The patient-doctor relationship is inherently intrusive. It's an unfortunate, yet necessary part of the process. I can and do ask questions of complete strangers that I would not ask my closest friends. Understanding people's sexual habits, drug use, violent thought-content, and gun-ownership status helps me (a training physician) work with them to mitigate risks to their health. That being said, I understand that access to such intensely private information opens the door to abuse.
In my school's curriculum--and I'm assuming at other schools too--there's a significant push to refactor the patient-doctor relationship into one of partnership rather than authoritarianism. I hope that this change in culture empowers patients with greater agency over decisions made about their lives. But it would be naive to think that even now, as a student on the wards, there isn't some sort of power dynamic at play when I speak with patients. I meet people at some of the most vulnerable moments in their lives. If I wanted to push personal agendas onto my patients, it would not be so difficult. As such, I think its crucial that checks be established over what I can and cannot do with a patient's personal information. If I abuse a patient's trust, there need to be repercussions.
Ok, now that you know where I stand, lets turn to the matter of guns--specifically in Florida. As the law currently stands, physicians are explicitly prohibited from asking patients if they own guns. I think this is gravely mistaken. Guns are valued by many as powerful tools of self-subsistence and defense. If you live in the United States, it is your protected right to own and use these tools. But they are not without risks.
Lets say I'm interviewing a patient who discloses to me that at multiple times in the past he has intentionally harmed himself, at one point going so far as attempted suicide. Most of the time he feels happy and satisfied with the course of his life, but sometimes he's overcome with spontaneous self-loathing. He feels he must punish himself for the ways he believes he has hurt other people.
I harbor significant doubt that such a person should own a gun. Even so, you might still be able to convince me that it's not my business to ask this man to cede ownership of his firearm. But at the very least, I would want to ensure that he keeps that firearm locked and unloaded in a safe place. Yes, this might impede his ability to quickly defend against home invasion, but this is a matter where disparate risks need to be balanced against each other. It is very much within the scope of my role as a physician to problem-solve through such a situation with my patient. Sometimes even to report to authorities if I believe that he poses a danger to himself. Whatever my opinion on guns, my first priority is to keep patients safe.
Florida law does not allow for such moments of physician intervention. By prohibiting a conversation about guns, the state's legislators implicitly state that the risk of me violating a patient's privacy far outweighs any good I might do in helping him make safe choices. I think this is wrong.
This post builds off of a video blog post made by Aaron Carroll, a pediatrician practicing in Indiana. In many ways, I have echoed the sentiments of Dr. Carroll. However, I felt the need to write this because I don't think he adequately acknowledges the very real risk that doctors might abuse their positions of power to force their opinions about guns onto their patients. Doctors are a mostly well-intentioned bunch, but they (we?) also have very strong opinions about the right way to do things. Sometimes that means we overstep our bounds.
I don't want patients to blindly accept that I will do what's right for them. I need to earn their trust. That being said, Florida law would effectively cut me off from operating in a critical realm of their safety. That needs to change.