About this "Doctor asked me"

[May Hamm]

I'm reading discussions about the family doctor asking if there is a gun (firearm? pistol?) in the home but I can't determine where it started, what the origin is. Did someone just mention that their doctor asked them out of nowhere? Did some state mandate that it must be asked? Does some insurance company require it?

I'm confused. I'd be startled were my doctor to ask me.

[patrice]

1. Maybe some doctors would be concerned about depressed, or alcoholic . . .

or other types of dysfunctional patients.

[WHEN CRABS ROAR]

2. They should be for the best possible outcome for the patient.

[May Hamm]

3. Huh?

Sorry but I can make no sense of your statement. Anyway, that doesn't answer WHY this subject was brought up. Was the question asked for a reason? Is it something the person who first mentioned thinks is asked of every patient?

[WHEN CRABS ROAR]

7. OK lets try this again.

The doctor should be concerned that the patient won't cause harm to themselves or others with a firearm, while being drunk or depressive if that's what they were being treated for. There wasn't enough information on the post as to why the doctor asked the question. The best possible outcome would be recovery without the use of a firearm on themselves or others. Having access to a firearm increases the chances of problems.

[benEzra]

4. Some medical schools teach asking about gun ownership and trying to dissuade it,

and some medical students absorb that view. There are those within the public health community who view guns as a "pathogen" and civilian gun ownership as a "disease," so the question does get asked. I have never had a primary care physician ask me, but I know people who have, and the doctors who ask are too often those who know the least about the topic but have a God complex about it or take an "abstinence education" slant.

I don't personally mind the question all that much, if the doctor (1) remembers that he's a paid consultant, not an authority figure, (2) does so with the appropriate humility, and (3) knows what the hell he is talking about rather than parroting some talking point. It would be an immense waste of my time if a consultant I hired presumed to lecture me condescendingly about a topic I know far more about than they do, particularly when I am paying them for their time. I *do* think the answer should be private, though, given the political climate surrounding this issue.

IMO, the biggest opposition to doctors asking about guns comes from (1) condescending asses who think they are gun experts because they read a gun control lobby press release or an "advocacy study", and (2) the increasing depersonalization and dissemination of our medical information to corporations and governments.

[patrice]

5. "dissuade"? Link please. nt

[AtheistCrusader]

10. It's essentially an over-reaction.

"The measure is partly a reaction to American Academy of Pediatrics guidelines encouraging physicians to talk to parents about protecting children from preventable accidents. This includes the use of booster seats in cars, swimming pool safety and proper gun storage.

"We're not against guns, per se. What we're concerned about is proper storage and handling of firearms," said Louis St. Petery, MD, executive vice president of the Florida chapter of the American Academy of Pediatrics."


The child is asked by the doctor, with the parent out of the room, if there is a firearm in the home. This 'conversation' that then follows, about safe storage of the firearm is often unsettling to gun owners. In many cases, and depending quite a bit on the subjective manner of conversation in which the doctor puts it, the recommendation can take on the appearance of suggesting no firearm ownership at all.

[May Hamm]

13. I would have a huge objection to that!

"The child is asked by the doctor, with the parent out of the room,..."

No way would I have allowed my children to have a private conversation with anyone about what goes on in our home. It's just wrong. Especially when they choose specify guns in particular. It just feels wrong and it's out of the doctor's territory and, yes, it's none of the MD's business.

[AtheistCrusader]

15. But this is also a vector to discover child abuse and other crimes.

I don't have a problem with that.

But around firearms, 'safe storage' is a moveable feast, and that gun kept in a drawer on the nightstand that the child has been taught not to touch, and is kept accessible for 'in case shit', isn't going to come across as safe storage to a doctor, and bam, that fast you're in a philosophical debate with the doctor, and nobody wins.

[May Hamm]

18. I wouldn't allow it to get that far

If my family physician suspects me of child abuse then I have the wrong doctor. If it's thought that ALL parents should be suspected of child abuse until ALL children are questioned then I DEFINITELY have the wrong doctor.

I have no room in my life for a health professional to get into a philosophical debate about things that I feel are none of their business. What are they going to ask about next? Religion? If we recycle? Do we take aspirin?

