Guns, Doctors, Patients, and the Second Amendment

Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality.

First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies like those in Newtown, Conn., or Aurora, Colo. Gun safety should be of paramount importance to all gun owners. However, if I am going to ask all my patients about gun safety and ownership, then there are a few more dangerous things I need to ask them about as well.

“Do you own a pool?” (Quite relevant since we live in Florida.) “If you do, do you have small children at home or as guests? Do the neighborhood children come by? Do you have a pool fence and is it locked at all times? Have you thought about how many accidental drowning of children there are in Florida every year? Have you taken a course in pool safety?”

Or how about this topic: “Do you own a dog? What kind of dog is it? Were there any pit bulls in its family lineage? Do you have small children at home or grandchildren? Has your dog ever bitten anyone? (Okay, the mailman doesn’t count.) Have you taken a course in dog safety ownership?”

You see where I am going with this of course. First of all, I, and most doctors, don’t have the time to engage in this dialogue with my patients, since I am too busy asking about percentage of seat belt use, quitting smoking, updating medicine lists and system reviews, and filling out ridiculous “meaningful use” of EHR forms, just to get paid from Medicare. And even if I did have time, it is really none of my business. And if even if it was my business, asking this would not prevent a mentally aberrant person from finding weapons and using them in a hideous fashion.

The fatal flaw in this logic is that the desire to do good, does not lead to good results. In fact the opposite is often the case. A recent opinion piece in the Wall Street Journal by Jeffery Scott Shapiro highlights this paradox. He was a criminal prosecutor in the District of Columbia from 2007 to 2009. In essence during the strictest gun ban years, the rate of homicides increased. Ultimately in 2007, the U.S. Court of Appeals in D.C. ruled the city’s gun ban to be unconstitutional. The U.S. Supreme Court also affirmed the ruling the next year. Since the ban was struck down in 2008, the homicide rate dropped from 186 to 88 in 2012, the lowest number since the original ban law was enacted in 1976.

Recent shooting tragedies do launch a knee jerk reaction by well-intentioned politicians, but as usual, the beneficial results of new laws often achieve the opposite, since the criminal, or deviant mind, will always find a way to purchase weapons. So here are my thoughts on what might help.

• Loosen the HIPAA laws so deranged individuals can have their psychiatric history quickly accessed by mental health providers.

• Tighten the “gun show” loop holes, so gun purchases meet the same measures at shows as at a gun store.

• If the government insists on throwing more money at a problem, (and they excel at always doing so), then invest in more mental health professionals and treatment facilities.

• Make it easier for teachers, (who want to), learn gun safety and obtain concealed weapons permits. Every adult who supervisors school outings in Israel is trained in weapon use and carry semi-automatic guns on field trips. You never hear about these tragedies in that country.

But mandating doctors to ask patients about gun possession? You can count me out on that one. This is an invasion of privacy, and worse, will do nothing to curtail the periodic catastrophe that occurred at Sandy Hook.

“To be prepared for war is one of the most effectual means of  preserving peace. A free people ought not only to be armed, but disciplined.”
      - George Washington, First Annual Address, January 8, 1790