HIPPOCRATIC OATH

07.30.14

Pediatricians Have the Right to Ask About Guns

A Florida law will prevent doctors from advising their patients on gun safety, even though research shows physician counsel on the matter keeps kids safer.

As a pediatrician, I have one, straightforward professional obligation: to safeguard and support the health and wellbeing of my patients. In my case, those patients are children, but you could change the age range of the people coming into the office and apply that statement to any medical provider.

Every question I ask and every part of the physical examination, no matter how uncomfortable or invasive they might sometimes seem, is directed toward that one goal. I don’t ask about my patients’ sexual habits for the sake of prurience, for example, but rather to assess their risk for problems like sexually transmitted infections or unintended pregnancy.

Asking about guns in the house is no exception. When I ask parents if there are firearms in the home, and if so how they are secured, it is for the sole purpose of keeping their children safe. Given that access to guns in the home has been shown to increase the risk of death from suicide or homicide, to say nothing of the risk of accidental death, these questions are important. I ask because the answer matters.

Physicians in Florida are being threatened with a law that, if enacted, will seriously hamper their ability to do their jobs. The Firearms Owners' Privacy Act, passed in 2011, would subject medical providers to fines and a potential loss of licensure for asking patients about gun ownership or recording that information in the medical record if it is not “relevant to the patient's medical care or safety.”

A federal judge blocked the law (PDF) from going into effect in 2012, a decision I viewed with approval and relief. Though I do not practice in Florida, I was appalled by the law, and was horrified at the thought that my colleagues there would face professional penalties for delivering appropriate medical care.

Unfortunately, the 11th Circuit Court of Appeals reversed the judge’s ban last Friday with an utterly flabbergasting decision (PDF). Stating that patients must “submit to the physician’s authority” (which is news to me), the court found that “the Act simply acknowledges that the practice of good medicine does not require interrogation about irrelevant, private matters.”

“Who is in a better position to determine what is relevant to a patient’s care?” asked Dr. Rathore. “The government or the physician? This puts the government in the exam room.”

But asking about guns in the home, while private, is hardly irrelevant. As noted by the American Academy of Pediatrics (of which I am a member) in a statement expressing dismay at the court’s benighted decision, “Research has shown that physician counseling about gun locks and safe storage, tailored to a child’s specific age and development, increases the likelihood a family will take the steps to store their firearms safely. Pediatricians routinely counsel families about firearm safety just as they offer guidance on seat belt use, helmets and parental tobacco use to reduce the risk of injury to children where they live and play.”

Gun advocacy groups such as the National Rifle Association have long opposed the AAP’s efforts to strengthen gun laws. But the Florida law has no effect on gun ownership or access. Its insidious reach enters into medical offices and chokes off the free-speech rights of the people trying to work there. I’m not entirely certain what kind of authority the court thinks physicians hold, but counseling parents about trigger locks or storing guns and ammunition securely and separately does not actually mean they have to follow our advice, as much as we hope they will.

“We are terribly disappointed by this decision,” Dr. Mobeen Rathore, president of the Florida chapter of the AAP, told The Daily Beast. “We are concerned about a chilling effect on the speech of our physicians, and that their First Amendment rights are being trampled.”

By daftly declaring that guns in the home are categorically irrelevant to the health and safety of our patients despite all evidence to the contrary, the Florida law and now the 11th Circuit Court have snatched the state’s medical providers’ decision-making capacity away from them.

“Who is in a better position to determine what is relevant to a patient’s care?” asked Dr. Rathore. “The government or the physician? This puts the government in the exam room.”

The implications of this law and the court decision are quite worrisome. There are all manner of politically-charged subjects that various advocacy groups might seek to declare off-limits. Is a statute preventing me from talking to my patients about their reproductive health somewhere on the horizon?

As much as the NRA and its ilk want to deny it, having a gun in the home is a risk factor for serious injury or death. Acknowledging that fact is not the same thing as taking the gun away. The Florida law seeks to “protect” gun owners from even having to be informed about truths they’d prefer to ignore, and seeks to cast medical providers in an unflattering light for having the temerity to question them.

By upholding this disgraceful law, the 11th Circuit Court has demonstrated allegiance to an ideology that favors the Second Amendment over not only the health and welfare of our patients, but over the First Amendment as well.