Brother blogger and good buddy Will clued me in to an interesting post by Ken over at Popehat. It’s about Florida’s appallingly stupid law that vaguely forbids doctors from asking patients about gun ownership “unless information is relevant to patient’s medical care or safety or safety of others.” Since the only reason to ask about gun ownership is to determine if it is relevant to the patient’s medical care, safety or the safety of others, this law is beyond meaningless. However, as it’s already been struck down by a federal judge and I can’t imagine Gov. Scott’s addle-brained appeal going anywhere, I figured commenting on it was moot. (It’s been a banner year for awful laws that restrict a physician’s freedom of speech, though, hasn’t it?)
However, there are several points that Ken makes that I think warrant a reply.
He starts the post with his recollection of a weird doctor and his weird questionnaire:
Back in 1980 or so, my parents decided to send me to a new doctor in town to address some youthful complaint or other. The doctor was youngish, well-qualified, and charismatic. He showed me into a consultation room, handed me a clipboard with a lengthy questionnaire, and told me we’d talk after I had completed it.
[snip]
Then the questionnaire turned odd and uncomfortable and intrusive. It asked about masturbation. It asked about looking at pornography. It asked about thinking about sex, and the frequency of such thoughts. (I was an eleven-year-old boy. There was no box to check for “I think about it all the time. I think about it between the seconds.“) It asked about same-sex attraction. At this remove, more than 30 years later, I’m not sure if the questionnaire had a religious sensibility or some other purpose. I only know that I found it instantly creepifying, and dreaded the doctor who would ask such things coming back into the room to touch me. I couldn’t put it into words at the time, but it was clear that the doctor had a non-medical agenda — an agenda beyond determining if I had ulcers or diabetes or fungus or something.
I have a few thoughts about this, largely informed by my training in adolescent medicine. I know that questionnaires are all the rage in medicine, and are considered a handy way of collecting information quietly and efficiently. I detest them. Any question I want to ask, I ask myself directly. I believe there is a requirement in the state where I practice that we do appropriate developmental screening as part of well child checks (which, obviously, should be done in any event), but I generally just glance at the screening form and then ask the pertinent questions myself.
Neither having seen the questionnaire Ken remembers nor knowing the doctor, it’s hard to know quite why those questions were asked in that way. Assuming good intent on the doctor’s part (notwithstanding Ken’s skeeved-out reaction), this illustrates the pitfalls of a one-size-fits-all questionnaire. I can see maybe wanting to know the answer to some of those questions for any given adolescent, but giving them to a barely-pubescent 11-year-old was developmentally inappropriate at best. For young adolescents, I ask a few preliminary questions about interest in dating, introduce the notion that I’ll be asking more in-depth questions at later visits, and leave it at that.
But that’s not really the crux of Ken’s point. He goes on:
I believe that the push to have doctors ask patients about guns flows primarily from a political-interest-group-driven anti-gun agenda. I also believe it reflects an unbecoming ambition by some in the medical profession to become entrenched in broader segments of patients’ lives. None of my doctors have asked me, but if they did, my trust in them would be diminished, and if they failed to accept a polite “I’m not going to discuss that,” I’d find a different doctor. If a doctor wanted to fire me as a patient because of that answer, I’d consider myself lucky to know that the doctor is an ideologue whose political views outweigh his or her commitment to my care, and happily avoid him or her — as I would with a doctor who restricted patients based on their voting record.
I have serious problems with much of this, but I will start with the part I agree with. I concur that there is an unfortunate tendency on the part of some in the medical community to over-medicalize or pathologize aspects of society or human behavior that are not pathological and do not require medical intervention or supervision. Lord knows, my own specialty is hardly immune to this. I hope regular readers would agree that I have a healthy skepticism about such interventionist tendencies, and I certainly have no desire to entrench myself more deeply in my patients’ lives. (Believe me.) I try to give sensible, reasonable and good-hearted advice insofar as I think it will be helpful, but in general I trust my patients and their parents to make their own best decisions without any clucking from me.
Now, then. That leaves the rest. It is with all due (and very sincere) respect that I heartily disagree with Ken’s assertion that doctors ask about gun ownership because they have a political agenda. I don’t actually ask about it on a regular basis, but I consider that a deficit, not a credit. For my part, I have absolutely zero problem with responsible adults owning guns, and would not be in any way inclined to use my professional position to dissuade anyone from owning one. (I have some qualms with the relative ease by which assault weapons can be obtained, but that’s not the same thing.) Asking if a family has guns in the house has nothing to do with a political agenda, and everything to do with knowing safety risk factors for my patients.