[benEzra]

28. Actually, the AAP *does* strongly recommend removal of guns from the home.

http://brightfutures.aap.org/pdfs/Visit%20Forms%20by%20Age%20110/5,%206%20Year/C.MCh.PH.5,6yr.pdf

Never have a gun in the home. If you must have a gun, store it unloaded and locked with the ammunition locked separately from the gun.

The AAP handouts that I received when my children were younger (TIPP, was it?) similarly warned that guns should be removed from the home but didn't even mention swimming pools. Given that pools are between 10 and 100 times more likely to result in an accidental child fatality than a gun in the home, on a per-owning-household basis, the bias was pretty obvious. At least they mention water safety now...

[benEzra]

22. A few sources from five minutes' Googling:

http://brightfutures.aap.org/pdfs/Visit%20Forms%20by%20Age%20110/5,%206%20Year/C.MCh.PH.5,6yr.pdf

Never have a gun in the home. If you must
have a gun, store it unloaded and locked
with the ammunition locked separately from
the gun.

http://www.aap.org/research/periodicsurvey/ps47exs.htm

In 2000, 21.9% of pediatricians always, 34.0% sometimes and 44.1% never recommend the removal of handguns from the home compared to 18.4%, 27.8% and 53.8% in 1994 (p<.001).

The AAP policy statement:

Because firearm-related injury to children is associated with death and severe morbidity and is a significant public health problem, child health care professionals can and should provide effective leadership in efforts to stem this epidemic. The AAP recognizes the importance of a variety of countermeasures (educational, environmental, engineering, enactment, enforcement, economic incentives, and evaluation) to begin to curb dramatically the number of firearm-related injuries to children. The AAP makes the following recommendations, which reaffirm and expand on the 1992 policy statement71:

1. The AAP affirms that the most effective measure to prevent firearm-related injuries to children and adolescents is the absence of guns from homes and communities.
a) Firearm regulation, to include bans of handguns and assault weapons, is the most effective way to reduce firearm-related injuries.

b) Pediatricians and other child health care professionals are urged to inform parents about the dangers of guns in and outside the home. The AAP recommends that pediatricians incorporate questions about guns into their patient history taking and urge parents who possess guns to remove them, especially handguns, from the home. Loaded firearms and unlocked firearms and ammunition represent a serious danger to children and adolescents. At especially high risk are adolescents who have a history of aggressive and violent behaviors, suicide attempts, or depression.30,68,71
2. The AAP urges that guns be subject to safety and design regulations, like other consumer products, as well as tracing.
a) The AAP supports efforts to reduce the destructive power of handguns and handgun ammunition via regulation of the manufacture and importation of classes of guns. Engineering efforts (eg, personalized safety mechanisms and trigger locks) are of unproved benefit and need further study. (Trigger locks, lock boxes, and other safe storage legislation are encouraged by the AAP, until guns are fully removed from the environment of children.) Other such measures aimed at regulating access of guns should include legislative actions, such as mandatory waiting periods and/or background checks.
3. The AAP urges the development of quality, violence-free programming and constructive dialogue among child health and education advocates, the Federal Communications Commission, and the television and motion picture industries, as well as toy, video game, and other software manufactures and designers, in an effort to reduce the romanticization of guns in the popular media.

4. The AAP supports the evaluation of firearm injury prevention and intervention strategies such as conflict resolution, alternatives to violence, storage techniques (eg, trigger locks, lock boxes, and gun safes), and educational programs for children and adolescents.72

5. The AAP urges that a coordinated, comprehensive, national surveillance data system be maintained by the Centers for Disease Control and Prevention as well as the National Center for Health Statistics.

6. The AAP supports the education of physicians and other professionals interested in understanding the effects of firearms and how to reduce the morbidity and mortality associated with their use. Organizations such as the Handgun Epidemic Lowering Plan may work with the AAP and individual chapters to foster an advocacy network to protect children from injury and death from firearms.

