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Bridging the Debate Over Florida’s ‘Docs vs. Glocks’ Law

An appeals court just ruled that the state is allowed to ban physicians from talking about guns with their patients. But educating doctors about firearms could lead to an honest conversation about health risks with gun owners.

The debate over Florida’s so-called “Docs vs. Glocks” law began in a pediatrician’s examination room in Ocala in the summer of 2010. Dr. Chris Okonkwo was interviewing Amber Ullman, a 26-year-old mother of three, before conducting an exam of her youngest child. Okonkwo regularly asked his patients’ parents about possible health risks they might not have considered: Did they talk on a cell phone while driving? Did they have a pool at home, and was it fenced in? Did they own a firearm?

It was the last question that upset Ullman. When she refused to answer, Okonkwo told her to find another pediatrician. “Whether I have a gun has nothing to do with the health of my child,” Ullman told the local paper. Ullman’s husband, Tom, threatened to make the incident a court case, saying: “If I don’t have to register my gun with the state of Florida, why do I have to tell my pediatrician whether I own a gun?”

Maybe it was just a misunderstanding and a bad day for all involved: Okonkwo told the paper he never got a chance to justify his question by explaining how firearm safety was, in fact, a safety issue, because Ullman got short with him, telling him that “it wasn’t any of my business … so there was no point.”

Misunderstanding or not, today the issue is a constitutional case. In 2011 the conservative-dominated Florida Legislature, believing that invasive doctors’ surveys were violating citizens’ gun rights, passed the “Firearm Owners’ Privacy Act,” which bars physicians from discussing gun ownership with their patients in virtually all circumstances. It also bans the recording of any facts about a patient’s firearms in questionnaires or other medical files. Popularly known as “Docs vs. Glocks,” the legislation has given rise to a bizzare clash between First and Second Amendment rights.

The law, which was initially overturned by a federal court as a violation of physicians’ free speech, was upheld on appeal late last month, and the case now appears destined for the U.S. Supreme Court. If the state of Florida prevails, the law could become a model for other states that fear their freedoms are being threatened by overbearing doctors.

Lost in this rancorous, four-year-long debate is the question of whether talking to patients about gun hazards actually helps reduce those risks. Recent academic studies on the issue suggest there are some limited benefits to educating gun owners on possible health hazards in the examining room — and benefits to educating doctors on the ins and outs of firearms ownership. In other words, the two parties can successfully find middle ground by talking out the issue rather than treating each other as warring factions.

Doctors insist there are statistically settled risk factors worth raising with gun owners. For instance, firearm ownership increases the likelihood of killing oneself or a loved one, either through suicide, murder, or accidental shooting by two to three times. The risk is particularly acute in households with children. Though Florida conservatives and the National Rifle Association frame Docs vs. Glocks as a gun-rights issue, they hardly ever acknowledge that doctors’ concerns focus mostly on gun owners’ kids.

Until recently, the research on doctors’ gun counseling had long shown that gun-owning parents were OK with this approach: A 1999 survey of physicians and parents found that “All parents who owned guns indicated they would acknowledge owning a gun if asked by their pediatricians,” and 98 percent of pediatricians “believed that [they] should discuss gun safety with all gun-owning families” — a discussion that did not simply label guns in the home as an inherent danger, but offered that unloaded or locked guns are safer. (It should be noted that pro-gun parents aren’t the only group whose feelings have hardened during the gun-rights renaissance of the past decade; the American Academy of Pediatrics has since called for parents to remove guns from their homes altogether.)

Which raises a question: Do doctor-patient discussions about health risks in general accomplish anything? In many circumstances, yes. A 2008 study found that “[t]elling smokers their lung age significantly improves the likelihood of them quitting smoking,” though little discussion so far has centered on developing a gun-owning equivalent of the “lung age” concept — perhaps a chart showing comparative life expectancies in gun households, or representations of the damage unsecured firearms can do to small children.

On the other hand, we do know that a lot of patients already withhold personal and health information from doctors for a variety of reasons — a desire for privacy, avoidance of shame and lecturing, even the cost of possible future health care. If patients lie about owning a gun in the first place, and the doctor doesn’t proceed with the conversation, then potential health benefits go unrealized. And lying seems even more likely if Docs vs. Glocks is overturned.

One possible solution may be transitioning to a different style of counseling. Many physicians deliver ponderous boilerplate lectures about risky behaviors — a so-called “directing” method of counseling — and many patients’ eyes glaze over when the in-person Public Service Announcement starts: Sure I smoke. Sure it’s killing me. But a more Socratic method of “guiding” a patient to conclusions about their behavior, what researchers call “a simplified form of motivational interviewing,” is more inviting and constructive in changing patient behavior, according to an oft-cited 2005 British Medical Journal article. A possible scenario might run like this:

Clinician: If we look at you and your family members’ life expectancy calculations on this scale, they come in a little lower than most because there’s a gun in the home. I wonder what you think of this?

