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

February 21, 2024

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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?

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.

Want To Help Reduce Gun Violence? Support The Children’s Firearm Safety Alliance.

October 18, 2024

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A new gun violence prevention organization has just popped up and their goals are worthy of mention here and elsewhere. The organization is called the Children’s Firearm Safety Alliance (CFSA) representing a coalition of physicians, law enforcement, prosecutors, lawmakers and gun violence prevention (GVP) advocates, and its goal is to reduce gun violence committed by or against kids.

cfsa You may recall that back in 2011, Granny Hammer got a bunch of her ass-backward Florida legislators to pass a bill that basically made it a felony for physicians to counsel patients about guns. The case is still awaiting a final appellate decision and there are several other dumb states that have enacted similar ‘gag’ laws. Until Docs vs. Glocks was enacted, the medical community had been fairly reticent to speak out about gun violence beyond the obvious policy pronouncements about the dangers of guns. But one thing that always seems to happen when it comes to any kind of public policy – push hard in one direction and someone will push back. Which is exactly what has happened when it comes to physicians and guns.

Last year eight of the most important medical associations, along with the American Bar Association, published a manifesto which declared that gun violence was a serious public health problem that required the medical community to get involved. And many of the national and state-level organizations followed by issuing their own statements of concern, as well as supporting and sponsoring educational programs to bring the issue of gun violence to the fore.

The CFSA represents another important step towards the involvement of the medical community in efforts to reduce gun violence, because although it is a physician-led organization, its membership embraces all of the major stakeholders who have an interest in GVP. According to the CFSA website, its mission is: “To reduce senseless child unintentional deaths and injuries in every state by advancing legislation holding adult gun owners responsible and educating the public how to keep children safe if a gun is in the home.” And to that end, their intention is to advocate for stronger and more comprehensive child access prevention (CAP) laws, of which there are no laws at all in more than 20 twenty states.

Of course the response of the Gun-nut Nation noise machine to physicians getting involved in gun safety is that such activity should not be within the scope of medical activities because most doctors don’t know anything about guns. This is the argument made by a handful of dopey doctors who run a website called Doctors for Responsible Gun Ownership, which happens to be supported by the 2nd Amendment Foundation, get my point?

But the fact is (note use of the word ‘fact’) that physicians have played a leading role in campaigns to protect children from all kinds of injuries and unintentional harm, including efforts to mandate harnesses and seat belts, safety barriers around in-ground pools, removing lead from paint and toys, and child-resistant bottle caps to guard against the ingestion of toxic substances and meds. I don’t hear anyone stating that doctors need to get certified as automobile mechanics before they remind parents to buckle in the kids. Nor for that matter do they need to become lifeguards in order to ask whether there’s a fence around that pool which just got installed in a patient’s backyard. But guns? Nobody except a licensed gunsmith should be allowed to voice an opinion about safety and guns, right?

I am pleased to be able to spread the word about the Children’s Firearm Safety Alliance and I urge you to give them your full support. Yea, yea, I know you just have to send Hillary a few more bucks this week but as regards the CFSA, you might also consider sending a donation their way. And just in case you missed their website address up above, don’t bother to scroll up because here it is again. Click here, check out their website and sign up for a great cause.

 

What Should Doctors Ask Patients About Guns? Everything.

May 17, 2024

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You may recall that back in April, 2015, eight national medical organizations plus the American Bar Association called deaths and injuries from guns a “major public health problem in the United States,” and asked for a stronger medical response to gun violence. Now if these medical groups, representing every medical specialty, had issued a joint statement about any other medical issue that causes more than 100,000 deaths and injuries each year, the public reaction would have ranged from ‘what took you so long?’ to ‘let’s get to work and solve the problem.’ But in this instance, of course, much of the public reaction came in the form of the now-traditional response by Gun Nation, telling the tribe that this was simply another attempt by gun-grabbing, anti-gunners to take away all the guns.

When medical groups advocated in favor of seat belts, did anyone say that car safety wasn’t a medical issue because physicians didn’t, as a rule, undergo training on car repair? The proper medical response to any problem that causes injury is both prevention and cure; prevent the injury before it happens which reduces the number of people who then show up looking for a cure. But the gun lobby is wedded to the idea that there is no such medical condition known as ‘gun violence,’ and to degree that on a rare basis someone accidentally gets hurt using a gun, it’s a small price to pay considering that armed citizens prevent millions of crimes each year.

Having observed the ease with which Donald Trump convinces his supporters that his lies are really self-proclaimed truths, I’m not surprised that millions of Americans and certainly a majority of gun owners agree with the nonsense that the NRA and like-minded sycophants continue to spread about the benefits of owning a gun. But physicians do not have the luxury of developing treatment guidelines for medical conditions based on what their patients might want to believe. When research indicates repeatedly that a certain type of behavior creates medical risk, then medical professionals must respond on that basis and that basis alone, regardless of what people who sell guns for a living would like their customers to believe.

