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NRO reader writes to ask: "So, what do I say to my 5-year-old
daughter's doctor when she asks if there's a firearm in our home
(my daughter has an annual checkup fast approaching)? I do have
a registered handgun in our house, but my daughter doesn't know
anything about it. And, for now, I don't think she has to know.
I can certainly refuse to answer, right?"
The American
Academy of Pediatrics (AAP), under the prodding of gun prohibitionist
Katherine Christoffel, has developed a policy a strong antipathy
to gun ownership. A few weeks ago, the president of the American
Medical Association announced his determination to involve the AMA
deeply in anti-gun political and "educational" work. Both
groups are tied to the HELP (Handgun Epidemic Lowering Plan) Network,
a consortium of gun-prohibition groups. The AAP and AMA also have
working relationships with the Brady
Campaign to Prevent Gun Violence, which was formerly known as
Handgun Control, Inc., which in turn was formerly known as the National
Coalition to Control Handguns, which, despite its name, supported
handgun confiscation, with "control" seen only as an intermediate
step.
Both the AAP
and AMA advise doctors to probe their patients about guns in their
homes. Both groups urge doctors to persuade families that they should
get rid of their guns.
People in pain,
people fearing cancer, and people who are injured and weak are vulnerable.
They all look to their doctor to do right — right for the patient,
rather than for the insurance company, or for the doctor's view
of social policy. Doctors have a fiduciary relationship with their
patients. They are obligated to set aside personal agendas and put
the patient first. Putting the patient first means that the doctor
must respect boundaries in the relationship with the patient. So
when the doctor makes a pass at a patient, or tries to sell her
real estate, or lobbies patients against gun ownership, the doctor
is committing an ethical-boundary violation. Patients notice when
a doctor abuses their trust or takes advantage of their pain and
fear. [For more on boundary violations by medical professionals,
see Frick, D., "Nonsexual Boundary Violations in Psychiatric
Treatment," Review of Psychiatry, vol. 13, (Washington,
D.C.: American Psychiatric Press, Inc.), 1994.]
What recourse
do patients have when confronted with a doctor who asks politically
motivated questions about their gun ownership? All patients should
recognize that they have no obligation to answer such intrusive
questions. There are several levels of measured response available
to all patients, the consumers of health care.
First, the
patient can change doctors. No doctor wants an unhappy patient.
A politely stated objection to the doctor's boundary violation will
be a warning for most doctors, giving them serious reservations
about continuing such intrusive and improper questions.
Second, a patient
can write a complaint to the member-service department of the doctor's
health plan or HMO. The doctor will be required to respond to the
complaint, and it will force him to think through the consequences
of abusing the trust of his patient. In the furiously competitive
service industry of medicine, a patient complaint is a black mark
on the doctor's record. Patients not in an HMO can send the complaint
to their county medical society.
The third option
for patients whose doctors cross the line is to send a formal written
complaint to the doctor's state medical-licensing board. Boards
are increasingly attentive to allegations of unethical physician
conduct arising from boundary violations.
Another option
when the physician brings up firearms is to ask him to sign
a form certifying that he is qualified to give such counseling,
and will take responsibility for its consequences. Actually reading
the form may help a physician think twice about whether he really
ought to be telling people what to do about guns.
As with any
relationship with a person who provides professional services, addressing
a potential problem in a polite and friendly way is usually the
best initial approach, with formal complaints reserved only for
situations where a personal discussion cannot resolve the issue.
Medical-journal
surveys reveal that most doctors are instinctively wary of asking
their patients about guns in their homes. Many doctors understand
that firearm ownership is normal behavior in America and that many
Americans consider it a fundamental right. For example, a 1998 survey
of internists and surgeons revealed that even though a large majority
(87 to 94%) felt that firearm violence is a public-health issue,
only a tiny fraction (2 to 4%) said they frequently talk to patients
about firearms in the home. [Cassel CK, Nelson B. "Internists'
and Surgeons' Attitudes Toward Guns and Firearm Injury Prevention,"
Annals of Internal Medicine (1998) 128:224-30.] This may
be an indication that, despite a general concern about firearm injuries,
doctors do not see politically motivated patient counseling as appropriate
professional conduct. Thus, if your doctor starts pestering you
about guns, you should understand that your doctor is not typical.
Even many doctors
who do not personally own guns recognize the minefield of ethical
concerns they would be entering if they brought up the subject.
Most doctors also know that to taint this trusting relationship
with a pitch for gun control or any other political cause is unprofessional
conduct.
So the answer
to the reader's question is: Of course you can refuse to answer.
If a doctor asked you to list every sexual position you'd ever used,
or asked if you had any liquor in your home, or asked if you were
a Democrat, you would refuse to answer. "That's personal information
which I'd prefer not to discuss," is a polite way to terminate
the inquiry.
If you'd like
to educate your doctor a little, give him a copy of the recent article
"Physicians,
Firearm Counseling, and Legal Liability", from the Southern
Medical Journal, which explains the legal risks that physicians
run by attempting to tell patients what to do with firearms. If
you're feeling really generous, spend $5 to buy your doctor the
20-page booklet, Firearms: A Handbook for Health Professionals,
which summarizes the best contemporary criminology research on firearms
use in self defense. Call 909-621-6825 to order your copy. Operators
are standing by.
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