DEC 1, 2011 9:55am ET

Guns and Patients: We’re Here at the Crossroads


A Florida law restricts physicians from talking to patients about guns and firearm safety unless they believe the information is relevant to the patient’s medical care or safety, or the safety of others. And if they do ask, they can’t enter the response into the medical record.

This has been winding its way through the courts (of course) and has also showed up in other state legislatures since the law was passed in June. To me, it’s an indication of the troubling crossroads between data and privacy we find ourselves at, something we wrote about in our October edition from a different but no less important angle.

The idea that a physician has legally defined parameters of how and when they can discuss guns with their patients is, on its face and maybe even a little deeper, patently ridiculous. No matter where you stand on the right to bear arms, when you get down to the objective brass tacks, guns are a significant public health hazard. The American Academy of Pediatrics says that 1 in 25 admissions to pediatric trauma centers are for gunshot wounds. Authors of an article appearing in The American Journal of Preventive Medicine cite data from the CDC that from 1999-2007, nearly 270,000 people were killed by firearms.

In my mind, it would be irresponsible for physicians, especially pediatricians, to not to ask about guns in the home, and I trust their professional judgment about which patients to have a conversation with and how to use that information within the physician/patient relationship.

But here we come to the heart of the matter. I think the National Rifle Association and the Florida legislature and gun owners also by-and-large trust physicians, but they don’t trust the health information infrastructure they’re wired into. Washington as well as state governments are collecting ever more data from EHRs and other sources to support population health and other grand-scale health care initiatives. That information is designated for use for the common good, but many people are nervous about who decides what the common good is: punitive measures aimed at the obese? Intrusive monitoring of diabetics? A new layer of scrutiny for legal gun owners in the name of public health?

Health care providers understand the enormous power good data has for saving and improving their patients’ lives. But many also chafe at the increasingly large amount of data they’re being asked to collect about their patients, question to what purpose that data will be used, and worry it will be used in ways they never intended or imagined when they asked the questions and entered the answers into an information system—a system designed to deposit that electronic data into increasingly vast data warehouses.

At some point, patients are going to say enough is enough, and we will see more damage to the physician/patient relationship that’s already cracking at the foundation. So the question to caregivers and federal overseers: when is enough truly enough? Or have we already passed that point?


Comments (4)
Violence is the most deadly epidemic we face as a nation. Paranoia is the most prevalent mental disorder. And our mythology that firearms make us either powerful or safe is the most dangerous falsehood.

Individually, they are dangerous addictions. Taken together, they are more deadly by orders of magnitude. The facts are fully documented and unambiguous.

It is far past time for an intervention. Thirty thousand Americans killed each year by gunfire in our homes, streets, schools and workplaces is unacceptable. The baby shot in his father's arms last night, the child crippled by a stray bullet at his piano lesson, the trick-or-treater blown off a front porch by a frightened elderly woman - it is all monstrously obscene and unacceptable.

Yes, physicians must present the truth to patients, particularly parents. Yes, educators. Yes, church leaders. Yes, public servants and agencies. Yes, non-profits. All of us must demand an end to this psychotic madness.

Gathering, documenting, and reporting the facts are the place to begin.

Posted by BruceSF | Friday, December 02 2011 at 4:47PM ET
Forgive the pun, but the NRA is trying to shoot the messenger. If they had their way, no data about gun deaths/injuries would be reported. To them, the personal right to bear arms is absolute and cannot be abridged in any way to reduce harm, so there's no point in collecting statistics. They would oppose any public health intervention suggested by the data. It would be like limiting free speech because someone's feelings might have been hurt by what was written or said. Their "rights" trumps everyone else's risk.

However, your points about how issues such as gun possession could derail efforts to aggregate EHR data for public health purposes is spot on. Already, an anti-vaccine website is advising its readers to opt out of immunization registries because of concerns they would be used to exclude their children from schools.

I am fairly sure that we are just one major data breach away from an opt-in only system for sharing EHR data. The public attitude towards EHRs could turn very quickly.
Posted by DREW H | Monday, November 28 2011 at 8:50AM ET
I agree w/ Andrew R. about the motivations behind Florida's inane gun discussion law - it is motivated more by single issue politics that larger issues. However, I believe that once the genie is out of the bottle, i.e. once it is recognized that providers are required to collect the data, the "second order" problem of data scrutinization becomes an issue. Not only will the single issue players that initiated the problem focus on the data, but so will every other private or government special interest who believes that the data can somehow advance their cause.
Posted by A D | Sunday, November 13 2011 at 12:56AM ET
Do you honestly believe that the motivation behind this "patently absurd" legislation is that its sponsors and supporters "don't trust the health information infrastructure [physicians] are wired into"? I don;t believe that they even considered for one nano-second whether the patient discussion is documented in an electronic chart vs. a paper chart vs. scratched in the sand. While I agree with your broader point that data protection and privacy as related to HIT and data exchange are bound to become increasingly important to patients and even a matter of concern with regard to physician/patient trust, I think you are stretching to find a relevant example. The sponsors of bills like the one enacted in Florida are simply pandering to their base, which they assume (right or wrong) to be single-issue driven zealots who don't want to know anything at all--certainly not public health statistics concerning firearms, let alone details about data protection and the national HIT infrastructure!
Posted by Andrew R | Thursday, November 10 2011 at 9:21AM ET
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