John Commins reports that physician groups will appeal the 11th Circuit ruling upholding Florida’s “Docs vs. Glocks” law. I am glad to hear that as I think the law is not only a gag on health professionals’ First Amendment rights, but a prohibition on professional speech/conduct that is a disservice to public health and safety. In my opinion, states should only be interfering in (regulating) doctor-patient discussions or care when there is sufficient evidence that a practice causes harm or puts patients at unacceptable risk. There has been no such demonstration in this case.
Just as pediatricians and those of us who work with children may routinely inquire about a child’s nutrition and sleep patterns in screening for factors that may contribute to health and functioning, so too do professionals screen for other factors that may affect our patients’ health – including the presence of guns in homes where there are impulsive or curious young children. Mental health issues such as depression or anger issues are not the only reason or justification for asking about guns.
Those supporting the Docs vs. Glocks law seem to believe that inquiring is just an attempt by professional groups to condemn guns or interfere with adults Second Amendment rights to own guns. It’s not. It’s an attempt to do our jobs properly.
And given that we are required to maintain patient confidentiality and no law requires us to record all of a patient’s answers, why is there even a problem?
In any event, the Docs vs. Glocks needs to be struck down – to protect the health and safety of the public and so that health professionals’ hands are not unreasonably tied. If the state wants to regulate our speech, it should have to meet a higher level of scrutiny.
Are the doctors also going to ask if knives are kept in the home? Katana swords? What about fireworks? Do the patients or members in their household own and operate ATVs? What about hammers, power tools and large CRT TVs?
Probably not, but if they’re pediatricians or involved in child health, they may ask about the use of car seats, bicycle helmets, and the like. Does that trouble you, too? Do you have a problem with health care professionals responding to the statistics on gun accidents and injuries in the home by screening patients so we can educate them about safety?
No, I just think it is inconsistent. According to the NIH, most children are killed due to car accidents, falls, poisons, drowning and fire. Do you ask if there are fire extinguishers in the home? Do you ask if poisons are kept either locked away or placed somewhere kids cannot reach them? In all my years as a parent, (starting in 1997), I have never had a single pediatrician ask me about any of the items you mention, or the ones I have added. The truth is, more kids are killed by falling objects, particularly furniture and TVs, than firearms. Of the children killed by firearms, most of those are killed by a firearm that was not in the home.
Unintentional injuries leading to death are the leading cause of death in ages 1-24, yes. But you might want to look at the CDC data that drills down into that category. Homicide involving firearms ranks 2nd in unintentional injury category for aged 15-24, ranks 3rd for 10-14, and ranks 4th for 5-9 age group. Those data do not include suicide involving firearms, which are broken out separately: http://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_injury_deaths_highlighting_unintentional_injury_2011-a.pdf
From one of the CDC’s studies:
The CDC’s data also shows that when it comes to intentional homicides or suicides, guns are the number one means, and that 75% of homicides/suicides happen in a house or apartment.
So yes, if I think a patient might be at risk – and not just do to mood disorder – I will inquire and suggest parents ensure that any guns are locked away and that the child/teen doesn’t know the code, etc. And I’ve never had any parent protest or question my questions – including cops who obviously do have guns in their homes. They all understand that the sole purpose is protect safety, not take away their guns.
And yes, I often ask about poisons – including prescription medications – being locked away or controlled in the home. But that may be a function of the type of patient population I work with.
The problem with your argument is that homicide is not unintentional. Unintentional firearm deaths only show up once on the chart – with 16 cases for children age 5 – 9 years. For perspective, 350 motor vehicle deaths occurred in that same age category.
So because homicide is not unintentional, we shouldn’t be concerned about guns in the home that might not be adequately secured? Seriously? BTW, the number of unintentional firearm deaths (16) in that chart is a significant decrease from a few years earlier (see http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6106a1.htm#tab22), which some of us attribute to better education of people about gun safety. Bottom line is that I don’t want any of my patients becoming either kind of statistic. Trying to make any health/safety topic “off-limits” or tying healthcare professional’s hands/speech does not serve children’s health and safety. What happens/is said in the consultation room is between doctor and patient and the state should stay the hell out of it unless what the provider is doing is dangerous to the patient(s).
I appreciate your passion, but my point still stands that the medical field is inconsistent. When was the last time you asked a parent/guardian if they drive while intoxicated, or received a speeding ticket? 350 children killed in that age group due to traffic accidents.
Since you bring up the decrease in gun related deaths, let’s talk about that. Gun sales have skyrocketed in the past 6 years. How can we account for the decrease in deaths with all those extra guns being sold? Yet, deaths by traffic accidents increased. More children are killed by drunk drivers every year than by a gun, intentional and unintentional combined. So tell me, why do physicians not lobby against alcohol? If physicians groups were truly concerned about patient safety, I would think they would focus on this area, no? Truth is, most doctors I know are drunks, and I would agree with you, they have no business near a firearm.
I appreciate your courtesy in this discussion, but you haven’t responded to the issue as I see it: states cannot/should not attempt to regulate healthcare professional’s speech (which they sidestep as a First Amendment issue by talking about “conduct”) unless they can demonstrate a legitimate state interest in protecting public health and safety. Not a “heightened scrutiny” standard, but certainly something more than what was used in enacting this law. Consider similar laws where states have regulated healthcare pro’s conduct (like sex identification conversion therapy) – those laws were upheld at the appellate level because of the risk of harm to minors. What’s the risk of harm to patients/minors by physicians or other healthcare pro’s inquiring about guns in the home? Where’s the risk in Massachusetts, where a hospital has now added routine screening questions about drugs and alcohol for patients seen in ER?
You’re concerned about gun rights. This is not about gun rights, which are not at risk by inquiries. It’s about First Amendment rights of health care profession, which I obviously support. There will be a law review article coming out on the topic which I’ve had the opportunity to preview. I will post a link to it once it’s published and maybe then we can continue this convo within that framework.
But to answer your question: it’s true I don’t routinely ask parents about driving while intoxicated or getting a speeding ticket. My screening questions are tailored to the population I work with – then supplemented depending on the answers I get to the routine questions or spontaneous utterances by the patient/parents or my observations.
As to the medical field being “inconsistent,” well, that’s true for a lot of fields, isn’t it? 🙂