Guns are one of those topics that really divide Americans. It's hard to have a calm and evidence-based discussion. But one place where we really need to do that is in the pediatrician's office. Why? That's the topic of this week's healthcare triage

(Intro)

So every year I go to see my doctor for a checkup. And when she's running through the usual list of questions, she asks me if I'm sexually active with my wife. Then she asks me if I'm sexually active with anyone other than my wife. She's not asking to be intrusive, she's not doing it because she's nosy. She knows that having multiple sexual partners significantly increases my chance of contracting a sexual transmitted infection. Asking about that lets her see if I am at risk. And then she can address that risk with me.

I'm not offended that she asks me. It's actually part of what makes her an excellent physician. Doctors are supposed to ask about sensitive things in order to help keep us safe. This is especially true for pediatricians. This kind of exchange is how we engage in prevention, sometimes called anticipatory guidance, and study after study shows it can prevent harm.  When pediatricians ask you about using car seats, they're trying to prevent injuries.  When they ask you about how your baby sleeps, they're trying to prevent injuries.  When they ask you about bike helmets, they're trying to prevent injuries.  And when they ask you about guns, they're trying to prevent injuries, too.

But not evidently everywhere.  In Florida in 2011, a law was signed that made it illegal for doctors to ask patients if they owned a gun.  If doctors violated this law, they could be disciplined, which could lead to fines, citations, and even a loss of their license.  A lower court struck down the law in 2012, but last year, a panel of judges on the United State Court of Appeals for the 11th Circuit upheld it.  In their ruling, the judges declared that the law regulates physician conduct, and I'm quoting, "to protect patient privacy and curtail abuses of the physician-patient relationship."  The clear assertion of the judges is that there is no legitimate health reason to be asking about gun ownership.

In 2012, there were 33,363 deaths by firearms in the United States, but only 12,093 of those deaths were by homicide.  About 62% of deaths by firearms, or more than 20,600 of them, were suicides.  Guns are used far more often in suicides than homicides.  Access to guns can make an impulsive suicide attempt far more likely to succeed.  Research shows that almost half the patients who have survived a suicide attempt report that the time between thinking about suicide and attempting it is often 10 minutes or less.  Guns work.  Suicide attempts with a gun succeed more than 85% of the time.  Suicide attempts with poison or overdoses succeed less than 2% of the time.  Meta-analyses show that there's a significant association between having access to a firearm and a higher chance of suicide succeeding.  And that's just the deaths.  There are also injuries.  In 2009, almost 7,400 children were hospitalized in the United States because of injuries related to guns.

Doctors who ask about guns aren't doing so because they're gossips.  They're doing so because the vast majority of those deaths and injuries are preventable.  They want to keep you and your children safe.  Before anyone thinks I wanna take your guns away, hear this.  It's entirely possible to keep a gun in your home safely.  This isn't a movement by physicians to remove anyone's right to own and keep guns.  But studies show that the majority of people who keep their guns in their homes do so in an unlocked space.  Few have any kind of trigger locks.  More than 10% report keeping their guns loaded or near ammunition in an unlocked area.  That's often how children get hurt.  Almost no one would argue that young children should have access to guns or ammunition, let alone unsupervised access, but that's what's happening in far too many homes in the United States.  Research shows that guns kept in the home are more likely to be involved in accidents, crimes, or suicides than in self-defense.

When I ask patients and parents whether they own guns, if they tell me they do, I immediately follow up with questions about how they're stored.  I wanna make sure that they're kept apart from ammunition.  I wanna make sure they're in a locked box, preferably in a place out of reach of children.  Doing so minimizes the risk to kids.  That's my goal.  When we as physicians ask you if you drink or smoke, it's not so that we can judge you.  It's so that we can discuss health risks with you.  When we ask you about domestic violence, it's not to act like police detectives.  It's so that we can help you make better choices for your health.  When we ask you about what you eat, or whether you exercise, it's so we can help you live better and longer.  We're doctors.  That's our job.  And hear this.  You can calmly refuse to answer any of these questions.  You can tell your doctor you'd rather not discuss any of these topics.  You can choose to lie.  You can even just not come to the doctor in the first place.  There's nothing stopping you from preventing us from helping you.

Of course, rejecting discussion of an uncomfortable topic isn't much different from rejecting discussion of what you eat or what's making you sick.  You're only hurting yourself.  What this now upheld Florida law does is prevent doctors from helping other people who might want that assistance.  Anticipatory guidance is about stopping injuries before they happen.  If the courts decide the physicians can't ask people sensitive questions, then they're putting patients, including children, at risk.  Even worse, a new law being proposed in Texas would do the same thing there.  In essence, these laws permit the government to interfere with you and your doctor's relationship.  Most people, I'd wager, would rather keep that relationship and what goes on in an examination room, out of bureaucrats hands and in their own.