The Florida legislature passes a bill which precludes physicians from asking patients if they own any guns. In case any of the nuance was lost on the public, the bill is called, “Don’t Ask.”
Docs are still allowed to ask when it is relevant to the immediate situation (e.g. a suicidal patient). What is apparently illegal is the routine questions, like the kind performed by pediatricians.
Not surprisingly, most people who are angry do not really understand what is at stake. Even Dr. Ronald Pies, of Psychiatric Times fame, wrote:
The constitutionality of legal possession of firearms is emphatically not the issue here. The issue is the physician’s professional right and duty to inquire into risk factors for harm to self or others, including but not limited to possession of firearms. Indeed, failure to so inquire—particularly in cases involving suicidal or homicidal individuals seen in emergency room settings—would pose a serious threat to the safety and well-being of both the patient and, potentially, society. It would also expose the physician to tremendous liability…
I sympathize with his anger; or, more accurately, there was once a time when I would have. But that was back when I was looking through a mirror, darkly.
First, the law reduces physician liability, not increases it. Dr. Pies makes the classic “information bias” mistake: assuming that knowing information is the same as acting on information. Put bluntly: if you’re not allowed to ask, it’s not totally your fault; if you are allowed to ask, what are you going to do about it? Seriously, what? All you’ve done is noted on the chart at Visit 1 that he has a gun, and that you did nothing for the next 14 visits. This is exactly what happens at all those “well baby visits”: pediatricians collect a gigantic amount of information, harp excessively on whatever happens to be their pointless favorite (“he has a prominent tongue thrust, you should have that evaluated”) and ignore the rest, and give out amoxicillin as a form of parental valium.
Second, the science isn’t on the side of the doctors. I’ve heard that
A gun in the home is 43 times more likely to kill someone known to the family than it is to kill someone in self-defense, according to the American Academy of Pediatrics (AAP)…. states with the most guns at home have suicide rates double rates of states with the fewest guns, and those suicides are often children..
and I do not doubt it; but is there any reduction in gun deaths because doctors get to ask this on their routine screens?
Third: getting an answer to the question is not the same as knowing the true answer to the question. If he says no, then what? Phew? (Asking this question didn’t prevent a patient from pulling a gun on me.) The clinical interview fails where it is most important; patients are accidentally/deliberately unreliable, and doctors use the information to excuse themselves. Docs would do well to adopt the old adage of the Navy Seals that I just made up: always assume the other guy is armed. And HIV+. And a lawyer. And etc.
Foruth, the intent of the bill is explicitly to prevent discrimination against gun owners from insurers and doctors. If you’re worried that your HIV status will adversely affect your employment, imagine what “owns two 9mms” will do.
One might ask what value there is in a five minute lecture about gun safety given to a long time gun owner by a doctor whose entire knowledge of guns comes from Hardcastle & McCormick, especially when the whole visit is 7 minutes.
One might also be tempted to ask about any racial bias: do doctors routinely ask minority patients about guns? If they do, how strongly does the doctor push them on it? (Or does he write with great relief: “patient denied guns.”)
Those outraged by the new law also seem to think that it is a free speech issue: “since when is the government allowed to tell me what I can or cannot talk to my patients about?”
And in this single aspect, they are absolutely correct and simultaneously completely oblivious: medicine is no longer a private matter, medicine turned its gaze to society and became an arm of social policy, at the service of the government. Time to bone up on our Foucault.
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