As a doctor, I'm going to keep asking about guns

Let’s set aside for the moment the question of whether it’s appropriate to talk about gun control in the wake of the shootings in Aurora, Colorado (though I can’t think of a more appropriate time to talk about it). And let’s not consider whether it makes sense that it’s legal to buy thousands of rounds of ammunition on-line in the U.S, without any background check (though could it, really?) And let’s not revisit that old argument about people, and not guns, killing people (though millions of “people,’ including evil and deranged people, do seem to live in countries with negligible amounts of gun violence).

What I’m thinking about today is the role doctors and other health professionals do and should play in preventing the 30,000 deaths and many more injuries in which firearms are involved every year in the U.S.

Behind the closed doors of my exam room, I ask patients many very personal questions: about their sexual behavior, alcohol and drug use, domestic violence, and other sensitive issues.

But there are no questions I ask–and I ask them routinely, especially of new patients–that meet with more surprise than these: “Do you own any firearms? Do you keep them locked and inaccessible to children?”

I believe the questions come as a surprise because people don’t usually think of gun ownership as something about which a doctor would or should be concerned.

But according to statistics from the Centers for Disease Control, homicide, suicide, and accidents are among the top three causes of death for Americans ages 0-54, and these deaths often involve firearms-over 30,000 per year. That’s seven times as many as die of cervical cancer, and nearly as many as die from pancreatic cancer annually.

It’s seems to me difficult to argue that health professionals shouldn’t be as interested in the prevention of gun violence as in the prevention of other causes of death.

Yet, doctors’ role in counseling patients about the potential danger of firearms is controversial, as expressed in this exchange. Some see such counseling as no different than speaking with patients about safe sex, smoking, and exercise. Some see it as an inappropriate intrusion of the doctor’s political views into the patient’s medical visit and an invasion of the patient’s privacy.

This latter view was in the news last fall when a Florida law, subsequently overturned by a federal judge, banned doctors from counseling patients about firearms, and would have imposed fines or even jail time on, for example, pediatricians who inquired about safe storage of guns in homes where children live.

In my own practice, most patients I ask about guns tell me that they don’t own any. This isn’t surprising because Massachusetts has one of the lowest gun ownership rates of any state in the U.S. (and, as it happens, the lowest rate of gun-related deaths).

And it’s possible that some patients don’t wish to discuss their gun ownership with me and choose not to answer my questions about it.

But occasionally I have a conversation such as I had not long ago with a man who lived alone and kept his loaded guns unlocked and accessible. Now and then his young nieces and nephews visited and it hadn’t occurred to him, until I asked, that his firearms might be a hazard to those children.

I’m going to keep asking about firearms, especially in regard to those at highest risk of harm from them: children, patients struggling with depression, patients with difficult family relationships.