Doctors and Guns Redux

[Aguila Blanca]

https://www.gunsamerica.com/blog/mas...with-patients/

According to Guns America, the Massachusetts Attorney General has asked doctors to talk to patients about gun safety, because it's a "public health" issue. In fact, according to the article, the AG's office has even put together a syllabus for the doctors to follow.

I think we have discussed previously the questionable medical ethics of doctors (who may or may not know anything at all about firearms) presuming to lecture patients about something that's a constitutional right. Many people (including me) think this is a professional "boundary violation" on the part of doctors who presume to do so (especially if those doctors are not themselves knowledgeable shooters and gun owners). Many of us have also previously expressed the opinion that "guns" are not a public health issue. You can't get a vaccine against a gunshot, and gunshot wounds are not spread by aerosol (coughing or sneezing), sharing a drinking glass or toothbrush, kissing, or sexual contact.

So now the Massachusetts AG has reportedly put her blessing on this boundary violation. As a dedicated conspiracy theorist, my immediate reaction is: "Why?" And the conspiracy theorist part of may brain says, maybe because the State of Massachusetts medical board has been receiving complaints from the public about doctors who do this, so the AG is doing this to provide "cover" for those doctors who engage in the practice.

I haven't heard or read much about this practice in recent months and I sort of hoped that maybe it had died down. Apparently it has not.

“Gun violence is a major public health threat and physicians can play a key role in curbing the violence by educating patients about the risks of gun ownership and encouraging our colleagues to talk to their patients,” said Gressner.

The fact remains that there are many other common factors in our lives that result in far more injuries and deaths. Why isn't there, for example, a corresponding program for doctors to "counsel" patients about bathtubs, and the dangers of slipping or drowning in the home bathtub?

[2ndsojourn]

AB, I'm sure you and everyone else here is as tired as I am of hearing the misinformed leftists rant on about "gun violence". It's common sense that in order to solve a problem, the first step is to correctly identify the problem. It seems that common sense isn't common anymore.

When nearly 2/3 of deaths by firearm are suicides, that's a mental health problem. When the majority of the remainder of deaths by firearm are inner-city turf/drug/gang violence, that's a socio-economic problem.

So, when you ask..."Why isn't there, for example, a corresponding program for doctors to "counsel" patients about bathtubs, and the dangers of slipping or drowning in the home bathtub?"

The only answer I can think of is, despite being reasonably intelligent, the AG and other politicians in MA (as well as a lot of other areas), don't have any common sense.

[Aguila Blanca]

The real answer on bathtub safety is that doctors are too busy to waste their valuable time on that. Having gone through a heart operation a couple of years ago, I know first-hand how this works. When I was discharged from the hospital, I was allowed to go home (over the somewhat mild objections of my doctor), but they sent around a specialist to survey my home to be sure it was "safe" for an invalid like me. I believe her title was "occupational therapist," which was somewhat misleading. What she did was to look for fall and tripping hazards. I already had handrails on both sides of both stairs (to the second floor, and to the basement). No loose carpets to slip or trip on.

She pushed hard to have me install ADA-type grab bars in at least one of the showers. The problem there is that such people understand grab bars, but they don't understand how grab bars get there. I'm an architect and a building inspector -- I check buildings under construction to ensure that the reinforcing is installed in the walls for grab bars to attach to. My house was built 67 years ago, with real plaster walls and ceramic tile in the tubs/showers. You can't jst drill a quarter inch hole and screw a grab bar to that, you would have to tear apart the entire wall. I told her that was not going to happen, and that was the end of the discussion.

Back to the point: bathtub safety isn't a "public health issue" for doctors not because they don't know it's an issue, but because it's not a political philosophy. They won't be bothered to do more than mention slips and falls in passing, because if/when there's a real concern (as in my case), they simply avoid the issue and refer the patient to an occupational therapist (or whatever the proper title is).

The proper analog for guns, then, should not be for doctors to presume to teach gun safety based on what they get out of a pamphlet from the AG's office, but for doctors to refer patients for whom it's a concern to an NRA instructor certified to teach "Home Firearm safety" (as I am). But ... that wouldn't satisfy their political agenda, plus it would tend to legitimize the NRA, and they certainly don't want to do that.

[62coltnavy]

Yes, suicides are a mental health issue--and the first stop where these issues are addressed is at the office of your personal physician. Physicians are often the prescribers of antidepressants long before referral to a mental health practitioner. Add to the fact that half of all suicides are by firearms (and a higher percentage among males versus females), discussions of guns and depression have a link that can be addressed at this level.