I am having a hard time finding any recent data on firearm-related deaths in the United States, with most of what I can turn up at least a decade old. Perhaps the recent numbers are much lower, I can’t say. However, in 1994 22% of the 1107 reported firearm-related deaths in children were unintentional. When I ask if there is a gun in the house, I want to know if it is appropriately stored and locked, and that older children have been educated about gun safety. That’s it. Of course I have an agenda, but it’s not anti-gun. I have the same agenda that every medical provider should have, which is to know about her patients’ lives with regard to factors that might compromise their health and safety. If I ask about safety belts and childproofing, is it not of a piece to ask if there are unsecured guns? Am I not to be asking about any of this?
I could say the same about gun proximity and the risk of completed suicide. If I have a patient who has admitted suicidal ideation to me, and I know that firearms account for half of all completed suicides, is it not an important consideration in helping me assess my patient’s risk of killing himself that there is a gun in the house? It would diminish Ken’s trust in me if I were to ask about this risk factor for morbidity or mortality? No sermon, no attempt to get him to get rid of it, but merely asking? I must say I find that uncharacteristically quick to jump to an erroneous and unfair conclusion.
I grew up in a small, rural town where lots of people hunted, and I know that people can own guns safely and responsibly. I also remember when a teenage girl a few years younger than me was killed when one of her friends shot her by accident with a gun he had secreted out of his house. It reflects no ambition to intrude into my patients’ lives if I ask questions to ascertain whether their homes are like the former, or if they are increased risk of a situation like the latter. It merely indicates that I want to do my job well.
This is a really great post, Russ. And I think it touches on the problem with demagogy. Many, including folks here, have ruminated on the lack of serious calls to further increase gun control in the wake of Aurora (though I’m curious to see what the recent shooting of police officers in Texas drums up). A large part of that conversation has focused not on how many guns are available, but who has them, namely folks suffering from mental illnesses. We at least started to have a conversation about recognizing mental illness, treating mental illness, and (most importantly) about how we even talk about mental illness. Lots of folks, from both sides of the aisles, seemed to realize that we didn’t need to necessarily further restrict access to guns, but instead needed to do a better job of understanding mental illness and preventing people from reaching a point of going homicidal; with this achieved, we seemed to realize, the questions surrounding gun access become somewhat moot.
And, it would seem, that medical professionals were best positioned to begin to facilitate these changes. If you had a patient you knew or suspected suffered from the type of mental illness that might lead to violence, knowing about this individual’s potential to inflict violence seems sort of important.
But, no, the potential that some physician somewhere might use this role as a soap box means we should forbid it. Sigh.
Don’t speak of mental illness until you’ve had half of your brain blown off in a failed suicide attempt. There is no way of getting around the fact that more guns equals less crime and violence. Just ask Sharon Tate and the LaBiancas. I rarely leave the hospital or my house without 2-3 guns. I’ve saved the lives of, at least, 30-35 people by merely carrying heat.
Let’s get real—violent criminals need to be killed, the sooner the better.
And the only relevant time to ask that question is if your patient is lying on the couch and you’re s shrink. You may as well ask where one can cop some good Owsley
Acid, aka, LSD-25 and not end up like Syd Barrett.
Hi, Franz. If you are who I think you are, do let’s try to stay coherent, shall we?
Auf ihr Wohl, Herr Doktor! Absolutely, sir. So good to hear from you, and may I express my sincere and heartfelt thanks for your very gracious words a few months ago regarding giving someone a “second chance”.
It was you and another gentlemen whose name I can’t recall, who came to my defense–my sincere appreciation and gratitude, Doctor.
Right. Now that you are back and enjoying your second chance, please please please try to stay on-topic, and don’t forget the rules I stipulated before regarding off-limits topics. (Also, I’d prefer that you keep calls to violence to a minimum.)
Regarding guns, here is another angle, http://www.huffingtonpost.com/2012/08/12/gun-violence-social-disease_n_1769754.html?utm_hp_ref=fb&src=sp&comm_ref=false#sb=3429695,b=facebook
Whatever the public health response to gun violence, it is only in glancing contact with my reasons for asking if there is a gun in the house. All I want to know is what I’ve stated above — if there are guns, are they stored and locked appropriately? Have the children who are old enough been taught about gun safety? If the answers are “yes” and “yes,” then I don’t perceive any further duty on my part.
