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On Being a Doctor |

The Firearm for Protection? A Risky BetThe Firearm for Protection? FREE

Erik A. Wallace, MD
[+] Article, Author, and Disclosure Information

From University of Colorado School of Medicine, Colorado Springs, Colorado.

Requests for Single Reprints: Erik A. Wallace, MD, 4863 North Nevada Avenue, Room 426, Colorado Springs, CO 80918; e-mail, erik.wallace@ucdenver.edu.


Ann Intern Med. 2016;164(10):698-699. doi:10.7326/M15-2100
© 2016 American College of Physicians
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When a patient threatened to kill me 4 years ago, the experience changed my thoughts and actions about life and death. Windows and doors locked at home—check. Security escort at work—check. Over the next several weeks, I tucked my cell phone with unanswered texts and e-mails deep in my pocket while peering behind parked cars, searching for the person who planned to end my life. I clearly needed a firearm for protection.

Or did I? Aside from my childhood cap gun and brother's BB gun, I had never handled a real firearm. Firearm ownership, and the joy of hunting and target shooting, was never ingrained in my culture as a child. However, fear was now the primary emotion driving my interest toward it. Of course I wanted to feel empowered to protect my family and myself from a looming death threat. And if that threat were to pass without incident, was I naive to think that I would never be threatened again?

As physicians, we are familiar with erratic patient behaviors that could lead to violence. Public shootings, including those in health care facilities, fuel our fear of premature death and the urgent need to protect ourselves. However, signs that prohibit firearms on site seem ubiquitous in our clinics and hospitals. How can I protect myself if I am not allowed to bring my gun to work? Although my fears were mildly pacified by the daily security detail, I still kept my telephone in my pocket and my eyes wide open with every nervous step.

Before heading to the local gun shop, I set my nauseating fear aside and carefully analyzed the medical literature to justify my pending purchase. As an internist, my job is to understand and communicate risks and benefits of decisions about the health and safety of my patients. Why should I treat myself differently? Given the impending death threat, the emotional benefit of owning a firearm was clear because it provided me with a sense of security. The practical risks and potential effect on my family related to owning that same firearm emerged as I dug deeper. As a father of two young children, I was engulfed in a new wave of fear with each national headline I uncovered on the Internet: “3-Year-Old Boy Shot in Mouth While Playing With 4-Year-Old Neighbor,” “Toddler Reaches Into Purse and Gun Goes Off, Killing Mom,” “Boy, 3, Wounds Mom and Dad With One Shot,” “3-Year-Old Shoots 1-Year-Old Sibling in the Face.” And so on.

As a curious 9-year-old, I vividly recall opening my dad's dresser drawer one day while my parents had stepped out of the house to run an errand. I stumbled upon a handgun with a clip of bullets nestled by its side buried beneath his sweaters. As an avid Star Wars fan, I knew that this weapon would be much more effective at killing the Stormtroopers who I previously had battled with my cap gun. After a few intense minutes of staring at the cold, black gun, I carefully covered it with my dad's sweaters, closed the drawer, and left the room. Fear prevented me from handling the firearm—fear of getting caught going through my dad's stuff but not fear of the lethal damage I could potentially inflict. Many kids do not understand or think about these outcomes, especially the toddlers in the stories previously mentioned who are simply interested in grabbing whatever is within reach, unaware of the possible violent consequences.

These types of unintentional injuries and deaths from firearm violence are not accidents. An accident would imply that they could not have been avoided—they just happened. However, these injuries and deaths, along with many others each year that seem to be increasing in prevalence in the headlines, are 100% avoidable if there is no access to a firearm. That's correct. Unintentional injuries and deaths that result from a child discharging a firearm could never happen as long as that child does not have access to one. The surviving family members and friends of the victims of these unintentional shootings live with physical and emotional scars forever. Although we feel empowered with the right to purchase and possess a firearm to protect ourselves and our families, the truth is that the safest home for a child or adolescent is one without firearms. If an adult chooses to own a firearm, it should always be kept locked and inaccessible to children. Herein lies the paradox of a firearm as protector. Could the risks of owning one to protect my family outweigh the protective benefits? Yes. Might I still successfully protect myself and my family? Perhaps.

Our patients may be consumed by these same fears that drive firearm purchases for protection. Although convincing patients to store their firearms for hunting or sport that are used sporadically may be relatively easy, convincing them to safely store the firearm that was purchased to provide personal, family, and property protection is far more challenging. “What if I need to access it and use it quickly?” one might counter. The owner of a new firearm is often unaware at the time of purchase that, if that gun is ever discharged and kills someone, the most likely scenario is suicide.

Several years ago, an older patient of mine with multiple chronic medical conditions missed his appointment for the first time. Out of concern, I called him. His wife answered the phone and, in tears, described how she had found him with a self-inflicted gunshot wound to the head. Deeply remorseful over his death, I regretted not asking about his access to firearms, although he had never verbalized suicidal thoughts. Unfortunately, the decision to attempt suicide is often impulsive, which further necessitates proactive firearm safety counseling rather than waiting for patients to declare their intent to commit suicide. Our parents, grandparents, and aging patients may have once been responsible gun owners. However, the increasing incidence of depression, cognitive disorders, and other impairments in our older population could put our families at risk for intentional or unintentional firearm injury or death.

Although our role as physicians in reducing firearm injury and death has been well-articulated (1), we have done an abysmal job of advocating for the safety of our patients given the current statistics. We must improve our efforts in conducting patient-centered conversations about firearm safety despite misguided legislative efforts to limit or prevent these potentially life-saving discussions. Our patients who own firearms because of fear or cultural reasons may resist our recommendations to decrease firearm access or improve firearm safety in the home. Developing a trusting physician–patient relationship over time is critical to achieve meaningful behavioral change. Physicians should never wait until a patient has committed suicide, or has suffered from unintentional firearm injury, to change their approach to reducing firearm violence.

Fortunately, I did not have positive emotions or deep cultural roots related to firearm ownership that clouded the objective evidence available about a firearm purchase. A firearm would increase the risk for accidental or intentional death of someone in my home despite the degree of potential protective benefit. Could I potentially use it for protection successfully? Yes. For me, did the potential benefits of firearm ownership for protection, even with a real death threat, outweigh the potential risks for unintentional firearm injury or death? No.

I relinquished my personal security detail a few weeks after my life was threatened and went back to checking e-mails on my telephone while walking in the parking lot. Although I have completed a firearm safety training course, I have not purchased and still do not own a firearm. As I reflect upon the daily risks and threats that my family faces in all aspects of life, the patients and friends I have known who have attempted or committed suicide, and the frequent headlines and staggering numbers of children and adults dying of firearm violence, I will not purchase one. I feel safer without it.

References

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; 162:513-6.
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References

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; 162:513-6.
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