COMMITTEE ON INJURY AND POISON PREVENTION, 1999-2000
Marilyn J. Bull, MD, Chairperson
Phyllis Agran, MD, MPH
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Susan B. Tully, MD

LIAISON REPRESENTATIVES
Ruth A. Brenner, MD, MPH
National Institute of Child Health and Human Development
Stephanie Bryn, MPH
Maternal and Child Health Bureau
Cheryl Neverman, MS
National Highway Traffic Safety Administration
Richard Stanwick, MD
Canadian Paediatric Society
Deborah Tinsworth
United States Consumer Product Safety Commission
William P. Tully, MD
Pediatric Orthopaedic Society of North America

SECTION LIAISONS
Robert R. Tanz, MD
Section on Injury and Poison Prevention
Victor Garcia, MD
Section on Surgery

CONSULTANTS
Murray L. Katcher, MD, PhD
Katherine Kaufer Christoffel, MD, MPH

American Medical Association article evaluating (and seemingly advocating) use of the Brady Campaign's STOP/STOP 2 curriculum to persuade patients to remove firearms from the home:

http://archpedi.ama-assn.org/cgi/reprint/159/11/1049.pdf

OUTCOME ASSESSMENT
The primary outcomes of this study were 2-fold. The first was
the removal of all guns from a household, which was ascertained
by asking, “Is there still a gun currently kept in your
household?” at follow-up. The second was the improvement
of gun storage by subjects who kept a gun in the household at
follow-up. Table 2 outlines the 4 different ways improvement
could occur and how each was defined.

(snip)

Did the intervention decrease gun ownership? At
follow-up, 13 (16.6%) families in the control group and
16 (22%) families in the intervention group reported having
removed all guns from the home (RR, 1.31; 95% CI,
0.68-2.54; P=.41). In addition, 8 (10.2%) families in the
control group and 7 (10%) families in the intervention
group reported removing some (but not all) guns from
the home (RR, 0.96; 95% CI, 0.54-1.70; P=.89).

[Name removed]

29. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Starboard Tack]

31. Nice links. There may be hope yet.

[MyrnaLoy]

6. complete frabrication

and I know based upon experience.

[cleanhippie]

9. What is?

[benEzra]

27. Normally I would just reference upthread to the primary sources,

(MyrnaLoy)
complete frabrication and I know based upon experience.

Normally I would just reference upthread to the primary sources, but since you're suggesting I'm lying, I suppose I will include links and text here as well.

The American Academy of Pediatrics policy statement:

Because firearm-related injury to children is associated with death and severe morbidity and is a significant public health problem, child health care professionals can and should provide effective leadership in efforts to stem this epidemic. The AAP recognizes the importance of a variety of countermeasures (educational, environmental, engineering, enactment, enforcement, economic incentives, and evaluation) to begin to curb dramatically the number of firearm-related injuries to children. The AAP makes the following recommendations, which reaffirm and expand on the 1992 policy statement71:

1. The AAP affirms that the most effective measure to prevent firearm-related injuries to children and adolescents is the absence of guns from homes and communities.

a) Firearm regulation, to include bans of handguns and assault weapons, is the most effective way to reduce firearm-related injuries.

b) Pediatricians and other child health care professionals are urged to inform parents about the dangers of guns in and outside the home. The AAP recommends that pediatricians incorporate questions about guns into their patient history taking and urge parents who possess guns to remove them, especially handguns, from the home. Loaded firearms and unlocked firearms and ammunition represent a serious danger to children and adolescents. At especially high risk are adolescents who have a history of aggressive and violent behaviors, suicide attempts, or depression.30,68,71

2. The AAP urges that guns be subject to safety and design regulations, like other consumer products, as well as tracing.

a) The AAP supports efforts to reduce the destructive power of handguns and handgun ammunition via regulation of the manufacture and importation of classes of guns. Engineering efforts (eg, personalized safety mechanisms and trigger locks) are of unproved benefit and need further study. (Trigger locks, lock boxes, and other safe storage legislation are encouraged by the AAP, until guns are fully removed from the environment of children.) Other such measures aimed at regulating access of guns should include legislative actions, such as mandatory waiting periods and/or background checks.

