October 9, 2016

Yes, You Can: Physicians, Patients, and Firearms

Physicians have unique opportunities to help prevent firearm violence. Concern has developed that federal and state laws or regulations prohibit physicians from asking or counseling patients about firearms and disclosing patient information about firearms to others, even when threats to health and safety may be involved. This is not the case. In this article, the authors explain the statutes in question, emphasizing that physicians may ask about firearms (with rare exceptions), may counsel about firearms as they do about other health matters, and may disclose information to third parties when necessary. The authors then review circumstances under which questions about firearms might be most appropriate if they are not asked routinely. Such circumstances include instances when the patient provides information or exhibits behavior suggesting an acutely increased risk for violence, whether to himself or others, or when the patient possesses other individual-level risk factors for violence, such as alcohol abuse. 

The article summarizes the literature on current physician practices in asking and counseling about firearms, which are done far less commonly than recommended. Barriers to engaging in those practices, the effectiveness of clinical efforts to prevent firearm-related injuries, and what patients think about such efforts and physicians who engage in them are discussed. Proceeding from the limited available evidence, the authors make specific recommendations on how physicians might counsel their patients to reduce their risk for firearm-related death or serious injury. Finally, the authors review the circumstances under which disclosure of patient information about firearms to third parties is supported by regulations implementing the Health Insurance Portability and Accountability Act.

In 2014, a total of 33 599 Americans died of gunshot wounds (1). Although the risk for firearm-related homicide is highest among young African American men, most firearm-related deaths are suicides, for which older white men are at highest risk (2). Public mass shootings account for a small percentage of firearm-related deaths but are occurring more frequently and could affect the character of public life in the United States (3). In early 2013, more than 40% of Americans worried that they could fall victim to firearm-related homicide or assault (4).

Physicians seek to prevent important health problems at the individual and population levels. They inquire and counsel—routinely in some cases, selectively in others—about a wide range of health-related behaviors and conditions. In certain circumstances, they disclose otherwise confidential information to third parties to limit the risk an affected person poses to others.

Physicians generally do not do well at firearm-related injury prevention, however. They ask infrequently about firearms and counsel poorly, if at all, although they are aware that the high lethality of firearms makes prevention efforts particularly important.
In this article, we examine several commonly cited barriers to practicing preventive medicine for firearm-related injuries. Some physicians believe that it is against the law to discuss firearms; we show that this belief is unfounded. We then discuss the circumstances in which prevention efforts might be most appropriate. We briefly review other barriers to their more widespread adoption, patients' opinions about physicians addressing firearms, and the effectiveness of such prevention practices; more extensive information is available elsewhere (5, 6). We offer specific recommendations, based on the limited evidence available, for how physicians can incorporate firearm-related injury prevention into the care of their patients.

Please read the full article here.

Garen J. Wintemute, MD, MPH

Marian E. Betz, MD, MPH

Megan L. Ranney, MD, MPH

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