Doctors should talk to patients about guns

IN 1991, PRESIDENT George Bush proclaimed March 30 as National Doctors Day, to salute physician leadership in the “prevention and treatment of illness and injury.” Physicians honor the designation; few professions have an annual national day of recognition acknowledging their work.

This year, however, on the 25^th anniversary of National Doctors Day, physicians across the Commonwealth are taking the day to raise awareness about gun safety, and specifically, the right of physicians to discuss the subject with their patients.

At issue is a 2011 Florida law making it illegal for physicians to ask patients if they own a firearm or to record information about gun ownership in a patient’s medical record. Regarding it as an intrusion into the physician-patient relationship, pediatricians in the state, backed by medical societies, sued to block the law, and it was initially struck down. The state appealed, however, and a three-judge panel of the U.S. Court of Appeals for the 11^th Circuit upheld the law in a 2-1 decision, which declared that the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.”  A provision of the law does allow inquiries and records if the physician “in good faith believes that this information is relevant to the patient’s medical care or safety, or the safety of others.”

Florida physicians, stunned at the ruling and believing the issue of “relevance” too weak to assure compliance with the law, have petitioned for a rehearing before the full court.  The stakes are high: if the court’s decision is again upheld, similar laws now pending in nearly a dozen other states are likely to be passed.

This is not just a bad law; it’s bad medicine.

The exercise of an unrestricted patient interview is the physician’s best approach to good patient care.  To declare that asking patients about gun ownership and talking about gun safety is an abuse of the physician-patient relationship is illogical and strains the definition of common sense.

Physicians ask patients about many topics affecting their health, and we hope their responses are forthcoming and truthful.  Smoking, substance abuse, alcohol use, driving ability, eating and exercise habits, and sexual activity are among those behaviors that affect health. Our obligation as health care providers compels us to ask about these subjects. All of them pose risks to health, and not only to the individual patient, but also to their loved ones and those around them.  Guns likewise pose risks: multiple studies show conclusively that guns in the home significantly raise the risks of homicide, suicide, and unintentional shootings.

That pediatricians are leading the fight for the right to discuss gun safety is appropriate. Research shows that firearm violence is among the leading causes of death for teenagers and young adults.

The health risks of guns to youth cannot be overstated.  Statistics from the U.S. Centers for Disease Control, as reported by the Brady Campaign, show that more than 2,600 children and teens up to 19 years of age die from gun violence in an average year. Additional research indicates that on average 20 children and adolescents are hospitalized each day due to firearm injuries.

Tragic shootings like those at Columbine, Colorado and Newtown, Connecticut grab our attention and inevitably raise calls for more action. Yet since the shootings at Sandy Hook School in Newtown in 2012, 104 additional school shootings in America – 59 of them in grades K through 12 – have occurred.

Youth are not the only victims, of course. We must recognize that America is filled with guns. Ownership estimates range anywhere between 100 million and 300 million nationwide, and in Massachusetts alone, the U.S. Bureau of Alcohol, Tobacco, Firearms and Explosives has accounted for 32,682 registered weapons.

The final outcome in Florida will have national implications for how physicians care for the patients. It may also create a terrible precedent: If discussions about gun safety are prohibited, what topics might next be banned?

Doctors Day acknowledges our leadership in health care.  The centerpiece of that care is the physician-patient relationship; it is where problems are discovered, diagnoses are made, care is delivered, and prevention begins. Health care works best when physicians and patients engage in confidential, private, open and free discussions. Restricting this exchange to any degree only prevents physicians from practicing good medicine – and denies patients – particularly our children – from getting the care they deserve.

Dr. Richard S. Pieters, a professor of radiation oncology and pediatrics at the University of Massachusetts Memorial Medical Center in Worcester, is president of the Massachusetts Medical Society, the statewide association of physicians with more than 24,000 members.