3. The AAP urges the development of quality, violence-free programming and constructive dialogue among child health and education advocates, the Federal Communications Commission, and the television and motion picture industries, as well as toy, video game, and other software manufactures and designers, in an effort to reduce the romanticization of guns in the popular media.

4. The AAP supports the evaluation of firearm injury prevention and intervention strategies such as conflict resolution, alternatives to violence, storage techniques (eg, trigger locks, lock boxes, and gun safes), and educational programs for children and adolescents.72

5. The AAP urges that a coordinated, comprehensive, national surveillance data system be maintained by the Centers for Disease Control and Prevention as well as the National Center for Health Statistics.

6. The AAP supports the education of physicians and other professionals interested in understanding the effects of firearms and how to reduce the morbidity and mortality associated with their use. Organizations such as the Handgun Epidemic Lowering Plan may work with the AAP and individual chapters to foster an advocacy network to protect children from injury and death from firearms.

COMMITTEE ON INJURY AND POISON PREVENTION, 1999-2000
Marilyn J. Bull, MD, Chairperson
Phyllis Agran, MD, MPH
Danielle Laraque, MD
Susan H. Pollack, MD
Gary A. Smith, MD, DrPH
Howard R. Spivak, MD
Milton Tenenbein, MD
Susan B. Tully, MD

LIAISON REPRESENTATIVES
Ruth A. Brenner, MD, MPH
National Institute of Child Health and Human Development
Stephanie Bryn, MPH
Maternal and Child Health Bureau
Cheryl Neverman, MS
National Highway Traffic Safety Administration
Richard Stanwick, MD
Canadian Paediatric Society
Deborah Tinsworth
United States Consumer Product Safety Commission
William P. Tully, MD
Pediatric Orthopaedic Society of North America

SECTION LIAISONS
Robert R. Tanz, MD
Section on Injury and Poison Prevention
Victor Garcia, MD
Section on Surgery

CONSULTANTS
Murray L. Katcher, MD, PhD
Katherine Kaufer Christoffel, MD, MPH

The AAP handout provided to parents, which as you know are the primary counseling resources used by pediatricians in their interactions with parents of their patients:

http://brightfutures.aap.org/pdfs/Visit%20Forms%20by%20Age%20110/5,%206%20Year/C.MCh.PH.5,6yr.pdf

Never have a gun in the home. If you must
have a gun, store it unloaded and locked
with the ammunition locked separately from
the gun.

American Medical Association article evaluating use of the Brady Campaign's STOP/STOP 2 curriculum to persuade patients to remove firearms from the home:

http://archpedi.ama-assn.org/cgi/reprint/159/11/1049.pdf

OUTCOME ASSESSMENT
The primary outcomes of this study were 2-fold. The first was
the removal of all guns from a household, which was ascertained
by asking, “Is there still a gun currently kept in your
household?” at follow-up. The second was the improvement
of gun storage by subjects who kept a gun in the household at
follow-up. Table 2 outlines the 4 different ways improvement
could occur and how each was defined.

(snip)

Did the intervention decrease gun ownership? At
follow-up, 13 (16.6%) families in the control group and
16 (22%) families in the intervention group reported having
removed all guns from the home (RR, 1.31; 95% CI,
0.68-2.54; P=.41). In addition, 8 (10.2%) families in the
control group and 7 (10%) families in the intervention
group reported removing some (but not all) guns from
the home (RR, 0.96; 95% CI, 0.54-1.70; P=.89).

Prevalence of pediatricians' making blanket recommendations about the removal of handguns from the home:

http://www.aap.org/research/periodicsurvey/ps47exs.htm

In 2000, 21.9% of pediatricians always, 34.0% sometimes and 44.1% never recommend the removal of handguns from the home compared to 18.4%, 27.8% and 53.8% in 1994 (p<.001).

Now, perhaps you attended a medical school that took a less intrusive view of the doctor-patient relationship, but particularly in peds, there is a significant "guns R bad" slant in the training for injury prevention counseling. Heck, there is a Joyce Foundation funded chair at the Harvard School of Public Health that pretty much exists to criticize gun ownership. If you are what you imply, get on Medline or somesuch and search for "injury prevention training firearms" and see what comes up, like the following:

Khubchandani J, Price JH, Dake JA, Firearm Injury Prevention Training in Preventive Medicine Residency Programs, J Commun Health 34:4 295-300.