My reaction to my doctor (well, physicians group) asking my about firearms would be to ask right back “why are you asking that, and how is it pertinent to my health.” Your reasons for asking are entirely appropriate, but I feel that if i didn’t really know my doctor, it would be akin to asking me if my wife has ever had an abortion. In other words, it butts up against the culture wars a little too closely for many people’s comfort.
I’d be quite happy to explain to anyone why I would ask that (or any) question. It would be singularly obnoxious to do otherwise.
My qualm with Ken’s post is that he assumes a political motivation behind the question, when I suspect there isn’t one for the vast majority of medical providers. I don’t have an anti-bleach agenda when I advise parents to put it out of reach of toddlers. As fraught as the gun issue may be in the country, my reasons for asking about guns are really no different.
Russell:
Sorry the AMA is anti-gun so I think there is some political motivation. There are many other things you could ask you patients that to me seem to be more relevant than if they own a gun.
Well, Scott. I couldn’t possibly care less about the AMA, as I am not a member. Though I would be fascinated by whatever citation you might choose to provide for your assertion, just for giggles.
Speaking of things about which I could not possibly care less, your opinion about the risk assessments I should be doing for my patients is right up there.
Funny you should say that when Barry is trying to make it against the law to listen to the kind of music we want to – I guess Barry just knows best, maybe we should just let Barry run our radio stations!
(Sorry, but I’m trying to hurry this along so we can move on.)
Russell:
So, catty, I guess I must have hit a nerve to get your petty personal insults. Here is one cite, hope you giggle. Sad to see folks that call themselves professionals use junk science to push their agenda. I had a chance to meet Dr. Kellerman when I was at Emory and he struck me as just another pompous doctor. I have to give the anti gun folks clever points for trying to frame gun violence as an “epidemic” so they could sucker doctors in.
http://www.keepandbeararms.com/information/XcIBViewItem.asp?ID=2136
Sure, fine. You hit a nerve. I’m catty. Whatever.
You bore me. Go somewhere else.
I will kick myself for letting tho drag on, but that is hilarious:
Your proff that the AMA is conspiring against Anerica is a link to a blogger that says the AMA is conspiring against America.
Seriously, that is awesome.
I think I will come to Scott’s defense for once. At least sort of. His view of the AMA is not uncommon and not just held by extremists. In the run-up to the Assault Weapon Ban being passed, the AMA Council of Scientific Affairs endorsed it. The AMA voted on endorsing a ban on handguns, though the vote did not go through. The AMA did endorse renewing the AWB in 2004.
Whether the above constitutes being “anti-gun” is a matter of perspective, but there is some support for it.
At the least, I think it was a mistake for the AMA to involve itself in this issue.
Well, Will, that’s more information than Scott bothered to include in his comment. In any case, the AMA has all manner of stances that have nothing to do with my practice, and its reasons for endorsing legislation do not inform my reasons for asking about gun ownership.
And none of this makes Scott’s opinions about the questions I ask my patients any more relevant.
And that is also “Baby with the bath water” thinking. Maybe the AMA IS anti-gun. Maybe they are wrong to take certain stances (or any public stances!) with regards to gun.
That still doesn’t inherently make their stance or any individual doctor’s approach to promoting gun safety wrong. It is a useful bit of data, which should be considered when evaluating the appropriateness of the practice. But just because they are or might be wrong on OTHER issues related to guns doesn’t mean they are wrong on ALL issues related to guns.
You ask about guns, or you might, but not about other means of suicide — one assumes you don’t ask about kitchen knives, or bleach, or any of the other means that a kid might use.
Is that because gun-related attempted suicides are more likely to be permanent?
1) As noted, guns account for fifty percent of completed suicides.
2) A knife or bleach are both more likely to be used in a suicidal gesture than an actual attempt. With the one there is the potential for self-injury without death or permanent disability, and with the other there is some potential to reconsider and get emergency medical treatment. With a gun there is far less potential to reconsider after it’s been used.
3) Almost everything can be used incorrectly or in a deliberately harmful way, with some potential for injury. One can’t cover every base all the time. But firearms are weapons, the sole purpose of which is to inflict bodily harm. Inquiring about the steps a family has taken to mitigate the potential for harm reflects nothing more than a respect for the potential for injury or death.
“guns account for fifty percent of completed suicides.”
