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Now Docs Have The Information They Need To Talk To Patients About Guns.

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Back in 2015, eight national medical organizations and the American Bar Association issued a ‘Call to Action,’ promoting the idea that physicians should take a more active and aggressive role in talking to patients about gun violence.  Nobody argues with the fact that more than 115,000 Americans are annually injured or killed with guns, but leave it to Gun-nut Nation and their various sycophantic noisemakers who claim it isn’t a medical issue.  According to these dummies, it’s the ‘person,’ not the ‘gun’ which causes gun injuries, so why worry about the gun?

md-counsel             It wouldn’t matter if the NRA and its toadies would just say what they have to say and leave it at that.  But in Florida they got a law passed which criminalizes physicians who counsel patients about guns, and there’s even a physician in the U.S. Senate who (briefly) ran for President and chased the NRA vote by telling everyone that he didn’t think that guns were a public health issue at all.

The good news is that the medical community has refused to be cowed by this distemperate demonstration of stupidity and has begun asserting its authority to put the discussion about gun violence exactly where it belongs, namely, in face-to-face meetings between patients and their doctors which happen every day. And the news is that last week the 11th Circuit told the State of Florida to take its pernicious attempt to gag doctors and shove it you know where.

But while most people have no issue with a doctor talking to them about guns (after all, there’s no law that requires a patient to follow a doctor’s advice) many physicians don’t know what to say to their patients in discussions about guns. It’s not part of the medical school curriculum, there’s no medical academy that has yet to publish a treatment protocol on the subject, and many physicians don’t own guns.  So how to proceed?

Now there’s an answer and it has been provided by a collaboration in Massachusetts by the Massachusetts Attorney General and the Massachusetts Medical Society which has now posted informational pamphlets on gun safety both for patients and physicians, as well as a Continuing Medical Education (CME) course on counseling patients about guns.  Together, these resources constitute the most comprehensive effort yet developed to help physicians both identify patients who might be at risk for gun violence, as well as specific counseling strategies that might be employed in a clinical setting.

The CME course, available to the public either as a video or viewable slides, includes a section on how to initiate a conversation about gun safety which recognizes the fact that most gun owners are very conscious of the necessity to be careful with their firearms, so reminding them of the need for safety should not be done in a judgmental or accusatory way.  Even more important is the presentation of five clinical scenarios, each describing a different situation involving potential gun violence risk (possible suicide, intimate partner violence, child playing with a real gun, etc.) and recommendations on how to effectively communicate risk-mitigating options to the patient and family members.  Perhaps the most instructive scenario covers how to respond to the patient who is reluctant to talk about the existence of firearms in the home, and the guidance offered for this scenario might also ease the concerns of patients who would rather not discuss the gun issue at all.

This effort marks a significant step forward in the medical response to gun violence because we now have a substantive resource that can be used to make physicians feel more confident in talking to patients about guns and give patients reassurance that their physician is interested in their health and not trying to promote a particular point of view. An effective doctor-patient relationship assumes that any subject which arises during a medical consultation can be treated in a compassionate, honest and medically-proper way. It also assumes that the physician will give the patient evidence-based information about any risk to health. These new resources do both – it’s a big win-win.

Want To Be Told That Guns Aren’t A Threat To Health? Publish Research Which Shows That They Are.

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It didn’t take seventy-two hours following the publication of a reasoned and respectful JAMA editorial on physicians counseling patients about guns before the self-appointed NRA medical sycophant, Timothy Wheeler, issued his usual pronouncement that doctors represent the enemy when it comes to anything having to do with guns.  Actually, I blame the Hospital and Health Networks blog for letting Wheeler crawl out from underneath his proverbial rock, because the truth is that to present him as some kind of medical authority on gun violence is to grant him a level of professional credibility that he doesn’t deserve.

The JAMA editorial, co-authored by two noted gun researchers, Drs. Marion Betz and Garen Wintemute, represents a very important step forward in the discussion about doctors and guns.  It follows from a “call to action” issued in April by eight professional medical organizations (plus the American Bar Association) that urged physicians to become more engaged in the issue of gun violence,  notwithstanding the heavy-handed effort by the gun lobby to legally de-franchise medical professionals from any connection to this issue at all.

conference program pic                The NRA has been pissing and moaning about public health and clinical views on gun violence for more than twenty years, and Wheeler is often quoted whenever relevant research is published and, in time-honored fashion, the media needs a comment from the “other side.”  I wouldn’t mind if Wheeler had ever conducted any research at all to justify his views on guns, but in fact he is a polemicist pure and simple whose pro-gun opinions come right out of the NRA playbook but are delivered with heightened authority because his name is followed by the initials ‘M.D.’

His latest salvo, written in response to the JAMA editorial, asserts that, “Physicians get no training in firearm mechanics, safety, or tactics in medical school or residency. They simply are not qualified to counsel patients about firearms.”  There was a time when physicians didn’t focus on health risks like obesity and tobacco companies routinely showed doctors inhaling a Lucky Strike cigarette in their ads. When the medical community decided that enough research had been conducted to classify obesity and tobacco as risks to health, doctors learned how to counsel patients by asking questions and, based on responses, dispensing appropriate medical advice.  Wheeler has never attempted to deny the reams of medical research that shows that the risks of gun ownership far outweigh the gains. Instead, he pompously and falsely accuses physicians of using that research to promote a ‘political’ point of view.

What kind of advice does Wheeler feel is appropriate for doctors to share with patients about guns?  You can find the answers in a book he published, Keeping Your Family Safe.  Most of the book is devoted to a warmed-over version of NRA training materials that describe how guns work, how they should be cleaned and how they should be stored.  Wheeler, incidentally, has absolutely no professional credentials in any of these areas, nor in self-defense laws and self-defense tactics, both of which are covered at length in this book.

I have absolutely no issue with anyone pushing guns as a means of self-defense; what offends me is the notion that guns represent the only or even the most effective way to respond to a possible or actual criminal event.  It’s not true, and there is no evidence-based research that proves it to be the case.  In fact, the latest research demonstrates that using a gun for self-protection is not only a rare event, but is no more effective than other protective actions, such as running away or calling 911.

After medicine took the lead in anti-smoking campaigns, the end result was that one out of two adults who smoked dropped to one out of five. Imagine what would happen to the gun industry if gun ownership followed a similar trend. If Wheeler wants to save the gun industry, he should stop pretending to be a medical expert and do what he does best, which is to figure out ways to sell guns.

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