I started writing blogs and books about guns in September, 2012, when I first learned about the Firearm Owners’ Privacy Act (FOPA) in Florida, which criminalized doctors who talk to their patients about guns. I couldn’t believe that my organization, the NRA, of which I am a Legacy Member, could attempt to make its membership feel threatened or otherwise suspicious about the motives and behavior of their physicians. Because if you can’t trust your doctor, with whom else can you talk about when it come to the most important issues of all – an elderly parent becoming senile, a teenage child who stays out all night?
The good news is that the law never went into effect because it was immediately challenged in court, and after six years of litigation was effectively killed in a 10-1 decision by the full 11th Circuit Court of Appeals. Variations of the statute had also been introduced in ten other states, but it can be assumed that those efforts to muzzle medical interventions into gun ownership will also become moot.
The NRA and other pro-gun advocates have been trying to push physicians out of the gun debate ever since public health research in the 1980’s and 1990’s found that gun ownership is a risk to health. The response of the gun industry to medical concerns about gun violence have been to shut down public health gun research, promote the idea that guns protect us from terrorism and crime, and deny that 120,000+ deaths and serious injuries from guns each year represents a public health problem at all.
A summary of the FOPA litigation has just been posted on the New England Journal of Medicine website and it should be required reading for everyone concerned with reducing gun violence today. But more than describing the legal case itself, what this editorial does is to call on the medical community to become more active in asserting their responsibility to counsel and intervene when the issue of gun ownership arises during a medical exam. As the authors point out: “most clinicians, including those who routinely encounter suicidal patients, rarely, if ever, provide firearm-safety counseling. This reticence predated the FOPA and has persisted since its passage, despite evidence that physicians believe that they have a right and a responsibility to engage in firearm-injury prevention, and that the majority of gun owners agree that such counseling may be appropriate.”
The reason why many physicians still feel reluctant to counsel patients about gun risks is because gun violence is not a topic found in medical school curricula, and national, professional medical organizations have not yet produced evidence-based, clinical resources that can be used as guides for effective medical interventions. But this informational lacunae is now beginning to be filled with the publication of several resources by the Massachusetts AG Maura Healey, in collaboration with the Massachusetts Medical Society, which contain clear and cogent advice for both physicians and patients on the medical issues of gun access and proper responses to gun owners whose behavior might make them risks for inappropriate use of their guns.
Anyone who believes that physicians should not warn patients about gun risk is either a jerk, a dope or a paid or non-paid mouthpiece for Gun-nut Nation writ large. Should doctors refrain from telling patients to use seat belts in cars? Should doctors avoid mentioning that unsealed medicines should be kept away from kids? And anyone who actually believes that physicians are part of a secret cabal that collect names of gun owners so that it will be easier to take all the guns away is someone who can go talk to the Martians living in Area 51.
The Massachusetts resources aren’t the last word in how doctors and patients should communicate about guns. But it’s a start and I hope it will be copied and used in other states and by other medical organizations as well. It took the medical community six years to get FOPA off its back and now it’s time to move ahead.