[Ed: This is a common-use excerpt from a Wall Street Journal article published in the print edition June 25. Following an introduction, an ER physician from the American Foundation for Firearm Injury Reduction in Medicine replied “YES”, then came Dr. Hsieh’s corrective. He is a friend, colleague and DRGO member, and we found that his thoughts showed the most clarity. But you are encouraged to read the entire article for the context in which he responded.]
NO: It would undermine trust between doctor and patient
At first glance, asking patients whether they own or use guns might seem unobjectionable, like asking whether they smoke or wear seat belts.
However, when I asked several law-abiding, responsible gun owners, including other physicians, whether this was a good idea, their overwhelming response was, “No.”
Most felt it was none of their doctor’s business, and some said such a question might prompt them to lie or find another physician. One said, “It’s annoying to be asked such an obviously politically motivated question.” Even patients theoretically “at risk” told me they found the question intrusive. One mother of two small children said, “It’s a hindrance to authentic conversation and crushes doctor-patient rapport.”
I agree with all these arguments. I also share the concerns of many gun owners I’ve spoken with, who were uncomfortable with the thought that their gun ownership could be noted and saved in their medical records.
Although the Health Insurance Portability and Accountability Act currently protects patient health information, laws can change and databases can be hacked. Given the politically powerful forces seeking to restrict Americans’ gun rights, many gun owners are rightly concerned such sensitive data may not remain private.
Many medical societies aren’t politically neutral in the gun-policy debate. The American Academy of Pediatrics supports “the strongest possible regulations of handguns for civilian use” and recommends on one of its websites, healthychildren.org, that parents “NEVER have a gun in the home” (“NEVER” is capitalized on the website).
Yet, the AAP doesn’t take a similar approach to other home dangers. Owning a swimming pool increases the risk of accidental childhood death, but the AAP doesn’t advise parents to “NEVER own a swimming pool.” Rather, it recommends adult supervision of children around pools and swimming lessons to teach children basic water safety.
Other gun owners have told me that, in their experience, many physicians show no appreciation of positive uses of firearms, such as for sports or self-defense. Nevertheless, a 2013 report by the Institute of Medicine and National Research Council, and sponsored in part by the Centers for Disease Control and Prevention, cited data which suggested that “defensive gun uses by victims are at least as common as offensive uses by criminals, with estimates of annual uses ranging from about 500,000 to more than 3 million, in the context of about 300,000 violent crimes involving firearms in 2008.”
Given that many physicians are unfamiliar with (or opposed to) reasons for owning a gun, it’s unsurprising that many patients feel uneasy discussing their use of guns with their doctor. Doctors have a professional and legal responsibility to notify authorities if patients pose an imminent threat to others or themselves. But routine inquiry about gun ownership goes far beyond this obligation. Such inquiries will only alienate many responsible gun owners, and undermine the trust essential to a healthy doctor-patient relationship.
For this reason, physicians should ask patients about gun ownership only if they have evidence that a patient poses an imminent risk to themselves or others. Say, a mother tells her pediatrician that her daughter just broke up with a boyfriend, has stopped eating and is cutting herself. That pediatrician may wish to ask if the parents have any concerns about safe storage of firearms, sleeping pills, or anything she might misuse. In such cases, it doesn’t make much sense to single out firearms as something different from other dangerous items. Rather, talking about guns is appropriately part of a broader discussion of overall safety.
There is a big difference between a generic invitation to discuss “gun safety,” which can be easily declined or accepted, and trying to pin down whether a patient owns, uses or keeps firearms in the house.
Apart from those cases where a patient poses an imminent risk to themselves or others, physicians shouldn’t routinely talk about gun use with their patients. It is especially important that physicians not routinely seek to include patients’ use or ownership of firearms as part of their formal medical record. The reason is simple: Doctors shouldn’t put themselves in a position where patients view them as willing (or unwitting) agents of a government working against their interests.
Sometimes, being a good doctor means keeping things out of the medical record, not in it.
Dr. Hsieh is a co-founder of Freedom and Individual Rights in Medicine, and writes regularly on health-policy issues from a free-market perspective. He is in private practice in the South Denver metro area. He can be reached at firstname.lastname@example.org.