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?

 

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