twenty-year freeze of CDC gun research, a freeze that Dr. Przebinda wholeheartedly supports, sufficient research has not been accomplished to determine exactly the degree to which gun ownership increases the possibility of deaths or injuries from intentional or unintentional use of a gun.

“They’re trying to identify gun ownership as a risk factor, the same way they would define smoking inside the house,” says Przebinda, and that’s exactly the point.  Because smoking is harmful. And so are guns. Period. End of story.  What does Dr. Przebinda think happens to human tissue when it is struck by an ounce of lead travelling faster than the speed of sound?

Now don’t get me wrong.  I’m not saying that it’s wrong to own a gun.  And if someone believes, massive evidence to the contrary, that keeping a gun in their home makes them safe from crime, then they can believe it all they want.  And they can also own a gun. But when was the last time doctors made a decision about what constitutes medical risk based on whether a marketing organization like the NRA agreed with them or not?  Did doctors refrain from asking patients whether they smoked before cigarette companies admitted that smoking causes cancer and other serious disease?

A rational and reasonable medical response to Pzrebinda’s pro-gun stance is provided by Dr. Eric Fleegler from Boston Children’s Hospital who says that discussions about guns should be “delicate conversations.”  But let’s remember that many discussions between doctors and their patients are delicate, which is exactly why such conversations are protected from public disclosure no matter what the NRA and their pro-gun acolytes would like gun owners to believe.

Physicians engage in very private and very delicate discussions all the time: an elderly parent is losing his mind, a teenage child is into drugs. These are medical risks that only doctors can evaluate and help patients to better understand. Which doesn’t mean the patient has to ever go along with what the doctor says. But it still has to be said. Guns are a risk.


If Schools Can Teach Safe Sex, Can’t They Teach Safe Guns?

Sooner or later, probably sooner, the number of Americans who die in car crashes each year will be exceeded by the number of Americans who die because someone put a bullet into their brain, or into their chest, or into some other vital part of their anatomy and the most skilled trauma surgeon on call when they are rushed into the ER won’t be able to put them together again.  I’m not being sarcastic when I talk about the skill of the trauma surgeon, by the way; gun injuries are much more difficult to treat than any other kind of serious trauma and the costs of gun injury to the medical system are two or three times higher than the costs of any other type of injury.

auto                An interesting commentary on the auto trauma – gun trauma issue was recently posted on Huffington written by a pediatrician, Claire McCarthy, who practices at Boston Children’s Hospital.  Dr. McCarthy makes the point that the response to injuries usually involves some kind of safety laws and rules that will limit injuries and therefore reduce risk when the particular product is being used.  In this regard she cites the fact that all states have similar licensing requirements for driving, and that all states require seat belts, particularly when kids are in the car. On the other hand, she notes that licensing for gun ownership varies from state to state if it is required at all, and that when new gun laws are proposed, somehow the argument turns into a disagreement about rights, not about safety.  The way she puts it, and I love this sentence: “I can’t imagine someone framing motor vehicle safety as a personal freedom issue.”

Dear Dr. McCarthy: Let me be the first one to welcome you to the world of guns.  Because in the gun world, particularly the gun world as it has been created and nurtured by the NRA, gun safety has absolutely nothing to do with safety, it only has to do with rights.  And your innocence in this regard (obviously intended, not real) is your comment that “we get that cars are dangerous.”  Which is exactly the point.  For the folks who live in the gun world, guns aren’t dangerous.  In fact, the whole reason for owning a gun is that it protects those of us who inhabit the gun world from things that are really dangerous like robbers, and street thugs, and terror cells which are now, according to the NRA, actively operating in every city.  What do cars protect us from?  Being late to work and getting chewed out by the boss?  Big deal.  That’s hardly a trade-off.  I’ll take the protective value of guns over cars any time.

But seriously Dr. McCarthy, your Huffington op-ed was what we would expect from someone with your background, training and experience.  It was literate, informed, rational and based on evidence-driven facts.  The only problem is that the folks who really need to be persuaded by your enlightened approach to the problem of gun violence don’t think that way at all.  The day after Christmas a young mother was shot to death in a WalMart in Idaho.  She wasn’t shot by a robber or a terrorist – she was shot by her two-year old son who reached into her pocketbook and yanked out her loaded gun.  Now what in God’s name made this poor woman actually think that she needed to defend herself in a WalMart store?  And we’re not talking about some semi-literate living in a trailer park in Tennessee.  The victim was a college graduate who worked at the U.S. Department of Energy lab and I’ll bet she made sure to buckle her kid into that safety seat before she drove off to the store.

Public health approaches to injuries – seat belts, window gates, pool fences – have worked again and again.  What we need in the case of guns is something much more fundamental.  We need education and if schools can teach safe sex and safe eating, why can’t they teach safe guns?