Which is why the new article by Garen Wintemute is so important because what he and his research associates are trying to do is develop a practical method to communicate concerns about gun risk to patients who might be predisposed to reject or be skeptical about what their physician tells them about guns. Their initial article, published last August, discussed the need for physicians to acquire a higher level of ‘cultural competence’ in order to communicate effectively with gun-owning patients; in particular calling on gun-owning physicians to provide leadership in developing messaging that gun-owning patients would more likely understand.

But adopting a respectful and supportive toward a patient with a different cultural outlook is one thing; knowing what has to be communicated from a clinical perspective is something else. And Wintemute’s group has now taken that step by publishing a new article that seeks to define what physicians should say and/or do if they believe that a patient’s access to guns creates a medical risk. Aligning proper responses to different levels of medical risk is standard procedure for nearly all public health issues, particularly those issues, like gun violence, that have been listed as public health concerns for more than twenty years. But thanks to the ban on CDC gun violence research and the continuous anti-medical drumbeat of the NRA, creating proper medical messaging for gun violence has been tantamount to finding yourself in deep water without a paddle or even a canoe.

The medical profession needs to ignore the NRA and self-aggrandizing politicians who cynically use their opposition to the concept of gun violence as a medical risk to inflame their base. After all, Galileo spent the last nine years of his life under arrest, but when we drop a solid object, it still falls straight down.

 

Should Doctors Stop Talking About Gun Violence Because Medical Errors Cause More Deaths? No.

May 7, 2024

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Gun Nation is abuzz with the publication of an article in the British Medical Journal which finds an alarmingly high rate of U.S. hospital deaths due to medical errors. Now why would the pro-gun noise machine care one way or the other about an article in a medical journal? Because it’s been an article of faith amongst the gun faithful that physicians should stop wasting their time talking about gun violence when the number of people killed each year by firearms is just a fraction of the number who die due to medical mistakes. And since the BMJ article states that medical errors account for anywhere between 200,000 and 400,000 avoidable deaths each year, and annual gun homicides only count around 11,000, why can’t doctors take care of really ill patients properly before they start making so much fuss about guns?

docs versus glocks Marion Hammer, former NRA President who spearheaded Docs versus Glocks in Florida, says that docs should “do no harm” and keep their political opinions out of the examining room. And in pushing for the gag law, Hammer distributed a document that listed ‘medical misadventures’ as three times more likely to result in deaths than accidental shootings. Other sources, like media that promote natural healing, paint an even grimmer picture, with one expose claiming that guns kill 31,940 Americans each year (homicide/suicide/accidents) but the medical system accounts for783,936 deaths! By the way, this particular website also published a story that said the San Bernardino shooting had all the “signs” of a staged government operation, and this story rolled out more than 31,000 times. Hmmmmm.

The problem is that the British Medical Journal isn’t an adjunct of the Area 51 gang, so when they publish something about morbidity from medical errors, it needs to be taken seriously, particularly if what they say ends up being injected one way or another into the gun violence debate. Now let me make it clear that I’m not a physician and I have no medical training of any kind. But I know how to read the King’s English and I can figure out whether data in a peer-reviewed journal aligns with the facts and conclusions on which the article is based. In the case of the BMJ, I not only read the article detailing mortality rates from medical errors in U.S. hospitals, I also closely read the articles on which the BMJ article was based. Let’s start first with the BMJ.

In 2013, 611,000 Americans died from heart disease, 585,000 died from cancer and 251,000 died from medical error, this last being the third most common cause of death. Since the medical profession doesn’t actually have specific medical errors as coded events in the ICD-10 coding system used almost universally as the primary indicator of health, the figure noted above is a best-guess estimate based on specific studies of in-patient outcomes throughout the U.S. The most comprehensive study from Medicare records, gave the total mortality for doctor errors as slightly more than 195,000 per year from 2000 through 2002, of which 75% of all deaths were attributed to something known as ‘failure to rescue,’ which means a diagnostic error leading to improper (or no) treatment, leading to the patient’s death.

But failure to rescue in a clinical context may have little, if anything to do with decisions made by physicians themselves. Many such deaths are attributable to mistakes in managing patient information, particularly for elderly patients who tend to suffer from multiple conditions requiring intensive and complicated care. A necessary treatment is omitted or delayed, vital signs begin to decompose, the patient is dying but his physician may be far removed from the scene.

