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Two Wrongs Not Adding up to a Right

Happening in Florida:

One would place restrictions on questions that physicians could ask patients about guns and gun ownership, including children. Violators could be fined $10,000 to $100,000, and a companion measure in the House would make it a felony.

The Florida Medical Association is rightly against it, saying it violates free-speech rights and the doctor-patient relationship that necessitates physicians have information about all factors affecting a patient’s safety.

The FMA is correct about the bill violating free speech and free association. I agree it’s untenable from a First Amendment viewpoint, and am very disappointed NRA is pushing this. But doctors have no right to pry into non-medically relevant facets of someone’s life, and gun ownership is not medically relevant. The only excuse I could see for prying into that area is if a psychiatrist was treating a minor patient for depression, and told the parents to keep the guns locked up, along with just about anything else that might be dangerous to a potentially suicidal individual. That fits in the realm of just being good advice. As a general matter, gun ownership is not a disease (no matter how much some wish it to be), and is therefore outside the field of medicine. Doctors should stop asking about it as a matter of routine.

This is really a case of both sides in this debate being wrong.

19 Responses to “Two Wrongs Not Adding up to a Right”

  1. David says:

    I lie on those questions. My doctor has no business knowing what I own, what I drive, or how I store either one.

  2. I agree with you. However, as more and more medical services are provided at taxpayer expense, it becomes legitimate to legislate the medical field’s activities to a greater degree.

    If people don’t have any realistic alternative to seeing a specific doctor that happens to take their medicare, then they really don’t have the choice to go see another provider.

    Still, this bill could be better tailored, and only affect doctors who take government funding or see medicare/medicaid patients (which will still be many of them).

    The long term implication though is that as we move towards more government control over medicine, medical questions will become political footballs.

  3. PhillipC says:

    I live in central FL, and have never had a question about firearms from either my doctor or my son’s pediatrician. Frankly, if either of those were to give me a problem, I’d be very quick to explain to them how what I own is none of their business.

    My primary care physician and most of his staff do actually know that I have and carry a firearm, though. I was trying to hide it at first, keeping it wrapped up in my cover shirt while nobody was in the exam room, and then one day I had to have a shot I wasn’t expecting, and got into a discussion with the nurse, who also had a CCW, then another one later on, and so on. Eventually I realized that the majority of his staff either owns a gun or isn’t bothered by one, with only one exception I’ve found so far.

  4. PT says:

    I just finished up my family medicine rotation for my 3rd year of medical school. My first day there I meet with the doc to go over all the orientation stuff and he has a copy of AR Guns and Hunting on his desk.

    This bill is stupid. So when I’m a doctor I can’t ask the guy who comes into my office with the Glock hat what he shoots? I’d be fined $10,000 for that?

  5. Sebastian says:

    Yeah, it’s unbelievably silly. You should really call NRA and complain as someone in the medical community. There are a lot of doctors on our side, actually.

    The problem is the associations creating a lot of this problem. Sometimes doctors have to ask personal questions. If you’re in complaining about it burning when you piss, questions about sexual history are relevant to the diagnosis. If a patients liver numbers are off, by the same token it helps to know if they down a quart of whisky every night. That kind of prying I get, because it’s relevant to a medical diagnosis.

    I don’t even really have a problem with, say, a pediatrician talking about guns in the context of other household dangers, like chemicals, swimming pools, bath tubs, electrical sockets, and sharp objects…. just to make sure the parents have thought about that.

    But you look at the American Association of Pediatrics, and they have banning guns as a policy. Why not ban swimming pools? They kill more kids. It’s the use of the medical profession to push an agenda that I really object to. This isn’t really something the law can fix.

  6. Garrett Lee says:

    What does the law say about doctors asking about lead poisoning? It’s a valid medical reason, after all…

  7. Sebastian says:

    I haven’t seen the actual text, but presumably they couldn’t ask whether you’ve been around a shooting range.

  8. Miguel says:

    Before you all rush with torches and pitchforks to Virginia, be advised that Marion Hammer said NRA is backing the fines and not the felony charge. Also they are making an exception for Mental Health docs if they feel a patient is a danger to himself and/or others.

    The bill is necessary for several reasons: AMA and the American Academy of Pediatrics are notoriously anti gun. The AAP makes no bones about asking the children about guns in the household without the consent of the parents or even their presence.
    http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/4/888

    Now tie your medical files which might record if you have guns with the regulations of Obamacare and you have yourself a nice database of gun owners.

