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Editorial: Whose Patient Visit is this Anyway, Gun-Owners?

People who are hostile to the right of self-defense want doctors to go off on paternalistic fishing expeditions when they see patients to determine whether they own guns or not. But when I completed my training to become a physician assistant in internal medicine during the 1980s and gun crimes were starting to peak (ironically, I worked in the medical care clinics of a prison system), no one ever mentioned that healthcare professionals should arbitrarily inquire about gun ownership.  I was never taught to ask about it because it was never deemed necessary to successfully treating patients.

I know how to perform a very thorough history and physical (H&P) examination, which is a dying art in our medical care industry that rewards technology, procedures, and data collection at the expense of safety and effectiveness. But, instead of repairing doctor-patient relations, self-defense opponents see current healthcare upheavals as an opportunity to advance an agenda aimed at people whose lifestyle choices they dislike.

For the uninitiated, there are predominantly two kinds of H&Ps. The first is a directed H&P, often recorded as Subjective-Objective-Assessment-Plan or SOAP. The second is called a review of systems (ROS) and is much more[amazon asin=0990463109&template=*lrc ad (right)] thorough. SOAP notes are for limited, discrete problems, such as when you turn your ankle during a run and are concerned about whether it might be broken. The ROS on the other hand is an in-depth conversation and exam, the kind that happens with a new patient or a patient with a chronic ailment, such as diabetes, that can affect multiple organ systems. Neither makes for an obvious entry to talk about firearms.

This issue arose in Florida in 2011 when the legislature passed, and Governor Rick Scott signed, a bill that put physician inquiries about gun ownership off limits unless the inquiry is relevant to the patient’s medical care or safety. The text of the law in question is available here. The Florida statute was upheld in 2014 by a federal appeals court as a reasonable limitation on physician speech. By the way, we place all kinds of limits on physician speech: physicians cannot solicit sex from patients; they cannot make false claims about their “success” rates; they cannot solicit payment in excess of their contractual limits; they cannot threaten or intimidate patients; they cannot refer people to facilities in which they have a financial interest, without disclosing the same.

So, why is the restriction on asking about guns so important? Because the entire line of inquiry is politically motivated.

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