Right now, according to recent studies, the life expectancy of white males has actually decreased in the last few years, a trend largely caused, statistically speaking, by a doubling of the suicides of white males in their forties and fifties. Depression, alcohol and drug abuse, abuse of pain medication,s poor economic outlets, etc, are leading to more suicides in this group, and of course, half of those deaths are due to firearms.

Does this mean that every doctor should ask all of his or her patients about their ownership of guns? Nope. Instead of politics, this should be an issue to be discussed based on good medical judgment. And of course, you can always lie.

[natman]

Well, I may be more inclined to buy that firearms are a legitimate health issue when doctors start asking about power tools, swimming pools and driving habits.

Until then it's just more political discrimination.

[jmhyer]

I frequently talk to my patients about guns...what they or I have acquired lately, how often and where do we shoot, etc.

After I've read them, all of my gun and hunting magazines go to my waiting room and into exam rooms for patient use.

I recognized and complimented one of my patients recently on the LCP I figured he was concealing in the Sneaky Pete holster on his belt.

Yep...I have lots of conversations with my patients about guns.

[TomNJVA]

Yes, suicides are a mental health issue--and the first stop where these issues are addressed is at the office of your personal physician. Physicians are often the prescribers of antidepressants long before referral to a mental health practitioner. Add to the fact that half of all suicides are by firearms (and a higher percentage among males versus females), discussions of guns and depression have a link that can be addressed at this level.

If personal physicians want to inquire about a patient's state of mental health, fine, that is within their domain. If they determine the patient has a mental health issue, then treat it. If the issue is so serious they the patient poses a risk to themselves, then direct or commit them for more intensive care. I don't see how discussing gun safety with a depressed or suicidal patient will stop them from committing suicide. In fact, it may give them ideas. And for mentally healthy patients, guns are none of the doctor's business.

TomNJVA

[jdc1244]

So now the Massachusetts AG has reportedly put her blessing on this boundary violation.

There is no ‘boundary violation,’ just as the issue has nothing to do with ‘Constitutional rights.’

Indeed, doctors acting in the capacity of private persons addressing with their patients the issue of guns in the home has nothing to do with the Second Amendment whatsoever – the rights protected by the Second Amendment concern solely the relationship between government and those governed, not between and among private parties, such as doctors and patients.

I'm sure you and everyone else here is as tired as I am of hearing the misinformed leftists rant on about "gun violence".

And everyone else is tired of dishonest, hyperbolic rightists contriving ridiculous lies and slippery slope fallacies concerning doctors talking to their patients about guns in the home ‘potentially’ violating the Second Amendment, when in fact nothing could be further from the truth.

[JohnKSa]

Indeed, doctors acting in the capacity of private persons...

When I interact with a doctor who is acting in the capacity of a private person I have no problem discussing any topic that happens to come up in the conversation. I also don't pay them for their time and expertise when they are acting in the capacity of a private person.

When I go to a doctor's office, I'm paying the doctor for a service and for his/her time and expertise. Therefore he/she is not acting in the capacity of a private person.

If I went to a firearms class and the instructor asked me if I had any prescription medications and how I stored them because kids getting hold of prescription medications is a "public safety issue", I'd be just as upset as I would be if I went to a doctor and he started asking me if I had any guns and how I stored them and offered me advice on the topic. Neither one of them has any business delving into aspects of my life that have nothing to do with what I'm paying them for.

[HiBC]

Seems to me like it conflicts not only with the 2nd Amendment,but the 4th,5th,and 10th. Of course ,others may disagree.
I pay a Doctor for professional services,not for him to be an agent for the Fed agencies.
Doctors ,in my experience,did not waste time asking me gun questions for over 55 years.They are only doing it because the feds require it.

The ultimate casualty is patient/doctor trust.

Trust in the fed gov being involved was at least destroyed with "If you like your doctor,you can keep your doctor." I don't trust those who lie to me.

And now the Doctor is acting as an agent for the Feds,sharing personal information with bureaucrat agencies,with the consequence a Constitutional Right may be compromised.
If the Doctor had to follow the same rules as Law enforcement,before the Fed required interrogation we should be Mirandized and have an attorney present before we answer.
Yes,I'm being sarcastic,but not without justification.

If you disagree that the Doctor/Patient Trust has been broken,search similar threads and read the posts. Don't Answer,Lie,or just say "Everything is beautiful,DocI'm SO HAPPY!!" Post after post. That is the result.

Now,how many people will suffer or die because of this stupid policy,because people won't talk to their doctor?

[jmr40]

Heads are exploding for no reason. There is nothing wrong with your Dr's asking the questions. If you choose to answer fine; if not fine. Problem solved. All you have to do is tell the Dr. that this isn't a topic you want to discuss. If you were forced to sit through a KGB type interrogation I could understand the concern. Your Dr. asking a couple of questions is in no way going to lead to your guns being taken.

