The Health Care Professional's Pledge: Protecting Our Patients From Firearm Injury

Christine Laine; Darren B. Taichman

doi:10.7326/M17-2714

Access the Comments on Wintemute's article to see who has committed to talk to their at-risk patients about firearm safety. Make your commitment now.

Too many of our patients suffer when bullets maim or kill them or their loved ones. And those not yet personally harmed by guns worry about the potential for future harm presented by the ubiquity of guns in America. Regardless of whether one believes guns hurt people or that people hurt people with guns, we have a public health crisis and health care professionals have an obligation to do what we can to combat it.

Annals of Internal Medicine has raised the alarm about guns since at least 1998 (1–3). More recently, we have published strong recommendations to reduce firearm injury from the American College of Physicians (ACP) (4) and another from the ACP with 7 other health organizations together with the American Bar Association (5). Improvements in public health require careful study. We've published rigorous reviews to help synthesize what is and is not known (6). The dearth of evidence to inform sensible gun regulation led us to solicit original research and work hard to help authors report it accurately to disseminate as much truthful information as possible for others seeking to learn from and build upon the findings (7–17). Firearms have also been the subject of On Being a Doctor essays (18, 19). We've repeatedly called on ourselves and our colleagues to examine the evidence, take action, and raise our voices (20–34). We've cried out that we must use our voices.

Nowhere are our voices more important than in the privacy of the examination room. This is where our work is done, where all the research and learning come together. Of all the times and places where we might speak, this is where our voices can do the most immediate good. We must commit to using that time and place to help protect our patients from firearm-related harm.

In this issue, Wintemute calls on each of us to make a commitment to ask our patients about firearms when, in our judgment, it is appropriate and to follow through (35). We know the factors that should alert us to the risk for alcohol, tobacco, and other substance use disorders; sexually transmitted disease; intimate partner abuse; suicidality; and other preventable harms to our patients. We ask about these risks and counsel accordingly. The risks for harming oneself or exposing others to harm from a firearm are also known. And we know we should speak up (34).

While changes in U.S. gun regulations are sorely needed to address population-level threats presented by the availability of military-style firearms and unlimited ammunition, physicians and other health professionals at the frontline of patient care can help prevent firearm-related harm one patient at a time. Go to http://go.annals.org/commit-now and make the commitment to start doing this right now. By making a public commitment to ask our patients about firearms and counsel them to reduce this risk, we show our patients and their communities that we are committed to their safety and health.

Feeling uncomfortable about how to talk with patients about guns is not a reason to shy away. Read when and how to do it (36). Let's start now. Too many of our patients are in danger. This simply cannot wait.

