An encounter with a suicidal woman two decades ago convinced Garen Wintemute that doctors shouldn’t be afraid to talk to their patients about guns.
Wintemute was a physician at UC Davis Medical Center at the time. While on his rounds one morning, he examined an older woman suffering from a chronic connective tissue disorder and depression. The patient told him that the evening before had been agony: She had writhed in her bed, unable to sleep due to the pain. The woman said she had retrieved a handgun left behind by her late husband and put it to her head, before deciding not to pull the trigger.
Wintemute guided the woman through a lethality assessment, a tool used by medical professionals to gauge a patient’s risk of suicide. In response to one of the questions, the woman said that the gun was still in her home. Wintemute called his patient’s family, and the weapon was safely removed.
Wintemute says he would like to see this kind of successful intervention whenever a doctor encounters a patient at risk for gun violence. An individual with access to firearms is three times more likely to kill themselves than someone without access to a gun and twice as likely to be a homicide victim. But most U.S. physicians — 58 percent, according to a 2014 survey — don’t ask their patients about access to, or ownership of, firearms, even though 86 percent say they believe firearm injury is a public health issue.
Wintemute says that too many doctors think they can’t ask their patients about guns in the home, or are afraid that they would be crossing uncomfortable boundary if they were to do so. To dispel those misperceptions, Wintemute and two of his colleagues in emergency medicine — Marian Betz and Megan Ranney — have published a new paper that they say proves there are no legal or ethical barriers preventing doctors from talking to their patients about firearms.
“I realized there was this idea that maybe physicians were prohibited from asking questions about firearms, and I wanted to make clear that it’s not just legal, but well within the purview of standard medical practice,” Wintemute tells The Trace.
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 most well-known attempt to prevent doctors from talking to their patients about guns is a Florida law known as Docs vs. Glocks, which was overturned by a district court in 2012. The legislation instructed state physicians to refrain from asking patients whether they or their family members own firearms. The legal fight is ongoing, and the case is set to be reheard this summer.
Minnesota, Missouri, and Montana have also passed laws involving health care practitioners and firearms, but none of the measures prevent a doctor from asking a patient about gun ownership. Minnesota’s legislation prevents the state commissioner of health and health care agency from collecting data on patients’ firearm ownership. In Missouri, it is illegal to require physicians to ask patients about guns, and for doctors to share information on a patient’s gun ownership without a court order. And in Montana, doctors are forbidden from refusing treatment if a patient declines to ask questions about firearm ownership.
A clause in the Affordable Care Act has also caused confusion for healthcare providers. The clause prohibits medical professionals from collecting information about the presence or storage of firearms in the home of a patient — but does not prevent doctors from asking about firearm ownership and counseling patients about its risks.
Wintemute and his colleagues found that it isn’t just fear of legal repercussions that keep doctors from talking about guns. It is that many are simply uncomfortable with the subject, because they don’t know much about guns, or think that asking pointed questions about firearm ownership makes patients uncomfortable. One 2006 survey found that doctors worry about damaging their relationship with patients by asking questions that are seen as too intrusive.
Michael Hirsh says that when he was chief of pediatric surgery at Allegheny General Hospital and Mercy Hospital in Pittsburgh he commonly asked families about keeping guns in the home. Sometimes, the answer was “none of your business,” he says. But most of the time the conversations were cordial.
“I would say that it was a fairly unusual response for the patient to get offended,” Hirsh says. “These conversations should be very routine, and it should be asked often enough that it becomes comfortable as a subject.”
In a 2005 study, 81 percent of African-American men said they believed it was important for a physician to talk to them about guns. Sixty percent of families in a predominantly Hispanic pediatric clinic who received gun safety counseling or other intervention either removed all guns from their homes or improved their gun storage safety practice in some way.
Even when doctors do identify at-risk patients with guns at home, they often aren’t sure how to respond. In the majority of states, physicians have no way to force an at-risk patient to relinquish their firearms.
“If somebody says ‘Yeah, I have a gun at home,’ well, I don’t know what to do with that information,” says Jahan Fahimi, an emergency medicine physician at the University of California, San Francisco. “Doctors are taught how to screen for lots of sensitive issues, but nobody has brought up the gun thing. We don’t know how to talk to gun owners, and they do make us uncomfortable.”
Fahimi says he has asked his patients about guns in their homes, especially when the person is suicidal or violent. But it can be difficult to develop a plan for keeping weapons away from an at-risk patient, he says.
In California, a new law enables police to temporarily remove guns from individuals through a short-term restraining order. But in most cases, the order can only be requested by a family member, not a health-care provider. If patients are suicidal, Fahimi says, doctors can try to convince them to surrender their firearm, but there’s no guarantee they’ll agree.
Wintemute says it isn’t a physician’s job to force someone into giving up their weapons. But he says that given the damage that guns inflict — firearms claim 33,000 lives each year — doctors who deal with high-risk patients should engage in potentially lifesaving conversations.
“The role that doctors play is to help patients make informed decisions,” Wintemute says. “It’s not our job to tell people what to do. It’s our job to help people decide for themselves what to do.”