Can doctors and gun-owners find a common language to discuss firearm safety?
A guide published in The Annals of Internal Medicine sets out to help clinicians engage with gun-owning patients to reduce firearm-related deaths or injuries, offering a roadmap for a subject that has become a sticking point in the national debate about gun control.
The guide, by authors from the University of California/Davis, Stanford University, Brown University, and the University of Colorado School of Medicine/Aurora, argues that conversations between clinicians and patients are important, at a time when gun-inflicted homicides and suicides in the U.S. have reached concerning levels.
Citing researching, the authors write, “Among industrialized nations, the United States has uniquely high rates of firearm violence. The firearm homicide rate is more than 25 times that of comparable countries.”
The guide includes a “Tool Kit,” which contains links to information on firearm risk and the importance of safer gun storage. In addition, it provides options to consider when a caregiver detects an imminent danger in a patient.
The info in the tool kit comes from organizations ranging from the American Foundation for Firearm Injury Reduction in Medicine to the American College of Surgeons.
The guide’s authors say that one of the key challenges for clinicians is finding the proper language to discuss the issues. Non-gun-owning doctors may experience trouble holding a conversation or offering credible advice to a patient who owns a firearm.
The guide helps clinicians who are unfamiliar with the types of safe firearm storage. It lists four common types, which include the cable lock (the least expensive–sometimes free in local police departments, the authors noted), the trigger lock, the lock box, and–for storing one to several guns–a firearm safe. Clinicians learn that certain safe storage types benefit certain patients more than other devices.
However, the authors say that regardless of the storage type, the patient–or those around the patient, such as a child–is most safe when the gun is unloaded, restricted by a locked device, and away from ammunition.
Yet, a clinician immediately jumping into instructions may turn a patient off, and risk causing a drown-out of advisement.
Language is important. “We suggest that language used in the discussion should convey not only understanding of why people own firearms but also respect for the patient’s decision to do so,” says the guide. Normalizing phrases might prove valuable, say the authors, who give the example, “‘Many families keep guns in the home.’”
The guide suggests other language solutions, some in the form of words or shorter phrases. It says that clinicians should avoid words such as “‘restrict’” or “‘seize,’”–instead opting for “‘recover’” or “‘keep safe.’”
Another key part of the guide helps physicians identify characteristics of patients at risk of harming one’s self or others from firearms.
What happens when a patient seems more risk-prone than another?
“In settings where many or most patients are at increased risk, universal screening may be the best approach,” says the guide.
However, the guide’s authors say that risk is not constant and can change due to new circumstances and the health of household members.
They list patients with acute risk—people with acute suicidal or homicidal tendencies— and recommend that clinicians keep an eye out for patients with histories of alcohol or substance misuse, histories of violent behavior or victimization, “dementia or another form of impaired cognition, and serious and poorly controlled mental illness.”
Recommendations to remove guns from the home, the authors note, are more likely to be given to patients with acute risk, versus people with less risk.
More frequent dialogue with riskier patients can play a key role. If the clinician is acutely worried about a patient’s safety (or the safety of someone in the patient’s home), the guide says, “he or she might arrange with the patient to make contact in the next 24 to 48 hours.”
Also, the guide advises that clinicians learn whether the state laws or rules allow them to arrange temporary storage of a patient’s firearm.
But the idea of conversations between physicians and patients about guns has run into opposition from the National Rifle Association (NRA).
“Someone should tell self-important anti-gun doctors to stay in their lane,” the NRA tweeted in a spar of words with the American College of Physicians last month.
Medical professionals responded with a hashtag, #thisisourlane.
In some states, there have been attempts to create legal obstacles for clinicians even discussing guns with patients.
Florida, for example, had a medical “gag” law that included prohibiting a doctor “from making written inquiry or asking questions concerning the ownership of a firearm or ammunition by the patient or by a family member of the patient.” The 11th U.S. Circuit Court of Appeals later struck down the law in a 10-1 decision. However, other states followed the Florida law.
At the time of an October 2015 report by the National Partnership for Women and Families and other contributors, “watered-down versions” of the gag law were enacted in Minnesota, Missouri, and Montana.
When clinicians find enough risk in patients and feel the need to warn others, the Annals guide again recommends that they be aware of the laws and rules. “States’ mandates of duty to warn vary by type of clinician, with many pertaining only to mental health professionals,” say the guide’s authors.
The full guide is available here.
Brian Demo is a TCR News Intern. Readers’ comments are welcome.