Stop those prying doctors!

 

Florida residents have their saviors in the Florida legislature to thank for shielding them from the insidious “prying into personal lives” that doctors have shamelessly been inflicting upon patients.

Apparently, doctors have been asking their patients questions about whether they own guns, and – prepare yourself for a shock – if the patient answers in the affirmative, some doctors have actually been counseling patients on how to store the guns safely and protect any other people in the home, particularly children, from accidental harm.

Fortunately, some attentive citizens were alerted to this disgusting practice and enlisted the NRA in helping them to get the Florida legislature to pass, and the Florida governor to sign on June 2nd, HB 155, which prohibits physicians from making written or oral inquiries regarding firearms ownership or recording such information in a patient’s chart (unless the doc believes “that this information is relevant to the patient’s medical care or safety, or the safety of others”).

It is a great relief to see that the physician-patient relationship — too long the purview of a suspiciously-dressed clique of highly-trained, dedicated professionals and their trusting patients, too long full of “prying into personal lives” as exemplified by questions like, “How do you feel?” “Does that hurt?”  “What do you use for contraception?” and “Did anybody in your family ever have cancer?” — is at last being exposed and regulated by those people we all trust way more than we do our doctors, the elected representatives in our legislatures.  My only regret is that some of the original provisions of the bill, such as the stipulation that a violation would amount to a third-degree felony punishable by up to five years in prison and a fine as high as $5 million, did not make it into the final legislation.

Encouraged by the NRA’s success, other bodies are stepping up to protect the unsuspecting public from some of the horrifying practices that routinely take place behind the closed doors of the consulting room.  The Tobacco Growers Coalition is promoting legislation to ban doctors from making inquiries about smoking, the GFFFA (Greasy Fried Fast Food Alliance) is working to make it illegal for doctors to counsel their patients about healthy diets, the NARL is drafting laws to ensure that doctors don’t counsel pregnant patients against abortion, and the Colombian drug cartels are looking for ways to prevent doctors from advising patients against using their special brand of products.

Sound too ridiculous to be true?  OK, I made that last paragraph up.  But read this.

Lest anyone misunderstand, this post is not about gun ownership, nor do I have anything against the NRA.  This post is about unwarranted encroachment upon the sanctity of the central economy of the medical profession, the physician-patient relationship;  and about what sort of Rubicon has been crossed when the paranoid intrusion and constraint represented by this bill is placed upon the good will and judgment of a doctor — and enshrined in the law of the land.

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Erik Clary
9 years ago

Interesting essay, Joe. Would you provide us with some history/background into why physicians are now asking questions about firearms and seeking to provide advice in an area (gun safety) that would seem to extend beyond their professional expertise?

Frankly, I see questions such as “how do you feel?” and “do you use any contraceptives?” in a category (directly relevant to the patient’s present medical condition) different from that which covers “do you own any guns?” (a question laden with social and political overtones). Do you typically ask your patients if they drive a car and if so, do you also dispense advice on safe driving? (I’ll set aside the question of whether physicians are sufficiently qualified for that task). It seems to me that if the physician is to address death by accident in a medical history, the list of questions will have to be much longer, and frankly, I am already a bit overwhelmed by the long questionnaires and the long waits in the physician’s office.

To be sure, a physician is entrusted to ask highly personal questions, and for good reason; but, there are limits; and on the issue of firearms inquiries, the appearance is that the medical profession is being enlisted to advance a social agenda that many patients find highly objectionable.

Joseph Gibes
Joseph Gibes
9 years ago

Erik,

Great questions, which I will answer after I reaffirm my central point: that legislating what a physician can ask about in the exam room is an unwarranted government intrusion into a professional relationship which detracts from that relationship, and in the process leads to poorer health care. The government has “intruded” into the relationship in a number of ways, for example, with HIPAA laws which legislate patient privacy; but as these laws aim to enhance the Hippocratic ethos rather than detract from it (“Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one”), they are not in the same category as the new Florida law. This law keeps physicians from fulfilling a fiduciary duty to their patients.

