Doctors and Guns

When I saw patients for routine exams, I would ask them, among other prevention issues, if they wore seat belts, had functioning smoke alarms  and whether or not they owned firearms.

The great majority wore seat belts and seemed to accept research showing a marked reduction in injuries and fatalities in those who buckled up.  When it became illegal to not wear them, most of the remaining stragglers appeared to sign on.

Patients were oftentimes puzzled at why I asked about smoke alarms.  They caught on when I suggested that it would be a shame to have corralled  their cholesterol and blood pressure with diet, medicines and exercise, only to go up in flames.  On returning one year later, many informed me, with great gusto, that they had installed fire alarms and regularly checked the batteries.

Asking about guns was another matter.  Most patients openly wondered at what gun ownership had to do with medicine.  While not comprehending the reason for the question, most listened politely to my concerns.  At least two individuals, however, became quite hostile about being asked  and told me it was none of my business.  I wondered if they possibly thought me an undercover agent for the Alcohol, Tobacco and Firearms Bureau (ATF).

With as much diplomacy as I could muster, I explained to all my patients that my concern was not over whether they owned guns but whether or not they were safely maintained.

That meant that the guns should be locked up so that children and intruders would not have access to them.  The ammunition should be stored separately from the guns and also locked up.

Why?  It is not unusual to read of children who kill themselves or their friends when playing with loaded guns which they have come across in explorations around their homes.  It's thought that about 2,800 children and teenagers die a year from gun related deaths.  This includes an appalling number of teen suicides.  Moreover, it is very common for intruders to disarm gun users and then turn the weapons against the owners.

Additionally, I recommended that those who kept guns loaded by the bedside (not at all unusual among patients living in high crime areas)  separate the gun from the ammunition, explaining that loaded weapons in the home resulted in more deaths of family members than criminal intruders (read: husband's night flight is cancelled and he comes home, unannounced at 1:00 AM, to a hail of bullets, set off by a terrified wife.) 

Over the years, it seemed that at least half of my patients had firearms, mostly rifles.  It was not at all unusual for a patient to say he had a rifle but hadn't seen it for twenty years and couldn't say exactly where it is.  This is where the kids and bad guys come in.  They have a nose for missing weapons.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Finally,  if I thought a patient suicidal, and learned that they owned a gun, I did what I could to get them and/or their families to disarm the individual.  This was especially urgent as guns are both a gateway and final destination for the majority of people determined to kill themselves.  

My efforts were not in vain as many patients would tell me they had locked up their guns and kept them unloaded as a result of our discussions.  

While I sometimes felt like  the nanny (nag?)-in-chief, I firmly believe that a discussion of gun safety issues belongs in the routine medical exam. Management of violence and mayhem is unarguably a health issue.