Therefore we should also ban trains and bridges, or at least require extensive licensing and psychological study before permitting people to cross a bridge or exist in the same world as a train. Because, y’know, preventing suicides is an important goal; and to prevent suicides there is, as it were, no bridge too far.
DD – it’s really just about convienence. Guns are readily available and it’s a quick death. It take 2 seconds to load a gun and pull the trigger. We had a neighbor who literally ate breakfast with his kids, gave them all a kiss goodbye, walked into his bedroom and shot himself with the gun in his nightstand. It happened that fast.
So guns DO present a unique risk with regards to suicide as opposed to jumping off a bridge or in front of a train which takes some planning.
“Guns are readily available and it’s a quick death.”
So’s a big bottle of vodka, and I can go into any grocery store in the state and buy as many big bottles of vodka as I can carry.
And heck, it’s not like trains or bridges are particularly difficult to find.
Reliability? Not always.
DD,
WE DO put fences on bridges so that people don’t jump off.
The only exceptions are historical landmarks.
Jesus Christ, DD. Always with the glib, simplistic replies.
So by your lights, because we can’t reasonably mitigate all risks, we therefore shouldn’t bother trying to mitigate any? And apparently “lock up your guns” and “ban all train travel” are equivalent societal burdens in your world?
If preventing suicides is important then there are many things we could be doing aside from asking about guns. There are more effective things we could be doing than asking about guns. I’m sorry if I don’t take the time to write a twelve-paragraph essay in every comment box, but I tend to assume that the people reading my posts are not pants-on-head retarded and are able to divine my meaning with a short bit of thought.
What a churlish man you are. You are familiar with the concept of cost/benefit analysis, yes? In this case, the costs associated with the abolition of train transport and the elimination of bridges massively outweigh the benefit of the suicides they might prevent, no matter how effective at preventing them it may be. Locking up one’s guns? Not so much.
We vaccinate against tetanus because the costs of doing so are much lower than the costs of massively irradiating the earth’s crust and eliminating all c tetani spores, even if that would be more effective at eradicating the disease.
I can divine your meaning quite easily. Your meaning displays your remarkably consistent shallowness of thought, is all.
Additionally, Russell is a doctor, with a particular sphere of influence. If he were an engineer and didn’t advocate the necessary safety features for bridges that would make suicides harder or impossible, maybe you’d have a point. He is working within his professional capacity.
When’s the last time YOU did something about suicide prevention?
Oh, so it’s a cost-benefit analysis? Better make sure to include the potential cost of the crimes prevented by the presence of a firearm, then.
My impression is that suicide attempts fall into two categories: ones that are intended to succeed, and ones that are intended to fail. The ones that are intended to succeed have a much higher success rate than the ones that are intended to fail, regardless of the method chosen to effect the suicide.
Indeed. And guns are one of the favored methods for those who really want to succeed.
I think that’s true, though I would also think that the comparative certainty of the success makes people who otherwise might talk themselves out of doing instead go forward. One way or another, within the US there is a link between gun ownership and (successful) suicides.
In a childproofing discussion, a pediatrician probably would ask about knives, household chemicals, and other potentially harmful objects are stored. She probably doesn’t need to ask, “Do you have any knives?” because everyone does. Not everyone has a gun, though.
In a mental health context where the patient might be suicidal or homicidal, a doctor should ask about all kinds of potentially harmful household objects, including firearms.
There was a trend for a while to use diagnostic psychological questionnaires as research material, and it happens that one of my cases involved a student aiming for a master’s degree in psychology administering a test intended to be given to children who exhibit signs of trauma as a diagnostic for the kind of trauma to which they had been exposed and the resulting conditions. In my case, my clients alleged that their consent to having those tests administered to their children was obtained throgh a deceptive practice, but that’s a different story. From the questions described, I wonder if the test that originally ooked out Ken was a similar test to the one from my case, maybe even the same one. And the ookiness after the test is why I thought this was worth taking on as a lawsuit. There may be a good reason to administer such a test just as there may be a good reason why a doctor might want to ask about weapons in the home.
An educated patient and a doctor acting in good faith ought not to have any reason to distrust one another. The concen is that the patient may fear the doctor’s actions are not in good faith or may not be educable, because the issue involved here has become so politicized.
I think your last paragraph is salient. I would hope that my rapport with my patients and their families would be such that they would presume good faith when I asked about such things, or at least sufficient that they would ask me why I’m asking and allow me to explain. I feel like Ken’s statement evinces a lack of such rapport with his physician, which to me is much more problematic than the question per se.
