Now that the Republican Party has decided the Affordable Care Act will simply ‘implode’ without their help, stories are appearing about out how the majority party in both Houses of Congress and also sitting behind the HMS Resolute desk in the Oval Office couldn’t get it done. This morning David Leonhardt, an op-ed writer for The New York Times, penned a piece in which he celebrated the efforts of a wide swath of citizens who were the activists behind the Republican legislative demise. And one of the groups he singled out for praise were physicians, whose professional organizations really stood up and helped lead the fight.
The idea of doctors being politically in a partisan way is a relatively new thing. Referring to a public statement by the chief of Mass General Hospital decrying Trump’s attack on transgender military troops, a primary care doctor at Mass General said it like this: “Traditionally, health professionals have not commented so boldly on the actions of politicians.” She then went on to say that, “many of the most critical current threats to our health — including poverty, lack of access to affordable health care, gun violence, the opioid epidemic — cannot be eliminated by individuals, no matter how well-meaning.”
I have no expertise in affordable health care or opioids, but I do know a little something about guns. And I have been watching and helping physicians deal with gun violence on the individual, i.e., clinical level for a number of years. And what concerns me about the medical approach to gun violence is that, unfortunately, it doesn’t appear to be rooted in the elimination of a public health issue which kills and injures 125,000+ people every year. Rather, the medical response to gun violence views the problem as one that needs better controls, which is not the same thing as getting rid of it altogether – not the same thing at all.
Last year the Massachusetts Attorney General and the Massachusetts Medical Society collaborated on the production of informational resources that physicians could utilize to become better informed on how to talk to patients about guns. Here’s what is suggested as an approach for counseling patients on gun risks:
Meet patients where they are. Where there is a risk, see if you can brainstorm harm-reduction measures with the patient, as opposed to prescribing one specific solution. For example, rather than advising a patient to get rid of a gun, you could suggest that there are a number of different ways to make guns less accessible, ranging from selling/surrendering the gun, to disposing of ammunition, to temporarily storing the gun outside the home.
This statement embodies what one of the most noted physician researchers, Dr. Garen Wintemute (along with several colleagues) suggested was the proper way for physicians to engage in gun discussions, based on the idea that “conversations should acknowledge local cultural norms,” with the desired outcome being “firearms are stored unloaded and locked, with ammunition stored separately.”
So the bottom line is that the new-found, public advocacy by physicians about gun violence should occur within certain, self-imposed constraints, the chief one being that doctors, unless there is an immediate and verifiable risk, should find ways to communicate with gun-owning patients which avoids the basic issue, namely, that guns, no matter how safely stored, are a serious risk to health. Period. End of story. Enough is really enough.
We have made remarkable strides in reducing smoking, another clear health risk. According to the CDC, the percentage of adult smokers is now less than 20%, when I was a kid, everyone smoked. This didn’t happen because doctors told patients that perhaps they should smoke less. It happened because no physician would ever dare tell a patient that smoking is anything other than a clear threat to health.
You think guns are any different? If someone wants to be ‘safe’ with their guns, they can always take one of those phony safety courses offered by the NRA. Physicians shouldn’t be promoting the idea that a gun isn’t harmful to health.
Aug 01, 2017 @ 13:05:36
As far as doctors are concerned, the main gun problem regarding self destruction is a suicide problem (~20k per year) vs. over 100k per year for smoking related cancers. Actual accidental gun deaths are a miniscule fraction of all gun deaths, most of which are of course intentional. So as far as gun safety, if my MD wants to ask me if I am despondent, that is fine and I hope he and I can have a meaningful conversation and he can direct me to a good shrink if necessary. Speaking of death wishes, I can, in return, ask him how fast he rides on his Hayabusa (no lie).
I met a guy who works a lot with NMTPGV who was a trauma surgeon in Chicago. He has little good to say about guns and I cannot blame him. Doctors, whether because of suicide or homicide or trying to keep people alive when they have been shot full of holes, are of course destined to be vocal about guns. Who can blame them and as the NRA found out, they have 1A and doctor-patient confidentiality rights. Of course, some of the same people who want to ban docs from talking about guns want to require them to “counsel” women on abortion. Hah.
Speaking of docs, I gave the ER folks at an Elmira, NY hospital a good laugh at my expense back in the day. I managed to slice one of my fingers almost down to the bone while field-dressing a deer; the blood trail out of the woods was from me, not Bambi. ER staff teased me that that was the deer’s way of getting even and that if I couldn’t manage to work a knife safely, maybe I ought not to be messing with a shotgun. Cringe….
Aug 01, 2017 @ 16:00:57
The words in this article look very familiar….taken right out of the Everytown playbook….as they attempt to position “gun violence” as a public health crisis. Sorry, it is not ringing true. Just another propaganda and manipulation tool.
Aug 01, 2017 @ 16:48:34
Just one question, does Malpractice Insurance cover Medical Doctors who give advise about guns?
Aug 01, 2017 @ 19:03:57
I suppose, if they confuse the muzzle for the breech.
Aug 02, 2017 @ 10:27:03
My point exactly. What type of training did they receive prior to giving their patient advise on firearms.
Aug 02, 2017 @ 13:31:28
My concern is that historically, some med associations such as American Pediatric Assn. basically says “guns bad. Got kids? get rid of guns.” (I am exaggerating slightly but not much). Such talk in the context of guns is polarizing and will result in most gun people turning off the message, which is the opposite of what we want.
As I said above, the biggest risks that MDs can help mitigate are (childhood) accidents (in the same way that health professionals can warn about leaving kids locked in hot cars, having unattended swimming pools, leaving chemicals or drugs around, sun exposure safety, etc) and in counseling patients who may be at risk of suicide. The NSSF has been working with gun shops on suicide prevention programs. Gunsmiths are not MDs and MDs are not gunsmiths.
We all need to work together. Bullets, once fired, don’t have a recall switch. A junior scientist I hired a few years back was driving me home from surgery. He checked with my wife about whether any of the pain meds would be a hazard for me given my penchant for having shootin irons around, in order to decide if we should discuss him storing my stuff until I was off the meds. That was how it should be. As it happens, when I was awake enough to be included in the conversation, I stated that I was not interested in taking that particular medication as I hate being disoriented. I’d rather deal with the pain. My wife, who has been through other surgeries and wisdom tooth removals with me, knew that was an accurate statement so we didn’t worry about it. But my junior colleague got the case of beer award for being alert and thoughtful.
Aug 02, 2017 @ 13:37:14
Oops. “American Academy of Pediatrics” as Mike has just posted.