Or heck, if you are what you imply, you have access to peds textbooks; look up "firearms" or "guns" in the index. I'd do it for you, but I don't own any general peds textbooks, just Whaley & Wong, and they don't delve much into injury prevention counseling.

[May Hamm]

32. You've been very helpful

Thank you for taking the time. I had no idea that medical professionals would ever be asking questions about guns in the home as part of a routine visit.

My kids are all grown. It would be easy for me to say now that I would never have allowed such a question but, truthfully, I don't know what I would have done. Maybe I wouldn't have seen anything sinister in it way back when, but...

[Hoopla Phil]

34. DAMN! Did you just get served!!! (see post #27 ) Would you like to post a retraction?

[MineralMan]

8. I believe you're going to have to provide a source for that.

Which medical schools. Where can I find this information?

[benEzra]

23. See post #5. (n/t)

[jpak]

11. Florida republics propose to fine doctors $25,000 if they even ASK that question

yup

[Glassunion]

14. Are you omitting anything? Are there circumstances where they can ask the question?

[jpak]

16. Nope - first offense $10K, second offense $25K and $100K after that

yup

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=118&topic_id=382408&mesg_id=382408

[Glassunion]

17. OK. Now I am 100% convinced that you do not read what you copy and paste from the headlines.

Do me a favor and double check that link, and read it... Go on... Read your entire post.

In your OP on that thread you pasted(however failed to read) the following: "unless the doctor believes a patient may immediately harm him or herself with a gun"

[jpak]

20. First Amendment FAIL

yup

[Glassunion]

21. Are you honestly stating that there are 0(zero) circumstances where a doctor could ask the question?

[Hoopla Phil]

35. Modus Operandi. I've already found just that to be the case in another thread. And don't forget

6 > 8. not wait. . .8 is grater than 6. . . no no no, what was that now? Ah yes, 6 and 8 are both greater than 10. I think that's it.

[rl6214]

26. Yup, I'd agree with fining the mds that ask that question

YUP

YUP

YUP

[rl6214]

25. Is Florida a republic now?

I don't think it is but a qwik google search will find a list of 20th century republics. Do I need to find it for you again, I will if I need to.

YUP

YUP

YUP

[MyrnaLoy]

30. It is wrong

to not ask it if a family member has witnessed violence in the home. If a woman see's her doctor and the doctor see's signs of abuse and admits to it then I see the GUIDELINES being relevant. It is not, as forum members would have us believe, an everyday clinic question. It is only asked when relevant. It is so rare that I've never seen it taught or asked. I've been in and around medicine since the mid 80s.

For forum members to suggest this is happening every day is just deceitful. It is, however, relevant when a physician or other health care provider sees signs of abuse. They also ask about alcohol when they see this. Call it a protection and prevention workup.

[X_Digger]

12. See here

http://www.ocala.com/article/20100723/NEWS/100729867/1402/NEWS

The American Association of Pediatrics urges pediatricians to ask questions of parents about gun ownership when they get children's medical histories and to suggest that parents remove guns from the home.

[May Hamm]

19. Bummer for them

It's too bad that with three children they had to find a different doctor. But if that were my MD it would been a mutual decision to part ways. I have no use for people who insist on intruding in my family's lives abut things which are none of their business no matter how self-righteous they are.

[rl6214]

24. Don't know where it started but

I had my 15yo son in the hospital last year and on admission they did ask it there were any guns in the home. I just asked them how that in any way had anything to do with my son being admitted to the hospital with a diagnosis of Type 1 diabetes.

[May Hamm]

33. That's scary

When do they tend to medical problems when they are using valuable time asking intrusive questions that have nothing to do with the current illness?

There are so many other things or situations which present much more danger to kids than guns. Alcohol, drug use, smoking, are they going to ask about stepparents next? How about ATVs and motor bikes and skateboards and grrr....