I guess for me there’s a blurry line between medicine and social work, especially with pediatricians. For the record, I’m 100% okay with a pediatrician doing a little bit of digging if there is cause for concern. For that matter I am also 100% okay with a general practicioner doing the same with adults.
With all of that said, I think this law is pretty silly and it reminds me of a recent law pased here in KY. That law makes it legal to carry a concealed weapon in your own home. I’ve talked to two different police officers and several civillians about this and none of us can figure out a scenario where this would be necessary. The law was simply passed to make a statement. I suspect the law you describe in the post is very similar.
I thought about you a great deal when I wrote this, Mike. When I think “responsible gun owner,” you spring to mind. (You certainly don’t seem like a lunatic.) I can’t imagine an exchange about gun ownership with you or anyone like you being anything other than brief and without drama.
I often feel like I’m supposed to cover every possible risk factor for every possible problem at every possible visit, which is problematic on many levels. Thankfully, I’m the kind of lazy, cynical schmuck who doesn’t think that what he says makes much of a difference for most people most of the time, and thus I try to keep my advice as focused and relevant as possible.
“I thought about you a great deal when I wrote this, Mike. When I think “responsible gun owner,” you spring to mind. (You certainly don’t seem like a lunatic.)”
I feel the same way… UNTIL I look at that gravatar…
I actually just shaved off my handlbar mustache yesterday. It was sad but the wife is happier.
Thanks Russell. I hope I am representing gun owners well in that regards. I LOVE, LOVE, LOVE firearms but you have to be responsible with them and I am always willing to discuss gun law rationally.
Along the doctor/patient responsibility lines, I once had a friend who was very depressed over getting dumped by his girlfriend. He actually gave me the key to his gun safe for a short period because he “didn’t want to do anything stupid” (I suspect the very fact that he thought to do that was probably a good sign he was going to be okay). He was pretty embarrassed when he asked for it back a couple months later but I understood. My father comitted suicide when I was 21. There were plenty of warning signs. Maybe his doctor would have caught them and suggested he get help. I’ll never fault someone for asking those kinds of questions.
Mike-
Your posts and comments here have brought a new dimension to my understanding of gun owners, a group of people I am generally woefully unfamiliar with. Generally speaking, gun control moving in either direction is low on the priorities list for me, so it is not something I think about or talk about much. But I’m fast reaching a point where when I hear left-crazies insisting that everyone holding a gun is a crazed killer, I think of your stories of hunting squirrels and dismiss them out of hand. And when I hear right-crazies insisting that the 2nd Amendment demands that everyone keep a howitzer and a nuke in their basements, I think of your posts about the problems with gun shows and other areas where control can be reasonably implemented without curtailing legitimate gun owners’ and users’ rights and dismiss THEM out of hand.
In a nutshell, folks on both sides of the aisle would be wise to get to know and listen to folks like you.
Kazzy,
It’s like every other thing else in public discoursse. There are probably a majority of people who are moderate on issues but the reasonable voices get lost in the noise from the extremes. You and I having a civil conversation about guns is boring to most. We start calling each other names and talking extremist positions and suddenly this comment thread blows up.
It’s also why I try to avoid the abortion debate most of the time. It’s the one issue I can’t be moderate about. The conversations are ugly and they go nowhere.
“It’s like every other thing else in public discoursse. There are probably a majority of people who are moderate on issues but the reasonable voices get lost in the noise from the extremes. ”
This. A thousand times, this.
“For the record, I’m 100% okay with a pediatrician doing a little bit of digging if there is cause for concern. For that matter I am also 100% okay with a general practicioner doing the same with adults.”
If I knew how to add emphasis, I would. But I think the important point here is “if there is cause for concern.” My hunch is that asking about gun ownership or access is not going to become a standard question for all but the most looniest of quacks (see what I did there???). If a patient gave a doctor legitimate reason to think that he is a harm to himself or others, I would do everything short of requiring that doctors ask about access to the means of carrying out that harm, including but not limited to guns. And, hell, I might consider requiring it, but stop short of that having not fully thought through the ramifications of such a policy. I’m sure the good doctor can comment on those.
That law makes it legal to carry a concealed weapon in your own home.
Which beings up lots of questions.
