Physicians today are required to spend more and more time doing administrative work — including checking off electronic boxes in the electronic medical record (EMR) — which results in less quality time with patients. Now, some in Washington, DC think that physicians should also be required to ask patients about guns in the home, in an effort to somehow reduce gun violence and gun-related deaths in the U.S. For me, the answer is simply NO. Physician focus should be on the prevention, diagnosis, and treatment of disease — we should advocate for our patients, but we should not be government agents (unless we all collectively become employed by the state). In an article published recently in The Atlantic, author Olga Khazan argued that doctors have a responsibility in preventing gun-related deaths. However, as physicians, how can we still protect patients’ privacy rights? How do we preserve our relationships with patients? Physicians certainly have to ask many uncomfortable questions of our patients (e.g., sexual history, drug and alcohol use, and other sensitive subjects), but should we really be asking about guns? The legal implications alone of these discussions are enough to make even the most steadfast physician a little weak in the knees.
The government has long attempted to insert itself into the sacred and privileged “doctor-patient” relationship. The bond between doctor and patient is like no other — honesty, confidentiality, and trust are paramount to all other concerns. There is an ongoing debate on the role that physicians should play in gun control and safety. For example, Surgeon General Vivek Murthy has said in the past that gun control was a top priority for his office. A law in Florida states that health care practitioners should refrain from asking about guns except in certain circumstances. In addition, others want to require physicians to ask and document patients’ answers in the EMR. I fear that allowing discussions on guns to enter an exam room may completely undermine a physician’s relationship with his or her patient. Patients may feel uneasy about answering the questions, and may also be suspicious of why they are being asked in the first place. Patients may be less likely to TRUST their physician (for fear of some repercussion), and may also be less likely to discuss other medical issues with honesty. Lack of honest dialogue between doctor and patient can result in a lack of patient engagement and, ultimately, negative clinical outcomes.
Don’t get me wrong. We MUST educate the public about the proper use and storage of firearms. Guns should never be accessible to children, and any person who owns a firearm must be trained in its safety and proper use. However, the role of the physician should remain, first and foremost, as healer — we should not be required to become firearm educators, nor should we be required to document firearm possession to the government. While I do concede that there is likely a role for the discussion of guns in a pediatrician’s office (with the parents) in order to ensure that guns are stored properly in the home, I do not think that there should be any type of discussion in adult medicine.
Although there has been much research in this area, much controversy remains. In the Annals of Internal Medicine, researchers found that there is a vast array of opinions among patients regarding physicians asking them about guns. Only 25% of patients surveyed thought that it was ALWAYS appropriate for a physician to have a discussion about guns. Thirty-four percent of those studied stated that it was NEVER appropriate for a physician to ask about gun possession or gun use. Study authors concluded by saying nearly two-thirds of respondents thought it was SOMETIMES okay to ask about guns. However, I believe many Americans feel that this type of interaction is not appropriate.
Sadly, there are far too many gun-related deaths today in the U.S. We must do more to prevent criminals, those with mental illness, and others who would do us harm to possess guns. This should be the work of the community and of the local, state, and federal government — NOT the work of the physician. I fear that if we begin to mandate data collection of this sort by physicians and other healthcare providers, we will undermine the trust that our patients place in us every single day.
Kevin R. Campbell, MD, FACC is with North Carolina Heart and Vascular and UNC Healthcare. He is also Assistant Professor at UNC Department of Medicine, Division of Cardiology, and Director of Electrophysiology at Johnston Health. In addition, Dr. Campbell is President of K-Roc Consulting, LLC.
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- Khazan O. How doctors can help prevent gun deaths. The Atlantic. Published July 26, 2016. Available online at http://www.theatlantic.com/health/archive/2016/07/doctors-gun-violence/493058/. Accessed August 8, 2016.
- Betz ME, Azrael D, Barber C, Miller M. Public opinion regarding whether speaking with patients about firearms is appropriate: results of a national survey. Ann Intern Med. 2016 Jul 26. doi: 10.7326/M16-0739. [Epub ahead of print]