Suicide is a huge problem and firearms are the most common and effective method. People contemplating suicide don't think the way most of us do. Everything they do is irrational to us and most of them leave clues that they were contemplating suicide. The problem is that most family and friends don't recognize the clues until after their family member or friend is dead. A Dr. asking a simple question could open the door to someone asking for help.

I've dealt with the aftermath of suicide too many times. I've been to the funeral of a 27 year old Marine who was the son of a close friend who saw too much during 4 deployments.

My wife and I volunteer with a SAR team and most of our searches are for suicide victims who park their cars, walk into the woods and shoot themselves. They don't want to be found and make things as difficult for us as possible. As of 2 weeks ago there were 7 such unsolved cases here in GA. One local guy was last seen on Oct. 29th. His car and suicide note were found 2 weeks later. I gave up the last month of our deer season participating in multiple searches for his body which was finally found just 2 weeks ago. He was almost 4 miles from his car.

When you smell week old corpses, start placing body parts in body bags and meeting the families of suicide victims it gives you a different perspective on things.

[Shenna9220]

Just this week an appeals court struck down a Florida law that would have prevented doctors from talking to patiences about firearms. So now when I'm asked, I will ask the doctor what safety training they have received, what firearms they have trained with, what they own, etc. without valid answers to these questions, I have nothing to offer them.

[Kevin Rohrer]

I disagree with post-11. Doctors have NO business talking about "gun violence" to patients, just as they have no business asking patients ANY questions about gun ownership, the exception being mental health professionals dealing with their patient's mental issues. It's none of their business, and they are intruding and enabling government intrusion and social conditioning.

[surveyor]

link about ruling in Wasington Post
https://www.washingtonpost.com/news/...93349#comments

I don't agree with the appeals court ruling by any means.
There were reasons the legislature enacted this law.

The issue I have with this is one of trust and recordkeeping.
I do not want any questions answered on a form that is included in my medical records available to whoever can view them.

It goes beyond that.
In a non professional conversation with a doctor I can see the first amendment argument that was used.

In a professional (for hire) setting where I am paying someone for their training and expertise, They should have just that. Training and expertise.

With insurance requirements, and other third parties viewing medical records from insurance to billing, I'm not ok with my answers to questions being asked and recorded on forms.

If the doctor makes a passing comment about " if you have any unsecured firearms, please make sure they are secured" I'm ok with that, but that's as far as I am willing to go.

[rkbanet]

This is quite an interesting thread. I do not think it is an MD's place to ask these ?'s. However ones 2nd Amendments rights are not be violated by the asking of questions, nor the recording of answers. One can always fire their MD if they disagree with them, just as an MD can "fire" a patient. I am in the medical field and this happens all the time for all kinds of disagreements. HOWEVER ANY PERSON has a First Amendment right to ask any other person any question they like, they also have a right to record their answers.

[thallub]

There were reasons the legislature enacted this law.

They enacted a feel good law designed to appeal to the conspiracy bunch.

[Aguila Blanca]

Originally Posted by jmr40

There is nothing wrong with your Dr's asking the questions. If you choose to answer fine; if not fine. Problem solved.

I'm sorry, but I have to disagree. By now it has been well and extensively documented that the AMA is promoting this not out of concerns for individual patient well-being, but as part of a general political agenda to reduce or eliminate firearms. Some doctors may actually know something about guns and can address the issue with some semblance of competence but most don't know anything about guns except that they're scary and evil, and therefore they're bad. That's why some of us talk about "boundary violations." For a thoracic surgeon to practice psychiatry would be unthinkable (and illegal), because a thoracic surgeon doesn't have the knowledge or the training to practice psychiatry. The same would apply to a psychiatrist practicing thoracic surgery.

Yet, somehow, the AMA doesn't see any problem with recommending that doctors talk about guns, even if they don't know which end of the "bullet" goes into the chamber. There are, of course, specialists who are certified to instruct and counsel people on this subject. They are NRA-certified instructors. But a general practice internist who wouldn't hesitate to refer a patient to a thoracic surgeon or to a psychiatrist probably would never consider referring a patient to an NRA instructor for gun safety issues. Why not? The NRA instructors ARE the qualified "specialists."

As to just choosing not to answer, the problem is that a refusal to answer may be interpreted as a "yes," and you have no control over what gets entered into your records -- which are now shared pretty far beyond just one doctor's office. So simply not answering does not solve the problem. Unfortunately, what solves the problem is lying.

"Are there guns in your house?"