1. Was that actually illegal before the law was passed?
2. Had anyone ever been arrested for it?
3. Convicted?
4. What was the penalty?
5. Wouldn’t a combination of the 2nd and 4th Amendments have been an absolute defense?
Probably what happened was the police visited someone’s home and the resident had a gun concealed on their person. Cops find out and they go bonkers (because of the risk to their own safety). Person gets charged, etc. Some state rep wanting to make his conservative voters happy hears about this and gets the law pushed through.
That makes a lot of sense.
Just curious, do you ask patients (or their parents, as appropriate) whether or not they live in a building built before 1979?
Yup. Lead risk.
So, the same reason you ask them about guns.
This thoughtful post deserves more of a reply than I have time to give it this morning, but I’ll make just a couple of points.
1. I have no problem with a doctor asking about guns when a patient expresses suicidal ideas.
2. Some individual doctors have expressed similar sentiments and assure me that their interests are not political. The issue is probably complicated by the fact that leaders of physician organizations have discussed the gun issue in an overtly political manner. Also, the encroachment in other areas — like the carbon-footprint thing in England — colors my view of the questions.
3. I have difficulty discerning the rational line between non-medical risks that a doctor asks about and non-medical risks they don’t.
I’m delighted you took the time to reply, Ken. As I hope I made clear in the OP, I really enjoy your writing and your perspective. If you get a chance to reply further, I have questions in reply:
1) Do you have a problem with a pediatrician asking about guns for the purpose of establishing that they are appropriately secured? If that was made clear when the question was asked, would that obviate your objection?
2) Perhaps I’m just disconnected from the leadership of my professional organizations, but I’ve not perceived a push to try to get guns out of homes.
3) This one is kind of catch-as-catch-can. As I mentioned, I don’t actually ask about guns on a regular basis, and have a relatively skeptical view about how much impact any given doctor’s advice has (certainly if it’s unsolicited). We can’t mitigate every risk for every problem, and I think most providers do their best to address those risks that seem most pressing to them.
You are not actually disagreeing with Ken. It is possible for you, personally, to have non-political reasons to ask about guns in the house and for there to be a political motivation behind a push to have doctors ask about guns in the house.
I agree with that. One of my college classmates, now a doctor, made a similar point.
But is there even a push to have doctors ask about guns in the house?
I do agree with Ken’s primary point, which is that passing a law is a bad way to deal with this.
Deal with what, exactly? Has it even been documented that a problem exists?
FWIW, I found this out there on the internets — the 1992 policy statement, which the link is re-affirming, seems like it would be off-putting to gun owners:
I’m still not following. To clarify my position, I’m not arguing that doctors aren’t discussing guns and gun safety with patients. I’m arguing that there is no evidence that doctors are violating 2nd Amendment rights, invading privacy, and/or harassing and/or discriminating against patients who own guns. It is precisely these points that advocates for the law have argued make it necessary. I just don’t see those causes supported by any of the facts put forward thus far. It is a solution in search of a problem.
Well, in your 9:19 PM comment, you ask “But is there even a push to have doctors ask about guns in the house?” — I thought that’s what you were asking about. The national organizations apparently encourage doctors to go beyond mere gun safety (which AFAICT no one is opposed to in the absence of any suspicion of ulterior motives) to advocate for gun removal (so much for absence of suspicion).
Ken-
I was referring about doctors asking about it in regards to anything other than safety. If inquiring about and discussing gun safety is sound medical practice, I see nothing wrong or political with advocating that. If more is being advocated, I’m happy to evaluate the merits of that. That being said, I’m still not sure that I see evidence that “national organizations apparently encourage doctors to go beyond mere gun safety (which AFAICT no one is opposed to in the absence of any suspicion of ulterior motives) to advocate for gun removal (so much for absence of suspicion).” The extent to which they seem to advocate gun removal is part and parcel with the advocating for gun safety. The best way to ensure your child does not become a victim of gun violence is to keep them away from guns. I’m not sure there is much arguing that point. Of course, that position can be abused and, if it is, I hope that doctor gets his comeuppance (ideally through a loss of patients).
It seems as if some, not necessarily you, are arguing that doctors asking these questions is really part of some super secret plot to rid the country of guns. That is a bit too conspiracy-theory for me, especially given that I have no reason to believe that doctors, on the whole, are more anti-gun than pro-gun, and thus doubt that they would collectively engage in such silliness. And, even if they were, the idea that this would somehow be a violation of the 2nd Amendment… well, it makes me wonder if these staunch defenders of 2A really know what it says.
