Debate simmers over doctors asking about guns

February 10, 2013

Do you have a gun in your home?

For some, that's a loaded question - particularly when asked by a doctor.

A debate is simmering over when and whether physicians should be allowed to talk to their patients about firearms.

Doctor groups say physicians are obligated to warn their patients about guns along with other health risks, such as riding in a car without wearing a seat belt. However, gun rights advocates balk at what they see as a needless invasion of privacy and blatant attempt at gun control advocacy.

State and federal lawmakers are weighing in.

President Barack Obama's plan to reduce gun violence says that doctors should be permitted to ask about firearms in a patient's home and safe storage of the guns "especially if their patients show signs of certain mental illness or if they have a young child or mentally ill family member at home."

The plan also seeks to clarify that the Affordable Care Act doesn't "prohibit or otherwise regulate communication between doctors and patients, including about firearms." More guidance on the issue is forthcoming, the administration says.

Earlier this month, Kansas legislators introduced a bill barring doctors other than psychiatrists from inquiring about firearms in the home when asking about a patient's personal information and medical history.

Florida passed a similar law in 2011. A federal judge blocked it last year, citing a violation of physicians' First Amendment rights. The ruling has been appealed.

No one has taken up the issue in Virginia yet.

Local doctors say they object to laws that intrude on the relationship between a physician and a patient.

"The patient-physician relationship should be a safe and even sacred relationship where the patient feels safe, feels comfortable in discussing anything they need to discuss," said Dr. Christine Matson, the chairwoman of Eastern Virginia Medical School's department of family and community medicine. "If there are constraints in terms of what I can ask, that also limits the doctor-patient relationship. I don't think government ought to go there."

Matson asks her patients about guns during their routine check-ups. She gives them a seven-page questionnaire that includes a section called "Behaviors that may put your health at risk" with questions about tobacco, alcohol, drugs and environmental toxins, among other subjects.

"Are there guns in your home?" is on page three, between "Ever forced to have sex?" and "A working smoke detector?"

Matson said the screening helps primary care doctors take an active role in promoting health and disease prevention, rather than just reacting to injuries and illnesses that already exist.

"I would say strongly that anything that confers risk is a valid part of the discussion with the physician," she said.

Patients rarely, if ever, bristle at the question, Matson said.

Other Hampton Roads doctors said the same, pointing out that their query comes along with others about equally sensitive subjects, such as illegal drugs and sexual preference.

"It's just what we do as doctors," said Dr. Phillip Snider, a family physician with Amelia Medical Associates in Norfolk. "We poke and prod in places that people don't enjoy."

Still, some people - including Charlie Pike - think that asking about firearms in the home goes too far. The 29-year-old Chesapeake resident has a concealed-weapon permit and wears a gun most days - including to medical appointments.

Pike's doctor asked about hunting after he saw the gun, and Pike was happy to chat. He would have been less responsive to questions about how many firearms he owned and how he stored them, however.

"It's not any of his business if firearm ownership is not related to the visit," said Pike, a production designer.

Doctors say the question gives them a chance to talk about gun safety with patients and their families. Snider lumps the conversation in with other "practical, low-cost, high-yield advice."

"It's stuff that needs repeating over and over," he said. "You tell kids to wear their bicycle helmets. You tell people to wear their seat belts. To use sunscreen, get adequate sleep, things like that."

Dr. John Harrington, a pediatrician, has asked his patients about guns and ammunition in their homes. The answers sometimes surprise parents.

"Kids tend to know a lot more than what parents believe," said Harrington, division director for General Academic Pediatrics. "You may think that you have something secure, when in reality it may not be that secure."

Most doctors recommend keeping guns unloaded, separate from ammunition and locked away.

Dr. Timothy Wheeler and other gun rights advocates wonder why they should listen to physicians' advice about weapons.

"They have absolutely no training about firearms in medical school or residency," said Wheeler, director of Doctors for Responsible Gun Ownership, a project of the Second Amendment Foundation. "Doctors and doctor organizations have consistently refused for the last 20 years to work with the real experts in firearms safety, groups like the NRA, groups like the NRA's state-affiliate gun owner organizations, groups like the National Shooting Sports Foundation."

Snider said his advice comes from his own experience handling guns when he was younger.

Harrington said the topic is tricky because there's not a lot of new research. Federal health agencies have been banned from studying gun violence since the mid-1990s because of concerns about using taxpayer money on a politicized topic.

The Norfolk pediatrician said his suggestions to families follow universal themes that apply with other child safety measures: If you make something less accessible, it's less likely to be used inappropriately.

However, Harrington said: "I would rather have evidence to go by, like I have with vaccines."

Dr. Firoza Faruqui takes her cue from guidelines by the American Academy of Pediatrics. When talking to patients' families, she cites the group's statistics showing that firearms in homes are more likely to harm family members or friends than to be used in self-defense.

Faruqui, a pediatrician with the Hampton Roads Community Health Center in Portsmouth, also tells families the academy's stance on the best way to avoid gun-related injuries in children: have no firearms in their home. She knows parents could be offended by such a suggestion, just as they could be offended by the notion that their smoking harms the health of their children.

Parents usually don't get rid of their guns after talking with her, but they often take pains to store their weapons properly, she said.

For Faruqui, the message isn't political.

"I'm not trying to control any guns," she said. "I'm just trying to keep children safe."

But Wheeler says the American Academy of Pediatrics and other doctor groups have taken a side in the gun debate. He fears physicians will misuse patients' trust to advance a political agenda.

He also is concerned about what happens to the information that patients provide. Doctors said they document whether a patient's home has a firearm in the medical record, but that the file is protected by privacy laws.

The federal Health Insurance Portability and Accountability Act, known as HIPAA, generally prohibits health workers from sharing patients' medical information without their permission. However, it allows disclosure under some circumstances.

Dr. Melissa Young, a New Jersey-based endocrinologist, worries that the government will elbow its way into doctors' conversations with patients about guns. It's already nosing into discussions about smoking, she said.

A federal program encouraging health providers to use electronic health records requires doctors to document the smoking status of at least 60 percent of their patients in their medical records. However, doctors do not report the data to the government.

Still, Young wonders if physicians may one day be required to report patient gun ownership information - even though the Affordable Care Act contains language saying it doesn't authorize the U.S. secretary of Health and Human Services to collect or maintain records on legal ownership or possession of firearms or ammunition.

"I'm not against the physicians asking it. There are certain patients to whom the question has to be asked," Young said. "But I think that the answers to that need to stay within the physician's office."

source:  Amy Jeter - Hampton Roads