November 24, 2017
Dear Doctor: Out of the blue, my new primary care doctor asked me if I owned a gun. Was it appropriate, or even legal, for her to ask that?
Dear Reader: I can understand why you were surprised. Doctors generally try to avoid wading into political discussions, which, as we know, the topic of guns has become. Lately, though, many have been reassessing that arms-length stance and focusing on guns as a public health issue. That’s because, as doctors, our concern is preventing illness and injury. We freely speak out against the abuse of alcohol, tobacco and sugar — all of which are legal — because we would like to prevent alcohol addiction, smoking and an over-consumption of sugar. Without advocating legal action against these substances, we ask probing questions of our patients and, we hope, give good advice to prevent injury.
The big issue with guns is violence. Put simply, guns are an effective way to injure and kill people — or, as we think of them, our patients. How many patients? Let me put it this way: In 2015, 36,252 people died of gunshot wounds in the United States. More than 80,000 others are injured each year.
The majority of deaths by firearms — two-thirds — are due to suicide. Simply having a gun in the house increases the rate of suicide by gun. This may seem obvious, but having a gun in the house also increases the overall rate of suicide, especially among men. The U.S. rate of suicide by firearm is about 11 times that of other industrialized countries.
Health care professionals particularly worry about depressed patients with access to guns, fearing that those who believe they would be better off dead will more easily act on that belief. Because guns are such an easy, impulsive way to commit suicide, knowing that a gun is in the house can help us more effectively counsel and guide patients.
This is especially useful information when we’re counseling military veterans, who have nearly twice the rate of suicide as civilians and who are often comfortable around guns, and when we’re assessing overall child and adolescent safety. For adolescents, the rate of suicide is two to three times greater when there is a gun in the house. Further, because of adolescents’ poor impulse control, we also worry that they’ll use the gun on other people.
Of course, guns in the house are often used for protection. But people with access to a gun have twice the likelihood of being a victim of homicide.
All these statistics lead us to this: Physicians increasingly feel a moral obligation to assess whether a gun is kept in the house and, if so, whether they’re kept unloaded and locked in a secure place separate from the ammunition.
It’s possible that your physician saw a risk factor — a history of depression or a potential threat to children — and is doing her due diligence. It’s also possible that she’s responding to recent calls from leading physicians to ask all patients about access to weapons within the home.
Regardless, her question was legal — and meant to protect both you and your loved ones.