Nothing to ad. Great post, per usual at MD.
Shit! Did I post this in the wrong blog?
BT! I meant BT!
MD is also awesome, of course.
BT has the MD. MD has the JB (who is merely a BA).
FYI, if you’d kept it on the QT, I’d have believed an MA.
Correction: MD has two BAs in the KY
TMI
Thanks for the post, Doc. It was exactly what I was looking for. I was less interested in the Florida law and more interested in the thinking on the doctor’s side.
On the guns front in particular, I think this is one of the problematic things about the political activism of medical groups. It would, to be honest, lead me to question what exactly the doctor was getting at by asking me about the guns. If that were the only problem, it wouldn’t affect me, but it would probably make me wonder a bit. The relationship between doctor and patient is a complicated thing, insofar as it’s one of those interactions that requires a high degree of comfort. This is particularly true when it comes to things like judgment about say tobacco use or whatnot (which leaves a doctor in an awkward place), and with guns it is both less awkward (in the sense that it can be avoided) or more awkward (in the sense that if a doctor approaches the issue, they should do so with caution).
I just visited my FP doc yesterday, and yes, there was a questionnaire and there was the gun question. If I’m recalling correctly, it was “is there a gun in your home”? I answered no, as my shotguns are in another location. But I brought it up with my MD — as in “why did you ask”. And she said that it was an opportunity to talk with parents about gun safety — esp. emphasizing the importance of safely securing the gun from inquisitive children.
Vincent Iannelli MD, who writes the “About” Column on Pediatrics, wrote:
I think it’s a reasonable question for pediatricians and family practice doctors to ask.
And frankly, I like questionnaires as they remind me of issues I might overlook.
I’m remembering Freakanomics (and there are reasons to see that book as silly) but one of the things that jumped out at me was the whole “swimming pools vs. guns” when it came to child deaths and how the former killed more children in any given year than the latter.
He provided numbers and everything. As such, I’m willing to say that he’s probably not lying.
Which brings me to wondering: what are the most avoidable causes of death that affect children?
If the FN guys are right, that makes me wonder if it’s normal for doctors to ask about swimming pools.
I will say that it does seem vaguely politicalish to ask questions about guns, but not about swimming pools, if more children die in pool-related deaths than gun-related deaths.
https://en.wikipedia.org/wiki/File:Causes_of_accidental_death_by_age_group.png
Looks like accidental firearm discharge is pretty close to ‘Complications Of Medical/Surgical Care’, for small children anyway (though firearms starts to rise precipitously after age 15).
Maybe you should ask the patients how often they visit a doctor 😉
Whoops, I misread that graph (and forgot the obvious caveat, that graph is obvs. from Wikipedia, so, you know). It’s poisoning, not firearms, that rises precipitously around age 15.
Accidental firearm deaths are fairly comparable with ‘Doctor Danger’ for most age cohorts, according to that graph.
“Did you hear about the Johnsons? They just got a… a… a pool! I know, right??? Why does ANYONE need a pool nowadays? If you are worried about not being able to swim, there is a public pool. If that isn’t good enough, you can go to a private swim club. And there are plenty of other ways to exercise. What’s that you say? Cooling off? Relaxing? Fun? How about an air conditioner? Or a hammock? Or backyard badminton. There is simply zero reason why anyone needs a pool. Only crazies want pools. And they’re dangerous! Do you know how many kids die every year in pools? It would make you sick. Downright sick! I’ll tell you this much… I will NOT let my kids go over to their house. Not with that THING there. They can cover it, lock the gate, put up an alarm… I don’t care. Kids just shouldn’t be around those things. Really, I tell you, no one should have a pool. Least of all the Johnsons. Have you see the Mrs. Johnson lately? No way those are real. Skank. [pause] So what time is bridge this week?”
In Jaybird’s America, THESE are the conversations folks are having.
Pools don’t kill people — lack of gills kills people.
As soon as the pools learn to use guns (or the guns learn to swim), we are all done for.
I, for one, welcome our semi-aquatic overlords.
Unfortunately they seem to have lost the subheader (‘Oh, s**t, says Humanity’) but this still comes to mind:
http://www.theonion.com/articles/dolphins-evolve-opposable-thumbs,284/
“”I believe I speak for the entire human race when I say, ‘Holy fuck,'” said Oceanographic Institute director Dr. James Aoki…”
That line is choice. I feel like you could insert any group in place of human race and have a money quote.