References

Davidoff
F
Reframing gun violence [Editorial].
,
Ann Intern Med
,
1998
, vol.
128
(pg.
234
-
5
)
PubMed
American College of Physicians
Firearm injury prevention.
,
Ann Intern Med
,
1998
, vol.
128
(pg.
236
-
41
)
PubMed
Cassel
CK
Nelson
EA
Smith
TW
Schwab
CW
Barlow
B
Gary
NE
Internists' and surgeons' attitudes toward guns and firearm injury prevention.
,
Ann Intern Med
,
1998
, vol.
128
(pg.
224
-
30
)
PubMed
Butkus
R
Doherty
R
Daniel
H
Health and Public Policy Committee of the American College of Physicians
Reducing firearm-related injuries and deaths in the United States: executive summary of a policy position paper from the American College of Physicians.
,
Ann Intern Med
,
2014
, vol.
160
(pg.
858
-
60
)
PubMed
Weinberger
SE
Hoyt
DB
Lawrence
HC
3rd
Levin
S
Henley
DE
Alden
ER
et al
Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association.
,
Ann Intern Med
,
2015
, vol.
162
(pg.
513
-
6
)
PubMed
Anglemyer
A
Horvath
T
Rutherford
G
The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis.
,
Ann Intern Med
,
2014
, vol.
160
(pg.
101
-
10
)
PubMed
Anglemyer
A
Miller
ML
Buttrey
S
Whitaker
L
Suicide rates and methods in active duty military personnel, 2005 to 2011: a cohort study.
,
Ann Intern Med
,
2016
, vol.
165
(pg.
167
-
74
)
PubMed
Díez
C
Kurland
RP
Rothman
EF
Bair-Merritt
M
Fleegler
E
Xuan
Z
et al
State intimate partner violence-related firearm laws and intimate partner homicide rates in the United States, 1991 to 2015.
,
Ann Intern Med
,
2017
PubMed
Goldstick
JE
Carter
PM
Walton
MA
Dahlberg
LL
Sumner
SA
Zimmerman
MA
et al
Development of the SaFETy score: a clinical screening tool for predicting future firearm violence risk.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
707
-
14
)
PubMed
Studdert
DM
Zhang
Y
Rodden
JA
Hyndman
RJ
Wintemute
GJ
Handgun acquisitions in California after two mass shootings.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
698
-
706
)
PubMed
Reid
JA
Richards
TN
Loughran
TA
Mulvey
EP
The relationships among exposure to violence, psychological distress, and gun carrying among male adolescents found guilty of serious legal offenses: a longitudinal cohort study.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
412
-
8
)
PubMed
Miller
M
Hepburn
L
Azrael
D
Firearm acquisition without background checks: results of a national survey.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
233
-
9
)
PubMed
Rowhani-Rahbar
A
Fan
MD
Simonetti
JA
Lyons
VH
Wang
J
Zatzick
D
et al
Violence perpetration among patients hospitalized for unintentional and assault-related firearm injury: a case-control study and a cohort study.
,
Ann Intern Med
,
2016
, vol.
165
(pg.
841
-
7
)
PubMed
Rowhani-Rahbar
A
Zatzick
D
Wang
J
Mills
BM
Simonetti
JA
Fan
MD
et al
Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study.
,
Ann Intern Med
,
2015
, vol.
162
(pg.
492
-
500
)
PubMed
Hsieh
JK
Arias
JJ
Sarmey
N
Rose
JA
Tousi
B
Firearms among cognitively impaired persons: a cross-sectional study.
,
Ann Intern Med
,
2015
, vol.
163
(pg.
485
-
7
)
PubMed
Butkus
R
Weissman
A
Internists' attitudes toward prevention of firearm injury.
,
Ann Intern Med
,
2014
, vol.
160
(pg.
821
-
7
)
PubMed
Boggs
JM
Simon
GE
Ahmedani
BK
Peterson
E
Hubley
S
Beck
A
The association of firearm suicide with mental illness, substance use conditions, and previous suicide attempts.
,
Ann Intern Med
,
2017
, vol.
167
(pg.
287
-
8
)
PubMed
Wallace
EA
The firearm for protection?
,
A risky bet. Ann Intern Med
,
2016
, vol.
164
(pg.
698
-
9
)
PubMed
Quinn
C
The pirates.
,
Ann Intern Med
,
1999
, vol.
131
(pg.
472
-
3
)
PubMed
Laine
C
Taichman
DB
Mulrow
C
Berkwits
M
Cotton
D
Williams
SV
A resolution for physicians: time to focus on the public health threat of gun violence [Editorial].
,
Ann Intern Med
,
2013
, vol.
158
(pg.
493
-
4
)
PubMed
Taichman
DB
Bauchner
H
Drazen
JM
Laine
C
Peiperl
L
Firearm-related injury and death: a U.S. health care crisis in need of health care professionals.
,
Ann Intern Med
,
2017
, vol.
167
(pg.
824
-
5
)
PubMed
Fisher
J
Bonomi
A
Firearm surrender laws: prompting promise for women's health.
,
Ann Intern Med
,
2017
, vol.
167
(pg.
591
-
2
)
PubMed
Webster
DW
The true effect of mass shootings on Americans.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
749
-
50
)
PubMed
Cook
PJ
At last, a good estimate of the magnitude of the private-sale loophole for firearms.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
301
-
2
)
PubMed
Hargarten
S
Firearm injury in the United States: effective management must address biophysical and biopsychosocial factors.
,
Ann Intern Med
,
2016
, vol.
165
(pg.
882
-
3
)
PubMed
Weinberger
SE
Curbing firearm violence: identifying a specific target for physician action.
,
Ann Intern Med
,
2016
, vol.
165
(pg.
221
-
2
)
PubMed
Taichman
DB
Laine
C
Reducing firearm-related harms: time for us to study and speak out [Editorial].
,
Ann Intern Med
,
2015
, vol.
162
(pg.
520
-
1
)
PubMed
Hemenway
D
Guns, suicide, and homicide: individual-level versus population-level studies [Editorial].
,
Ann Intern Med
,
2014
, vol.
160
(pg.
134
-
5
)
PubMed
Kapp
MB
Geriatric patients, firearms, and physicians.
,
Ann Intern Med
,
2013
, vol.
159
(pg.
421
-
2
)
PubMed
Fisher
CE
Lieberman
JA
Getting the facts straight about gun violence and mental illness: putting compassion before fear.
,
Ann Intern Med
,
2013
, vol.
159
(pg.
423
-
4
)
PubMed
Chapman
S
Alpers
P
Gun-related deaths: how Australia stepped off “the American path”.
,
Ann Intern Med
,
2013
, vol.
158
(pg.
770
-
1
)
PubMed
Frattaroli
S
Webster
DW
Wintemute
GJ
Implementing a public health approach to gun violence prevention: the importance of physician engagement.
,
Ann Intern Med
,
2013
, vol.
158
(pg.
697
-
8
)
PubMed
Coulehan
J
The tragic events of April 1996.
,
Ann Intern Med
,
2000
, vol.
132
(pg.
911
-
3
)
PubMed
Betz
ME
Ranney
ML
Wintemute
GJ
Physicians, patients, and firearms: the courts say “yes”.
,
Ann Intern Med
,
2017
, vol.
166
(pg.
745
-
6
)
PubMed
Wintemute
GJ
What you can do to stop firearm violence.
,
Ann Intern Med
,
2017
, vol.
167
(pg.
886
-
7
)
Wintemute
GJ
Betz
ME
Ranney
ML
Yes, you can: physicians, patients, and firearms.
,
Ann Intern Med
,
2016
, vol.
165
(pg.
205
-
13
)
PubMed

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1 Comment

Steven Kulback MD, FACP

Alabama Internal Medicine

January 21, 2018

A Conservation

To the Editor:
In the December 19 issue of the Annals, Drs. Laine and Taichman recommend finding a way to have a conversation with our patients about guns. I have found a very effective way to initiate such a conversation with my patients who have firearms – I leave my latest copy of The American Rifleman in the exam room. I have had some very interesting talks with my patients about our favorite pistols, time at the firing range and the use of firearms for hunting and for self-defense. We also talk about firearm safety and safe storage. Those not interested in guns just ignore the magazine and look at People or Southern Living instead.

Steven Kulback, MD, FACP

Editorials |19 December 2017

The Health Care Professional's Pledge: Protecting Our Patients From Firearm Injury Free

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Editorials |19 December 2017

The Health Care Professional's Pledge: Protecting Our Patients From Firearm Injury Free

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