The controversial debate of gun regulation and ownership just became even more intense with the recent UCLA campus shooting. The murder-suicide on Wednesday brings the U.S. to a total of at least 186 school shootings since 2013. The tragedy does not just end on school campuses, as the number of gun-related incidents is increasing everyday.
With statistics showing 32,000 deaths, 78,000 wounds, and over 20,000 suicides all directly connected to guns, there is no question that gun violence is a problem. What is less certain, however, is if physicians have the ethical or legal grounds to be a part of the solution.
A discussion of public health
Gun safety discussions typically involve arguments relating to stricter laws or more thorough background checks. But when you consider the types of injuries and fatalities that result from gun violence, you realize doctors should also be a part of the conversation.
The most obvious reason is because doctors are the ones that will be caring for the victims of gun violence, whether it be self-inflicted or otherwise. Physicians also have a responsibility to protect public health, and prevent injury. A doctor asking a patient questions regarding their mental health, or if they smoke cigarettes, falls into this category - gun violence is often related to mental illness and also causes harm, so many proponents believe that asking a patient if they have a gun is a similar preventative tool.
“I think that it's within our purview to talk to our patients about guns because it's an important health issue, particularly in America. As part of an annual or comprehensive visit, it's something that should come up, just like how we ask patients about smoking, alcohol, whether they wear a helmet when they ride a bike, and whether they practice safe sex. Do they have any hazardous hobbies? I think it falls under the same rubric. It's health. It's maintaining health”, said Bart A. Kummer, MD in a Medscape panel discussing the current status of gun violence in the U.S.
Medical opinion seems to be divided
Not all physicians agree that gun safety should be discussed during a visit; in a survey 47% of physicians said that doctors should be talking to patients about gun safety, while 39% said no, and the remaining 14% said maybe. Legal implications, such as a ruling in Florida that bans physicians from asking if there are guns in their home, do not make the case for counseling easier. However, there are exceptions to the rule when certain risk factors are present, and these same risk factors play a role in determining the best way to approach a patient regarding their history with firearms.
Dr. Garen Wintemute shared his approach in a publication for The Annals of Internal Medicine, “I don’t ask [questions about guns} of everybody; I don’t want to waste their time. But if I sense mental distress of any kind, I will pursue that. And I get a sense of some risk factors, I will talk about the risk factors and fold in firearms into those questions. I don’t do routine screening [and ask everyone about guns] but I’m doing case finding. Depending on the patient’s history and answers to my questions, I will either have more questions to ask and more to work out, or not.”
Statistically, patients whose doctors spoke with them regarding gun safety were more likely to follow practices described in the brief counseling. Whether a proponent or opponent of firearms counseling, all physicians and organizations such as the AMA want to fulfill their duty or protecting patients from any kind of injury or death.