Physicians, Patients, and Guns

There's little disagreement that the events at an elementary school in Newtown, Conn., on December 14, 2012, were a tragedy and a wake-up call to many about where and how violence strikes.

In the series of "What could have been done differently?" inquiries made since that date, the attention recently turned to physicians and other healthcare providers. In two of 23 executive actions that comprise his initiative against gun violence in this country, President Obama made it clear that there should be nothing that prevents physicians from asking their patients about guns in their homes, and subsequently reporting any concerns to local law enforcement.

"Doctors and other healthcare providers … need to be able to ask about firearms in their patients' homes and safe storage of those firearms, especially if their patients show signs of certain mental illnesses or if they have a young child or mentally ill family member at home," said a statement from the White House further defining one of the president's executive actions.

Then disagreement picked up steam.

The ongoing debate found in the comments section of endocrinologist Melissa Young's blog post on PhysiciansPractice.com, "Gun Discussions Should Not Be Required for Physicians" (http://bit.ly/Physicians-and-Guns), on whether or not doctors should even breathe the word "gun" in the exam room, mirrors the current divide over gun control in our nation in general.

To be clear, the president's action was in part to clarify that there is no federal law - notably HIPAA - that prevents physicians from reporting to authorities possible or real threats of violence. This was clarified even further by a letter to all healthcare providers on the same day by Leon Rodriguez, director of the HHS Office of Civil Rights, who also advises all physicians and providers to consult state laws.

And that's where it becomes a bit more complicated, because there are states- seven in fact - that pondered laws to flat out prohibit physicians from discussing gun ownership with patients. Florida is the lone state to pass such a law, but it is on hold, caught up in an ongoing legal battle between the First and Second Amendments.

While physicians are already under a professional and legal obligation to share imminent threats, real or perceived, with law enforcement, there's a vast majority of Americans - including physicians - who say it is not a doctor's place to bring up gun ownership. The reasons range from being none of their business to another thing for physicians to inquire about in short patient visits to the fear of personal beliefs of the physician influencing a patient.

Now I don't think any physician would hide a threat made by a patient from law enforcement, whether or not it involved a gun, due to his personal opinion on firearms.

But, as physicians well know, patients are not always the most upfront when it comes to the issues behind their symptoms. Discussions of depression, family issues, financial troubles, and other "personal" matters often creep their way into the exam room, and can be a discovery that moves a patient from noncompliance to the road to better health and wellness.

If something has the potential to harm a patient, I believe physicians have the right to inquire about it. The president's action is neither a mandate nor an order. It is a reminder that we all have a role to play in our society so we can eliminate "What could have been done differently?" in the first place.

Keith L. Martin is managing editor of Physicians Practice. Tell him what you think at keith.martin@ubm.com. Unless you say otherwise, we'll assume that we're free to publish your comments in upcoming issues of Physicians Practice, in print and online. Have a "Bigger Picture" opinion of your own? Send it along via e-mail and we'll consider it for a future issue.

This article originally appeared in the March 2013 issue of Physicians Practice.