To compare the ‘responsibility’ of physicians for patient deaths to the ‘responsibility’ of a gun owner who lets his gun get into the wrong hands, is to make a comparison with no basis in fact. But since when did Gun Nation respond to the issue of gun violence with any facts at all?

 

Why Should Doctors Ask Patients About Guns? Here’s Why.

July 18, 2024

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Over a period of three days in June 2014, an agitated and obviously extremely upset young man named Christopher Hampton showed up seven times at hospitals in Fargo, ND, claiming that his roommate, who was also his cousin, was trying to poison him. During one of the visits, Hampton was tested for poisons in his system but the tests showed only traces of marijuana and amphetamines. He was told on several of these visits to seek psychiatric care but was not considered to be a danger to himself or anyone else.

On June 26, shortly following his last encounter with medical practitioners, Hampton went back to his apartment, grabbed a gun and shot his cousin to death. At his trial, which is going on right now, Hampton had obviously regained his composure to the point that he was claiming self-defense and may testify that a series of arguments led up to a serious fracas in which he was victim, not assailant, and had no choice but to defend himself with a gun. But the last witness to testify for the prosecution was a pathologist, Dr. Mark Kaponen, who noted that the entry wounds were in the back of the victim’s head, which is a pretty interesting way to shoot someone if you’re using a gun in self-defense.

docs versus glocks The way things are going, it looks like there will be somewhere between 11,000 and 12,000 homicides committed this year with a gun. And most of these shootings will involve perpetrators and victims who not only knew each other, but had been engaged in an argument or a series of arguments for hours, days or weeks leading up to the fatal event. As Dr. Lester Adelson put it in a classic article: “With its peculiar lethality, a gun converts a spat into a slaying and a quarrel into a killing.” I actually prefer Walter Mosley’s more prosaic statement: “If you carry a gun, it’s bound to go off sooner or later.” Either way, the bottom line is that what we have in the Fargo homicide is a classic mixture of drugs, an argument and a gun.

But there was something else about this case that needs to be addressed and understood. The fact is that the shooter, Christopher Hampton, certainly tried to draw attention to himself in the days leading up to the tragic event. He visited health facilities six or seven times, he made it clear that he was concerned about his own welfare and safety, he may have made some pretty nutty statements about his cousin, but that was exactly the point. People who walk into a medical facility under their own free will and say crazy, delusional things need to be taken seriously, not just told to ‘go home and relax.’ In fact, Hampton had previously been diagnosed as having bipolar disorder but stated that he had stopped taking his prescribed meds. How many red flags did this young man need to wave?

In fact, he waved one more, the reddest flag of all, because he told a cop just before the shooting that there were guns in the apartment and asked the cop to take them away. The police officer decided there was no criminal activity going on and declined Hampton’s request to seize the guns. Two hours later, Hampton shot his cousin to death.

According to the NRA, there’s no reason for physicians to even ask patients about gun ownership unless the patient poses a clear health risk. But how does a clinician know that a patient has stepped across that line? How could anyone know for sure that Christopher Hampton’s delusional behavior would lead to a life-ending event? The point is we don’t know, which is why doctors need the widest possible latitude in asking questions about the presence and use of guns. And anyone who truly believes that physicians should not be concerned about guns is as delusional as Christopher Hampton the night he ended his cousin’s life.

Want To Talk To A Physician About Guns? Go To York, PA.

November 26, 2024

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Back in 2011 I went to a gun show somewhere in York County, PA and had a wonderful time. It wasn’t just the fact that I could play with lots of guns. It was because everyone at the show seemed to be in a good mood, the atmosphere was festive, the people friendly, the home-cooked chow was great and even my wife bought some jewelry from a local craftsman who had a table across the aisle from the show sponsor’s exhibit, which of course was an exhibit for the NRA.

Gun licenses and concealed-carry permits spiked in York County after Sandy Hook, but even before that unspeakable event, York was always known as a gun-rich zone. York often ranked even or higher in gun licenses with much more populous counties, and in the clamor following Sandy Hook, the County Sheriff had to open a special office to process CCW applications because his regular staff was overwhelmed with concealed-carry requests.

So I found it interesting that the local Fox television affiliate that covers York County, Channel 43, ran a story yesterday about doctors asking their patients about guns, and to my pleasant surprise, it was a well-researched, well-balanced and fair piece which isn’t something that usually shows up when guns are the topic on Fox. Notwithstanding their claim to be “fair and balanced,” Fox gives virtually unlimited media time to NRA apologists like John Lott, who continues to promote the dangerous nonsense of expanding gun-free zones in the face of overwhelming evidence that shows such jurisdictions to be no more safe than places where guns are banned.