Patient: Well, I’m sure there are a lot of careless people with guns out there bringing your statistics down, but that’s not us.

Clinician: It’s good to hear you take precautions. In what way?

Patient: I keep my weapons in a safe place away from prying eyes.

Clinician: I’m glad you’ve given this some thought. Our statistics show that you can never eliminate the danger from guns, but it’s mitigated by safe practices. What other precautions might be manageable for you right now?

For doctors, winning the right to speak with patients about firearms risk factors is only part of the struggle: Learning how to speak about guns is critical, and that requires the sort of education most physicians don’t receive. Two doctors — Marian “Emmy” Betz, an associate professor of emergency medicine at the University of Colorado, and Garen J. Wintemute, a professor of emergency medicine at the University of California Davis — argue in a recent article in the Journal of the American Medical Association that doctors lag in “cultural competence” when it comes to guns.

“As physicians, we have to talk to patients about a lot of things we may or may not know about but that are important to health,” Betz told The Trace in an email. Doctors, for instance, constantly struggle to understand and administer aid to patients with particular ethnic, religious, or sexual considerations. “I don’t need to use cocaine to talk to someone addicted to it, but I do need to respect that patient as an individual.”

Betz — who has treated numerous gunshot victims and lost family members to suicide by firearms — says she tries to gain that cultural competence by asking a lot of questions and seeking out information, especially on weapons-storage options. “This fall, I’m taking a basic firearms course because I want to learn more,” she says. “I don’t think this is something every physician needs to do, but for me it’s important because so much of my research is in this area.”

Betz and Wintemute point to a key untapped source that can help less gun-savvy physicians raise the issue tactfully with patients. Research shows that doctors who do own guns, while less likely to see firearms possession as a public health matter, are far more likely to counsel their patients on safe gun ownership and storage. “Physicians who own guns should be asked to provide leadership in developing cultural competence in firearm safety counseling, rather than being marginalized or silenced within the physician culture,” Betz and Wintemute write. Such doctors could help fix “knowledge gaps or biases” among uninitiated colleagues. “This includes recognizing that there are actually multiple subpopulations of gun owners whose perspectives and preferences may vary based on their reasons for owning firearms.”

This is precisely how the American marketplace of ideas is supposed to work: The intersection of diverse views is where greater understanding occurs. Half-informed caricatures — redneck gun-nuts, clueless nanny-state doctors — give way to more nuanced views.

But those are the kinds of conversations that the conservatives and gun lobbyists behind Florida’s gag rule seek to ban. Working toward a common understanding threatens their constructed self-identity, to the confused dismay of outsiders. South Florida Sun-Sentinel columnist Michael Mayo neatly described the disconnect recently. “I don’t own a gun, but I do own a pool, and when my daughter’s pediatrician asked me about the pool safety measures I had taken when she was an infant, I didn’t take offense,” he wrote. “I didn’t think she was trying to take away my pool. I just thought she was trying to protect my daughter’s health and well-being.”

Why should talking with their doctors about guns be any different? Because of an ascendant attitude among the loudest gun-rights advocates that treats firearms not as tools but as totems of absolute freedom — and considers any qualification of guns’ elevated status to be a profane threat to that freedom. Regardless of whether the Docs vs. Glocks law is ultimately found constitutional on further appeals, this attitude is symptomatic of a new libertarian brand of gun-rights, one that refuses to water down any personal freedom with talk of personal responsibility. It’s a view that equates social obligations with socialism. It also drives the push for license-free open carry, and campus carry, and “stand your ground.”

Paradoxically, this gun-rights-on-steroids argument now needs government intervention to preserve its peculiarly broad interpretation of Second Amendment freedom — even, in this case, at the expense of free speech. “[A] constitutional right is a right to be free of governmental restrictions on the exercise of the right,” the libertarian Washington Post blogger and constitutional attorney Eugene Volokh wrote last week in decrying Docs v. Glocks as a violation of the First Amendment. “[I]t is not a right to be free of private criticism for the exercise of the right, much less private questions about the exercise of the right.”

But this is where we are, when the only culturally acceptable way to be pro-gun-ownership is to believe that the right is both unlimited and superior to every other right. “Your dead kids don’t trump my constitutional rights,” Joe the Plumber, the cartoonish mascot of modern American conservatism, told the parents of mass shooting victims last year. When that sort of rhetoric drives the conversation, it’s impossible to have an honest discussion about making firearms possession safer, or introducing health professionals to more gun owners. The gun owners’ self-appointed representatives would rather shoot first and ask questions never.

[Photo: Flickr user Alex Proimos]