    We do have a doctor’s group that has been fighting this anti-gun crap: Doctors for Responsible Gun Ownership.
    They were at the last Gun Rights Policy Conference explaining the dangers of AAP and the AMA in their quest for Gun Info from patients. You can find the speech at the ProArms podcast website under Gun Rights Policy Conference Podcasts…which incidentally I recommend you listen to all of it.
    http://www.claremont.org/projects/projectid.39/project_detail.asp

  9. Matt Carmel says:

    I think there are circumstances where a firearm does have medical implications – as an adaptive aid for the handicapped. Someone who is missing an index finger, suffers from arthritis, muscular distrophy or any number of other maladies, is just as entitled to extension of life expectency (another way of saying right to self defense) as an able bodied person. Under these patient circumstances, it is very appropriate for a doctor to ask “do you have a firearm suitably adapted for your condition as a viable means of self-defense?” In fact, a doctor who fails to ask this medically relevent question should be sued for malpractice! : )

  10. PhillipC says:

    This is one of those things where if the groups that are creating the problem (AMA, AAP, etc.) should just agree to change their policies in exchange for the legislation being tabled. It’s a reactive legislation, one that has come about because of certain doctor’s groups prying into things they don’t have a business prying into, as well as refusing to treat patients based on their political views.

    If they hadn’t squeaked, nobody would be holding up an oil can. Unfortunately, too many doctors tend to think of themselves as being ‘better’ than the patients they treat, and telling them to do things ‘for their own good’, without being aware that they’re crossing the line from medical care into political activism. If they would have changed their policies, there wouldn’t need to be a law passed.

  11. bullbore says:

    We dropped a pediatrician once for asking our daughter that question. When I got home from work my daughter pulled me aside and told me that the doctor asked her if I had guns in the home. She said “no” to the doc and then told Her mother and me, as we had instructed her. Then we looked for a new doctor.

  12. bullbore says:

    As an add on I have always liked but never tried to use the firearms malpractice form which can be found at:

    http://www.seizeliberty.com/Documents/

    under

    “firearms malpractice form”

    it cracks me up.

  13. John A says:

    I agree this is a misreable proposal. But….

    As noted in previous comments, the danger is not of having a doctor asking/talking about weapons but in being required to do so – and more than one large doctor group is on the verge of making it a requirement with the law presumably to follow.

    Lawyers have a different approach, you should not ask a client if he is guilty and if he does admit it but still wants to plead otherwise you must go along, and this stance is supported by lawyer-client privilege laws. The only exception I am aware of is a lawyer can be prosecuted for actually helping in the commission of a crime, such as by providing a false alibi or knowingly allowing perjured testimony.

    There are laws protecting doctor-patient privilege as well. But unlike lawyer-client laws they already have far more exceptions. Many places require doctors to report gunshot and knife wounds. Should a patient admit to certain crimes – especially having killed or planning to kill – the doctor must report it. There are other exceptions, even of indications of desire with no indication of acting.

  14. @bullbore: That’s awesome. I think it’s worth a whole post all by itself.

  15. david says:

    I practice medicine in a rural WV community. I am also an NRA instructor and have put about half our clinic’s staff of 50 through the First Steps curriculum, which satisfies the state’s CCW education requirement. Some of my patients or their family members have taken my classes, and many more know that I am an active “gun crank.”

    While the idea of routinely querying patients about gun ownership on public health grounds strikes would not have even crossed my mind, I understand other posters’ concerns about it, particularly in combination with that Obama’s push towards EMR’s, which mean that anything you tell your doctor will be public knowledge (yes, I know medical records are supposed to be confidential, but do you think they will even be guarded as securely as the State Department secrets released on Wikileaks?). I would ask patients about gun ownership if they had expressed suicidal thoughts, along with asking them if they had considered other, non-firearm means of suicide (similar questions for homicidal thoughts, but since I’m not in psych this is not part of my world), but aside from that, physicians have no business asking about firearm ownership.

  16. GeekWithA.45, USA says:

    There actually is *one* medically appropriate time to ask about guns: when diagnostically probing for the distinction between suicidal ideation, when the patient has considered suicide in the abstract, and suicidal intent, in which the patient has both the plans and the means.

    That being said, we all know what the turd floating in the bowl actually is: political ideologically driven medical “science” that inappropriately applies methods of epidemiology in an attempt to prove that guns per se are a health risk and public threat.

  17. Matt says:

    Geek is right on that one. Suicidality evals are the only place where firearms should rationally come up, as they can help differentiate between idle contemplation and an actual plan.

    I see one major issue here: this restriction, like so many others, holds the doctor accountable without putting any protections in for their complicity. If a doctor, say, does not ask a family about firearms and their child ends up shooting himself because they left it unlocked, that family could fairly easily take the doc to court for failure to meet what the American Academy of Pediatrics says is a practice standard. I think the law is stupid at the outset, but if it’s implemented, there better be civil protections for physicians complying with the law.

    As far as Doctors for Responsible Gun Ownership goes, I like what they do, but they apparently don’t want more physicians to join. I’ve tried to contact them several times and no response. Oh well.

  18. armed_partisan says:

    There’s been a long time push to nationalize medical records, and attach them to a National ID card “for emergency purposes.” If those medical records contain information about firearms ownership, then your medical records become a back door gun registration, or at the very least, gun owner registration. Plus, I don’t need a doctor to lecture me on how to live my life, what I own, where I work, etc. He can tell me to cut the salt, or get more exercise, but if he tries to tell me what kind of car I should drive, we’ve got a problem.

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