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Law barring doctors talking to patients about gun ownership undermines public health issue

SAN DIEGO, CA -- A Florida law restricting physicians from counseling patients and parents about firearms safety endangers open communication between doctors and patients on a critical prevention and public health problem, experts warn in a "Current Issues" article published online today in the American Journal of Preventive Medicine.

The measure, signed into law by Gov. Rick Scott on June 1, requires that doctors, emergency medical personnel and other healthcare providers refrain from asking about gun ownership unless they "in good faith [believe] that this information is relevant to the patient's medical care or safety, or the safety of others." If they do ask, they can't enter the response into a patient's medical record.

The AJPM article, by Eric W. Fleegler, MD, MPH, of the Division of Emergency Medicine at Children's Hospital Boston and an instructor at Harvard Medical School, and colleagues, says the law is an assault on the physician-patient relationship.

"The open and confidential nature of the physicianpatient relationship is fundamental and allows doctors to talk effectively with their patients about a wide range of social issues such as smoking, alcohol use, health insurance, and intimate partner violence," the authors write.

The article notes that "as early as the 1890s, physicians have made recommendations about the ownership and safe handling of firearms. The physician visit offers a unique and valuable opportunity to provoke reflection among our citizens on these health-related topics. How can a physician instruct and encourage their patients to lock their guns and store them unloaded if the physician cannot even ask about gun ownership?"

After Gov. Scott signed the bill, three Florida physicians, the American Academy of Pediatrics (AAP), American Academy of Family Physicians and American College of Physicians sued the governor and other state officials in federal court to block the measure, saying it effectively barred doctors from talking with patients, or their guardians, about guns and gun safety and violated their First Amendment right to free speech.

U.S. District Court Judge Marcia Cooke of the Southern District of Florida, Miami Division, issued a preliminary injunction in September prohibiting enforcement of the law. The state has said it would appeal but has not done so as yet. After the Florida measure was signed, Alabama, Minnesota, North Carolina, Oklahoma and West Virginia introduced bills that also would bar physicians from asking about guns in the home. However all of the bills died when those states' legislative sessions ended, an AAP spokesperson says.

Gunshot wounds account for one in 25 admissions to pediatric trauma centers in the United States, according to the AAP, which also notes that a gun in the home is 43 times more likely to be used to kill a friend or family member than a burglar or other criminal. AAP and American Medical Association guidelines cited by Fleegler and colleagues "encourage physicians to inquire about the presence of household firearms and support the storage of unloaded firearms with trigger locks and in locked cabinets."

The authors cite data from the Centers for Disease Control and Prevention that found a total of 269,871 people were killed by firearms, including 19,846 children, from 1999-2007. "In 2007 alone, firearm fatalities accounted for over 1 million years of potential life lost. Notwithstanding the personal costs, firearm injuries and deaths result in substantial economic costs as well. In 2005 the combined medical and work loss cost of all firearm injuries and fatalities in the U.S. was $31.7 billion."

The authors emphasize that "guns and ammunition that are stored safely can protect children and youth from suicide and unintentional firearms injuries."

"Morbidity and mortality from firearm injury represent a ubiquitous and costly epidemic," they conclude. "But if physicians are not allowed to ask about firearms as a health issue, then they cannot even attempt to work toward prevention of injury. The only way to deal with a problem is to talk about it, not to suffer in silence."

Contact: Beverly Lytton
Elsevier Health Sciences

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