Yesterday’s article begins by quoting a York resident who was “shocked” when his pediatrician asked whether he owned guns. But it turned out that when the Fox43 reporter posted this issue on the channel’s Facebook page, a surprising number of comments came from people who didn’t register the same degree of alarm. Here’s an example from a woman who identified herself as the recent purchaser of a 9mm pistol: “ I’ve been asked by my children’s pediatrician. They simply wanted to make sure it was kept out of their reach in a safe spot so my kids are safe. I don’t see the big deal unless someone has something to hide. All gun registrations are accessible by the public. Its not like its top secret!”

Of course a majority of the Facebook comments were the usual “none of their GD business” that you would expect from a gun-owning population in an area like York, PA. But there were enough replies similar to the one above that no doubt played a role in the balanced approach of the piece. The story noted that Obama’s Affordable Care Act prohibited physicians from sharing information about guns, despite the oft-heard comment by gun-owning diehards that the ACA is a back-door scheme to help Obama take all the guns away. The story also quoted a family physician, Joseph Cincotta, who correctly stated that the question was motivated by concerns about safety, not about the ownership of guns.

In the interests of being fair and balanced, the reporter also contacted the NRA whose spokesperson, Catherine Mortensen, trotted out the usual bromide about how doctors have no right “prying into your personal life.” Following from this flight from reality I guess that when a teenager shows up at the health clinic complaining about a rash that turns out to be a sexually-transmitted disease, the examining physician shouldn’t ask the patient whether they engage in unprotected sex, or even whether they engage in sexual activity at all.

The article contained two quotes that took the position that doctors shouldn’t ask patients about firearm ownership, and five quotes from physicians and everyday individuals justifying the physician’s right to ask patients about guns. I would expect that kind of coverage from a media outlet in places like Boston and New York, but an article favorably inclined towards doctors talking to patients about guns in York, PA?

Another Gun Violence Expert Tells Physicians How To Do Their Jobs

August 22, 2024

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While editorial opinion seemed to be running against the recent 11th-District ruling that reinstated Florida’s gag law, there were some notable exceptions, chief among them being an op-ed that appeared in the Pensacola News Journal written by Marion Hammer. As a career NRA lobbyist, this lady has a long and courageous history fighting for the rights of gun owners in the Gunshine state, as well as for standing up for the oppressed in general, having been responsible not only for Florida’s concealed-carry law but also as the architect of Florida’s Stand Your Ground law, the first of its kind in the U.S.

Marion Hammer

Marion Hammer

Hammer begins her diatribe by reminding readers that the real agenda of physicians is to rid the country of guns, and she lifts anti-gun statements from the AAP website to support her case. She then goes on to remind physicians that if they “genuinely wish to offer safety information [they] can simply hand out firearms safety and safe storage brochures to all patients. Interrogating parents and children about what they own or have in the home is not only an intrusion but is a violation of privacy rights.”

Now I know that the press is very sensitive to anything that even remotely smacks of censorship, hence, if someone wants to express their opinions the editorial policy usually means that the writer can say more or less anything they damn well want to say. But if Hammer thinks she’s presenting anything other than a total fiction about the role and responsibilities of the physician in counseling patients, then either her own physician never went to medical school, or she simply doesn’t have the faintest idea about what physicians actually do. Her statement that doctors are violating privacy by inquiring about items in the home is a mind-boggling distortion of the doctor-patient relationship and I only hope that she has the good sense to avail herself of medical care that’s a little more aware of the requirements of the Hippocratic Oath than she seems to be.

In a way I can’t blame her for promoting a vision of medical care that’s so at odds with the reality of doctor-patient relationships, because there’s even a physician out there named Robert Young, who basically said the same thing in an op-ed piece published by the Sarasota Herald-Tribune. Like Hammer, Dr. Young also believes that physicians should limit their concern about gun ownership to handing out gun safety brochures developed by the NRA, whose gun-safety program for children, Eddie Eagle, has never been shown to have any positive safety results at all.

I’m not surprised that Ms. Hammer would follow Dr. Young’s lead in advocating the distribution of gun safety materials to patients. After all, she’s a lobbyist for the NRA and all their training courses emphasize safe use of guns. On the other hand, the NRA avoids the issue of safe gun storage like the plague, because the last thing they would endorse are mandatory laws requiring gun owners to lock away their guns. After all, if guns are locked away to keep them from the kids, how will the “good guys” with the guns stop the “bad guys” with the guns?

Physicians need to ask patients if they lock away their guns for the same reason they ask patients whether their children are constrained while sitting in the car. Unlocked guns are a health risk just like unlocked seat belts, and if Marion Hammer wants to dispute the studies which link gun ownership to higher levels of child mortality and morbidity, she’s also has the Constitutional right to promote the idea that the moon is made out of cheese.

 

 

 

 

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