"No."

So far, at least, it isn't illegal to answer this question incorrectly, and I firmly believe that this is an instance when it is morally acceptable and appropriate to lie.

[FITASC]

Not just the anti-gun AMA, but also the anti-gun CDC.

As a dedicated conspiracy theorist, my immediate reaction is: "Why?" And the conspiracy theorist part of may brain says, maybe because the State of Massachusetts medical board has been receiving complaints from the public about doctors who do this, so the AG is doing this to provide "cover" for those doctors who engage in the practice.

And since the gov't can violate HIPAA and secure your "private" medical records at anytime, there could be a more serious underlying reasons. Maybe the gov't wants your doctor to keep notes so that they cqan then come and take your guns away if your doctor feels you might "have issues".

How's that for conspiracy theory?....

[Frank Ettin]

Originally Posted by FITASC

...since the gov't can violate HIPAA and secure your "private" medical records at anytime,...

Exactly how can the government violate HIPAA and get one's private medical records at any time?

[heyjoe]

i read threads on this subject and wonder how many of you have actually been asked by their doctors if you have guns. I would also like to see documentation on the common assertions that its required by a federal law or agency policy. Unfortunately after prolonged intensive exposure to toxins, I have had to go to numerous doctors over the last 16 years in various specialties for screening and treatment of several conditions, including doctors in a federal program and have never been asked do i have guns. And this in a one of the most gun restrictive states, New York. The only offices where i have ever been asked about how i feel, am i depressed was in the federal program. The once a year federally funded health screening i get includes a questionnaire containing literally hundreds of questions about various systems in the body, neurological, circulatory, respiratory etc. that takes about 25 minutes to complete. There are no questions on guns.

[Aguila Blanca]

Originally Posted by heyjoe

i read threads on this subject and wonder how many of you have actually been asked by their doctors if you have guns.

I have been asked, both verbally and as a question on the patient intake/update form.

I would also like to see documentation on the common assertions that its required by a federal law or agency policy.

I'm not aware of any "common" assertions that this prying is required by any federal law or agency policy. I'm certain that I have never made such a claim, and I have posted about this problem previously. The initiative seems to be coming from the AMA and the CDC. Yes, the CDC is certainly a federal agency, but I have not routinely posted about them. It's the AMA that bothers me more.

As to the CDC, I think the only documentation you need is the fact that the Congress specifically voted NOT to fund any CDC programs associated with "gun safety." If they weren't meddling into things not associated with disease (their middle name), there would have been no need for the Congress to slap their wrists.

https://www.pri.org/stories/2015-07-...h-gun-violence

http://www.webmd.com/mental-health/n...s-group-says#1

[heyjoe]

the monitoring and treatment program i am in is funded and administered by the CDC and no gun questions have ever been asked going on 13 years now.

[Aguila Blanca]

You are very fortunate.

I get most of my treatment from the VA hospital, and they do ask. The question has also been in new patient intake forms when I have seen outside specialists.

[heyjoe]

Aguila Blanca You are very fortunate.

I get most of my treatment from the VA hospital, and they do ask. The question has also been in new patient intake forms when I have seen outside specialists.
Today 02:29 PM

yeah i would get tired of that pretty quickly. i also would find that intrusive.

[ShootistPRS]

The biggest problem is that government wants to prevent death by firearms. They don't care if it is suicide, robbery, accidental, demented mass murderer or a terrorist act. They want to prevent it.

It can't be prevented! at least not without taking away our rights and tracking everything we do 24/7.

I am less concerned about somebody offing them selves than I am about the thug who robs a liquor store and ends up shooting two people in the process. Tying violence and suicide together because they both use a gun is infantile in its simplicity and astounding in its error. The biggest problem with suicide by gun is that it usually works. If you slash your wrists you get taken to the hospital, bandaged up and told to get help. If you take pills to end your life you get taken to the hospital have your stomach pumped out, given stimulants and when you leave you are told to get help. The state gets to take care of you if the suicide is unsuccessful but if you are successful then it's a tragedy.
People use all kinds of tools to commit suicide. They use cars by driving into a wall or bridge or they walk out in front of a car or truck. They use cops - threaten a cop or grab a person and hold them hostage with a toy gun - make a menacing movement and you have suicide by cop. They use kitchen knives, screw drivers and even electric drills! If someone wants to commit suicide the don't think anyone - including themselves care about what they are going through. You can't keep people from committing suicide any more than you can keep them from stealing, bullying, or killing. We don't have a gun problem in the states - we have the same problem with violence here that they do in England or France or anyplace else. Get rid of the violence and you get rid of the problem - and we will still have our rights!