Marian E. Betz, MD, MPH; Deborah Azrael, PhD; Catherine Barber, MPA; Matthew Miller, MD, ScD
Presented in poster form at the 144th meeting of the American Public Health Association, Denver, Colorado, 29 October to 2 November 2016.
Funding Source: By the Fund for a Safer Future and the Joyce Foundation.
Disclosures: Ms. Barber reports grants from Fund for a Safer Future and Joyce Foundation during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0739.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available in the Appendix. Statistical code: Available from Dr. Betz (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Marian E. Betz, MD, MPH, Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, B-215, Aurora, CO 80045; e-mail, email@example.com.
Current Author Addresses: Dr. Betz: Department of Emergency Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, B-215, Aurora, CO 80045.
Dr. Azrael: Harvard Injury Control Research Center, 677 Huntington Ave, Kresge 310, Boston, MA 02115.
Ms. Barber: Harvard Injury Control Research Center, 677 Huntington Avenue, Kresge 316, Boston, MA 02115.
Dr. Miller: Department of Health Sciences, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA 02115.
Author Contributions: Conception and design: D. Azrael, C. Barber, M.E. Betz, M. Miller.
Analysis and interpretation of the data: D. Azrael, C. Barber, M.E. Betz, M. Miller.
Drafting of the article: D. Azrael, M.E. Betz.
Critical revision of the article for important intellectual content: D. Azrael, C. Barber, M.E. Betz, M. Miller.
Final approval of the article: D. Azrael, C. Barber, M.E. Betz, M. Miller.
Provision of study materials or patients: D. Azrael.
Statistical expertise: D. Azrael.
Obtaining of funding: D. Azrael, M. Miller.
Collection and assembly of data: D. Azrael.
Health care providers have been encouraged to discuss firearms with patients; whether patients view these discussions as appropriate is unclear.
To estimate, in a national sample, the perceived appropriateness of provider discussions about firearms.
Probability-based online survey conducted in April 2015. Analyses used survey weights to generate nationally representative estimates.
3914 English-speaking adults (55% participation rate).
Participants were asked, “In general, would you think it is never, sometimes, usually, or always appropriate for physicians and other health professionals to talk to their patients about firearms?”
A majority (66% [95% CI, 63% to 69%]) of participants said that it is at least sometimes appropriate for providers to talk to patients about firearms. Specifically, 23% (CI, 20% to 25%) said that provider discussions about firearms were always appropriate, 14% (CI, 11% to 16%) said that they were usually appropriate, and 30% (CI, 27% to 33%) thought they were sometimes appropriate; 34% (CI, 31% to 37%) felt that such discussions were never appropriate. Views varied by firearm ownership: 54% (CI, 52% to 57%) of gun owners said that provider discussions are at least sometimes appropriate, compared with 67% (CI, 62% to 71%) of nonowners living with an owner and 70% (CI, 66% to 74%) of nonowners not living with an owner. Firearm owners who were more likely to think that firearm discussions are at least sometimes appropriate included those with children at home (62% [CI, 57% to 67%]), those who thought that having a gun at home increases suicide risk (75% [CI, 67% to 83%), and those who thought that provider discussions of seat belts are at least sometimes appropriate (73% [CI, 70% to 75%]).
The provider discussion question did not specify clinical context.
Two thirds of non–firearm owners and over one half of firearm owners in the United States believe that health care provider discussions about firearms are at least sometimes appropriate. The observed heterogeneity underscores the need to better understand assumptions that may underlie these views, particularly among firearm owners.
Fund for a Safer Future and Joyce Foundation.
Table 1. Weighted Characteristics of Survey Participants (n = 3914)*
Views on when it is appropriate for health care providers to talk to their patients about various topics, by topic and firearm status (n = 3914).
Survey data include weighting variables for generation of national estimates. Weighted percentages may not sum to 100 due to rounding. Bars represent 95% CIs. Full data are available in the Appendix Table.
Appendix Table. Views on When It Is Appropriate for Health Care Providers to Talk to Their Patients About Various Topics, by Topic and Firearm Status (n = 3914)
Table 2. Views on Whether It Is at Least Sometimes Appropriate for Health Care Providers to Speak With Patients About Firearms
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In this video, Marian E. Betz, MD, MPH, offers additional insight into her article, "Public Opinion Regarding Whether Speaking With Patients About Firearms Is Appropriate. Results of a National Survey."
Medical Oncologist & Internist
July 26, 2016
Firearm Discussions with Patients: Too much to do, so little Time
The article by Betz et al presents results of an online poll that asks the question: Is it appropriate for physicians to discuss firearm safety with patients. This could not be more straightforward. Is such a survey even needed? But is gun safety a "sacred cow" that requires physicians to tread softly when it is clear that lack of such safety has resulted in thousands of deaths per year? How is this different than taking a family history, discussing sex, diet, alcohol, tobacco, mind-altering drugs, etc? Does not key principles in medicine involve the therapeutic index = patient benefits/adverse effects of treatment? But on the other hand, it seems clear to me that medicine today is in crisis insofar as a growing population that is underserved by a shortage of physicians. Presently, in my consulting practice spanning almost 50 years, I see less and less time spent in discussion with the patient. In med school we were required to read a book entitled "Talking to Patients" but this now is a fait non-accompli. Talking to patients is replaced by ordering labs and imaging studies. In my discussions with patients they all say the same thing re patient-physician discussions: my doctor spends about 15 minutes with me at an office visit. So my take on this survey by Betz et al is that it is absolutely necessary to discuss issues that matter with our patients, but is this gun safety talk a realistic add-on to the growing list of what docs need to talk to patients about? Should not those wanting to acquire firearms be asked to take a "driver's test" similar to what the DMV requires to secure a driver's license, and with periodic retesting? At the end of 2014, the CDC reported that death rates per 100,000 population from motor vehicle accidents and gun violence were identical. So why not a Gun Operators License?It is not realistic for the physician to stuff more discussion into the 15 minute office visit. And given the dangers of guns, as with cars, should not the onus be transferred back to the consumer, like the DMV test?
Betz ME, Azrael D, Barber C, et al. Public Opinion Regarding Whether Speaking With Patients About Firearms Is Appropriate: Results of a National Survey. Ann Intern Med. 2016;165:543–550. [Epub ahead of print 26 July 2016]. doi: https://doi.org/10.7326/M16-0739
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Published: Ann Intern Med. 2016;165(8):543-550.
Published at www.annals.org on 26 July 2016
Cardiology, Coronary Risk Factors, Emergency Medicine, Ethics, Prevention/Screening.
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