Skip to main content

Asking Patients About Guns is a Loaded Question for Docs

 |  By jfellows@healthleadersmedia.com  
   April 10, 2014

The American College of Physicians says gun-related violence is a public health problem that doctors should address with patients. But few physicians actually do.

It is time to recognize that gun-related violence is more than an endless and polarizing political debate. It is a public health problem that doctors need to start discussing with patients.

That's the unavoidable message from a new policy paper from the American College of Physicians published today in the Annals of Internal Medicine.

Citing the mass shootings in Aurora, Colo., Newtown, Conn., and most recently (and for a second time), at Fort Hood, Texas, ACP President Molly Cooke, MD, FACP, says physicians have a role to play in reducing gun-related injuries and deaths.

"We felt we needed to call the attention of our members and physicians in general to the regularity with which this is happening," Cooke told HealthLeaders Media. "We recognize gun ownership is a constitutional right, but we are intending to call attention to the risk associated with that right, and that people have a responsibility to manage their gun safely."

The ACP outlines nine recommendations for reducing gun-related violence, including waiting periods; a universal background check to prohibit gun sales to felons and people with a mental illness who are at risk for hurting themselves or others; a ban on assault and semiautomatic guns to civilians; safety features such as trigger locks; and more education on preventing gun injuries and death in medical schools, residency programs, and CME courses.

The ACP's position is not new, nor is the organization alone in calling for more physicians to talk to their patients about guns, says Daniel Webster, director of the Johns Hopkins University Center for Gun Policy and Research. The American Academy of Pediatrics advocates talking to patients about gun ownership as part of the general conversation about safety precautions.

"When I studied pediatricians about 25 years ago, even though they recognized guns as a safety hazards for children and teens, they hadn't felt it was their place to bring up the topic," says Webster. "But times have changed, and in pediatrics, asking about guns in the home has become more commonplace. Pediatricians can talk about guns in the context of child development (their impulsiveness, inability to consider long-term consequences) and injury prevention."

As the mother of a seven-year old boy, I'm very familiar with safety questions. In fact, they are old hat now, but I remember that first visit to the pediatrician. Did we always use a car seat? What type of bathtub were we using? How often was he eating?

As my son got older, the list got longer: Does he always wear a helmet when riding a bike? Do we use sunscreen? Does he know the rules about talking to strangers? Is there a gun in the house? Scratch that last question—I have never been asked it by my son's pediatrician. I have also never been asked that question by my own primary care physician. And chances are the question is foreign to you, too, as a patient and as a physician.

Few physicians discuss guns

In addition to its new recommendations for reducing gun-related injuries and death, the ACP also released a survey of 573 general internists, representative of the ACP membership. The findings concluded that 85% of internists believe gun-related injuries and deaths are a public health issue, yet most report they don't initiate these types of conversations.

The survey included five specific questions about how frequently physicians discuss gun-related issues. Only 3% say they always ask whether a patient has a gun in the home; 58% report never asking. When it comes to talking about ways to reduce the risk of a gun-related injury or death, 2% say they always have this conversation with patients, 21% say they do sometimes; and 77% reported never talking about it. The remaining questions garnered similar responses.

The gap in physicians' belief and action is noted in the ACP's survey results, and the authors state that further study is needed to determine why physicians are reticent to talk to patients about something they obviously believe is a public health issue.

Cooke suspects that one reason physicians don't bring up guns in the exam room is because they know it is a volatile issue.

"Doctors, in general, attempt to avoid politicized conversations with their patients," says Cooke, who admits to having been part of the majority of physicians who do not ask patients about guns in the home.

"I ask patients, 'Do you feel safe in your neighborhood? In your home? With your partner?' " she says. "I have had patients bring up the fact that there is a gun in the house in response to those questions. This policy paper has sensitized me to this issue. Now I know to ask, 'Do you have a gun in your house?' "

Webster also sheds some light on why guns are not part of routine questions physicians use to find out more about their patients.

"I've found that many people think of gun safety as something that deals with safe handling and storage of guns, and those don't seem to be within the wheelhouse of physicians," says Webster. "But when medical, behavioral, or social conditions come to the attention of the physicians that are relevant for self-directed or intrapersonal violence, the physician has credibility and a comfort zone to discuss gun-related risks and how to reduce those risks."

Viewing guns in the home as a risk to be mitigated in a doctor's office could take some of the political sting out of the conversation, though there has been legislation introduced in states to prohibit doctors talking about guns with patients.

The "Docs vs. Glocks" lawsuit spurred by a Florida bill passed in 2011 is the most well-known example, but a similar law in Tennessee was proposed this year. A federal judge issued an injunction in Florida that prevents the law from being enforced.

Cooke acknowledges that doctors will have to be educated on how to talk to patients about guns. It won't be easy, but the time has come, she says.

"Physicians are a trusted voice in the service of health and safety and we're not comfortable being silent when we see a significant public and health safety issue."

Jacqueline Fellows is a contributing writer at HealthLeaders Media.

Tagged Under:


Get the latest on healthcare leadership in your inbox.