On to your questions. When I see patients for routine health maintenance exams, I deal not with disease, but with risk factors for disease and death. I do this with various tests and with various questions; and yes, there are a large number of questions I ask (and that I teach my students and residents to ask) about what are the leading causes of death, injury, or disease among many age groups, particularly the young. Many of these tests and questions are tailored to particular age groups: for instance, I do not send 5-year-olds for pap smears and colonoscopies, as cervical cancer and colon cancer are not significant causes of death and disease in this age group; however, pool accidents, drinking bleach, and firearm accidents are. I don’t ask if people drive cars, but I always ask if they wear seat belts. I ask all kids (and many adults) if they ride bikes, and if so I counsel them on bike helmet use. I ask if there is a pool that children might possibly have access to, and if so I counsel about pool safety. I ask all kids and their parents about how much time they spend in front of a computer/TV/video/smart phone screen, and counsel them to limit that time, as good data shows multiple risks from excess time spent in such activities. I ask whether household cleaners and other poisons are where children can’t get them. I ask whether patients get exercise and counsel them about it. And I ask if there are firearms in the home, and if so, ask whether they are locked up. There is good data to back all of these risk factors. I am not asking these questions because I am against driving, bicycling, the internet, household cleaners, backyard pools, and guns. I ask them because they are leading risk factors for death in various age groups, and I practice preventive medicine; and just as I can be held responsible for not ordering a mammogram for an at-risk woman, I can be held responsible for not asking age-appropriate preventive medicine questions (and in fact, my insurance company audits my charts and dings me if I do not document that I have asked these questions). I do not, and I am certain 99.999% of physicians do not, try to advance anybody’s social agenda by asking these questions. I do not judge people or suggest that people get rid of their guns. This has NOTHING to do with second-amendment rights. (It might have something to do with first-amendment rights for physicians!) More than anything, I am concerned about the professional freedom to practice good medicine, and intrusion into a relationship that exists to promote the health and life of people, not deprive them of their rights. I don’t doubt that there are a very few bad apples that do try to push an agenda in the exam room; however, this legislation is very obviously pushing an agenda, pushing it with an iron fist onto the entire membership of a profession, and doing so without considering the harm to patients that it might entail.

Erik Clary
9 years ago
Reply to  Joseph Gibes

Thanks Joe. I appreciate your thorough explanation of how the firearms issue fits into a preventative medical paradigm. It is my impression that firearms safety is a relatively new dimension of the medical consultation. Is that correct? If so, why is that? Do you believe it simply to be a reflection of a growing awareness of the importance of preventative care? Or, is there substance to the concern that the medical profession is being drafted into the present war over gun ownership?

What, precisely, do you believe the Florida citizenry and their legislators are attempting to communicate in their disapproval of firearms inquiries in routine medical consultation? Do you think it is a question solely of privacy rights, or is there a fear among some that any firearms information documented in the medical record might pass into the wrong hands (e.g. activists and bureaucrats who perceive gun ownership as an evil)? Can we really dismiss it all as mere “paranoia?”

Perhaps I’m reading too much into the situation, but it seems to me that Florida’s measure is a case of the citizenry seeking relief from what is perceived as an over-reaching government intent upon disarming law-abiding citizens. The medical profession, it would seem, has been caught in the cross-fire.

Joseph Gibes
Joseph Gibes
9 years ago
Reply to  Erik Clary

Erik,

I do not know how long firearm safety has been part of preventive medicine. It was part of my training 20 years ago, so I don’t believe it is that recent. At some point it was added to medical care, not by an “over-reaching government” but by physicians themselves, in response to data showing that firearm death was a significant preventible cause of death in their patients. Studies done over the years show that brief counseling in the course of an office visit does not make a change in gun ownership or acquisition, but DOES make a difference in the use of trigger locks and safe gun storage. So, if we doctors are being drafted into a war on gun ownership, we’re doing a pretty poor job of it; if, however, we are trying to teach our patients how to own guns in a way that’s safer for their children and themselves, studies show that we’re doing a far better job than either the NRA’s “Eddie Eagle” or the Brady Center’s “STOP” programs.

From what I’ve read, the Florida citizenry are concerned about two things: that doctors asking questions about firearms somehow leads to abridging their Second Amendment rights (a huge logical leap to me); and that, in an imagined future in which gun owners are hunted down as criminals, the physician records will provide ammunition to the hunters (my, there are a lot of gun-related metaphors in our language, aren’t there?). Perhaps I’m naive (I certainly had no knowledge the gun-owner wars before this bit of legislation), but both of these concerns betray a certain “everybody’s against me” thinking that seems at least to start to approach something that looks like paranoia. (Probably just my naivete.)

Again, my central point has nothing to do with gun ownership per se; it is that the physician-patient relationship has been hijacked by a special-interest group for purposes other that doing what is best for the patient. Doctors hate government interference as much as gun owners do; this government interference is particularly odious because it comes right into the heart of the profession and prevents me from doing the best I can for my patients.

Erik Clary
9 years ago

Thanks for the interaction, Joe. Your genuine concern for minimizing accidental gun deaths comes through loud and clear . . . and also your disdain for government intrusion into the physician-patient consultation. On these points, we have no disagreement.

While from your perspective the issue is one of the government encroaching upon a private and sensitive relationship between doctor and patient, from the perspective of Floridian citizens, I gather, the issue concerns respect for civil rights – specifically, a right to bear arms and a right to privacy that if violated might threaten the former.

The encroachment of government today upon the right of law-abiding citizens to bear arms is real and not imagined. I recall, for example, that not long ago in Chicago a sitting AG attempted to make public a citizen firearms registry, a move that would have given criminals an advantage over all citizens (those who own guns and those who do not).

Whether or not the Florida legislation was an overreaction is debatable, but it seems to me that to simply dismiss the proponents as “paranoid” fails to do justice to the political realities of our day.