Curbing Firearm Violence: Identifying a Specific Target for Physician Action Free

Robert B. Sklaroff, M.D.

Nazareth Hospital, Philadelphia, PA

August 6, 2016

Curbing Firearm Violence: Tempering Physician Action

Just as was the case two years ago (1), because “public health research predictably guides generation of public policy, it is necessary to scrutinize the political science underlying the paired systematic review and editorial (2) on gun control.” Inasmuch as the term “gun control” carries divergent meanings to liberals [restricting firearm access] and conservatives [aiming firearm properly], it is necessary to recognize that editorialization—particularly in a scientific journal—is most effective when it is devoid of proselytizing.

It is claimed physicians “have a broader societal obligation to improve population health [and, thus] to inform and educate their patients and the public at large to effect changes in behavior and adoption of important preventive measures.” A broad-brush assertion is invoked to justify deputizing physicians—like it or not—to accumulate behavioral information subject to transfer to a “third-party” [read: “government”]. Such is the nuanced segue from recognition of the noble duty to promote public health, to the elitism inherent in forcing both “ends” of the patient-physician relationship to submit to mandated questioning-and-answering.

In addition, it is claimed physicians “should not shirk their responsibility to seek information about gun ownership when appropriate” based upon an accompanying article that supposedly identified “only rare occasions when physicians cannot ask a patient about firearms.” To the contrary, careful scrutiny of the article by Wintemute and colleagues fails to identify any putative exceptions for, instead, it seeks to justify such querying globally. Such is the lamentable truth-disconnect between false citation of an allegedly-corroborative article and excessive opining.

Not surprisingly, it is also claimed—incompletely—that “The authors focus on the particular importance of addressing firearms with patients when there is information, behavior, or individual factors suggesting a risk for violence to self or others.” Actually, the article uses demographic characterization [a.k.a. “profiling”]—misquoting the literature in the process—to trigger justifying such probes.

Finally, physicians are tasked to band inter alia with the legal community to “mitigate the risk for firearm-related injury and death,” ignoring the societal and political forces-at-play that dwarf allegedly-“medical” considerations. In fact, fear that physicians could become data-fonts for the National Security Agency (3) is ethically linked to how some would justify expanding databases, both made available for background-checks (4) and accrued by questioning students pursuant to Common Core “educational” grants (5).

Clinical interactions must uphold patient-physician privacy-rights and be untethered from mandates, both regarding history-taking and how it is recorded.






References

1. Sklaroff, RB. Guns, Suicide, and Homicide [Letter]. Ann Intern Med. 2014;160(12):876-877. doi:10.7326/L14-5012-2

2. Weinberger SE. Curbing Firearm Violence: Identifying a Specific Target for Physician Action. Ann Intern Med. 2016;165:221-222. doi:10.7326/M16-0968

3. [Anonymous]. National Security and Medical Information. Electronic Frontier Foundation. San Francisco, CA. Accessed at https://www.eff.org/issues/national-security-and-medical-information on 5 August 2016.

4. [Anonymous]. The Role of HIPAA in Gun Control. Scripted. San Francisco, CA. Accessed at https://www.scripted.com/writing-samples/the-role-of-hipaa-in-gun-control on 5 August 2016.

5. American Principles Project. New Changes to National Assessment of Education Progress (NAEP) Are Illegal [Press Release]. American Principles Project (June 27, 2016). Washington, D.C. Accessed at https://americanprinciplesproject.org/education/8385/ on 5 August 2016.

Stephen Strum

Private Practice of Medical Oncology/Internal Medicine

August 9, 2016

Curbing Firearm Violence

Being up-close and personal with patients over a span of four decades provides perspective that is often lost in today's world of rapid-fire conclusions. The era of a patient having significant time during a physician encounter is over. We are immersed, whether we acknowledge it or not, in what I call McMedicine i.e. fast-food medicine. Consultation reports for new patients are more often than not lacking in detail. Follow up office visits are now most commonly copy-paste functions of the so-called electronic health record, whose purpose is often optimal insurance reimbursement. As a medical oncologist who remains consistent in his belief that integrative care is crucial to the best outcomes no matter what the primary illness may be, I rarely see expressions of serious cognitive thinking in consultations and office visits. The primary focus of most physicians is on ordering lab tests and imaging, and not on history, physical examination and diagnosis. Just ask patients. And now we propose to add on to this harsh reality a discussion by the physician relating to the significant problem of firearms.

Why not have those wishing to obtain a firearm obtain a permit just as we do with a driver's license? The risk of death from either is comparable. Motor vehicle accidents accounted for 11.2 deaths per 100,000 population in 2013 in comparison to 10.6 deaths per firearms (CDC,National Vital Statistics System). If anything, such testing would at the very least increase education relating to gun safety and proper gun handling. And isn't it painfully tragic that the source of the quotation below is from a victim of gun violence.

"Our lives begin to end the day that we become silent about things that matter."
-Martin Luther King

Steven E. Weinberger, MD

American College of Physicians

September 30, 2016

Author's Response

Dr. Sklaroff’s letter is politicizing the view expressed in my editorial (1), framing it as a “gun control” position rather than as a recognition of the medical profession’s responsibility to address issues that affect the health of the public and the potential for injury or death to each clinician’s patients and family members. There is absolutely no intent for physicians to be deputized to report gun ownership to local, state, or federal governments, and it is unfortunate that gun rights advocates, such as Dr. Sklaroff, take this unfounded position. There is also no proposal for “mandated questioning” that would be imposed upon physicians, but rather a recognition that such questioning is permitted when there might be the potential for injury or death to the patient or to others in the household.

The joint statement by major medical organizations, the American Public Health Association, and the American Bar Association to which Dr. Sklaroff refers is a recognition of the commitment of these major professional communities to curbing firearms violence (2). It is a professional responsibility that goes above and beyond the polarized political positions that have unfortunately become the norm in American society.

Steven Weinberger, MD
American College of Physicians
Philadelphia, Pennsylvania


1. Weinberger SE. Curbing firearms violence: identifying a specific target for physician action. Ann Intern Med. 2016; 165:221-222.

2. Weinberger SE, Hoyt DB, Lawrence HC III, Levin S, Henley DE, Alden ER, Wilkerson D, Benjamin GC, Hubbard WC. 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; 162:513-16.