Doctors Should Talk to Patients about Firearm Injury Prevention

For years, we doctors have advocated to approach gun violence as a health care issue—with studies showing that public health strategies can be beneficial in preventing firearm injury similar to approaches taken for COVID-19, substance use and motor vehicle safety. We appreciate the unique position of the health care industry in being able to address gun violence from a purely apolitical, harm-reduction standpoint. And for those who wonder, most patients, gun-owning or not, are supportive of questions related to firearm injury prevention being asked by their doctors as they understand it relates to health.

But there’s one major issue: most health care workers still don’t talk to patients about firearm injury prevention. In many health care settings, questions and counseling about firearm safety continue to be taboo and fall well outside the umbrella of “routine care,” being reserved for high-risk patients like those who are suicidal or with perceived risk. As you can imagine, this targeted screening can introduce a significant amount of bias, judgment and stigmatization, which in itself hinders our ability to normalize conversations about firearm safety with our patients.

If we can figure out how to create normalcy in having firearm safety conversations with our patients—lessons learned would not only serve us well but would provide policy makers and organizations across the country valuable insight into how to depolarize, depoliticize and humanize conversations surrounding firearm injury prevention. After all, we in the health care lane have a one-of-a-kind opportunity to figure this out and succeed where others haven’t, with an approach that focuses solely on injury prevention and safety and has nothing to do with the second amendment.

So, what if we could systematically change culture across the health care industry to start thinking of questions about firearm injury prevention as part of routine care, no different than questions about other health risk factors like smoking, substance use, motor vehicle safety and drowning avoidance? We can. And a radical rethink of our approach—starting with universally screening and talking to all patients about firearm injury risk, regardless of why they are visiting a health care provider—may be the catalyst needed to make both doctors and patients more comfortable with this topic.

This type of universal “we ask everyone” screening strategy—which can serve to destigmatize, remove the pressure from health care workers to decide who and who not to screen, and normalize conversations as part of routine medical care—has successfully been used in public health approaches to other polarized issues, such as substance use and HIV.

“Hello, what brings you to hospital today?” says the doctor. “I’m here for my usual check-up,” the patient remarks. “Great, let’s start with routine screening questions to identify risk factors so we can discuss prevention if needed,” the doctor says. “Do you exercise, consume alcohol or other substances, and/or have access to a firearm inside or outside of the household?” “No, no, yes,” says the patient. “Okay, let’s talk about firearm safety,” the doctor says. Sounds simple, right?

Not really.

Firearm injury remains one of our nation’s leading unsolved public health crises, resulting in nearly 40,000 deaths yearly and hundreds of nonfatal firearm injuries daily, culminating in a tremendous burden of trauma and cost to our health care system. And there are data of health care–driven prevention strategies, including the benefit of doctors talking to their patients about firearm safety and resultant improvement in safe storage practices. So why are many doctors hesitant in discussing firearm injury prevention, while being able to discuss other sensitive topics such as substance use and sexually transmitted diseases?  

The truth is, we lack the research to fully know why. When it comes to health care settings, we know very little about how to normalize and humanize conversations about firearm injury prevention. We don’t have the data we need to inform us on the best way to have these conversations. Even without good quality research, there are a number of already evident barriers health care workers face when it comes to counseling about firearm injury prevention, including lack of education yielding discomfort; fear of offending patients; limited time for screenings; and inadequate resources to execute screening, counseling and the distribution of preventative strategies.

If we as a health care industry don’t take the time to comprehensively evaluate how to overcome barriers in approaching our patients about this sensitive topic, we risk not being able to practice what we preach. But if we figure out how to implement a universal approach in talking with patients about firearm safety, this could be a game changer in increasing doctor and patient comfort on this topic and yielding data on who, when and how to screen for injury risk.

Fortunately, the tide is changing. The perfect storm of federal funding for firearm injury prevention research, health care industry momentum and a staggering level of gun violence in this country may be the recipe needed to empower doctors to ask and counsel every patient about firearm safety and gun violence risk as part of routine health visits. Of the utmost priority, we need to work diligently, with gun owners, survivors and community-based organizations alike, to develop culturally competent education and intervention strategies geared towards normalizing and humanizing health care conversations on firearm injury prevention.

If we want to make true progress on gun violence prevention from the health care lane, we need to be able to talk to patients about it. Being able to ask the questions in the first place is an essential starting point for any public health approach. We’ve made progress, but there’s a lot left to do. The country is finally behind us in supporting a public health approach to gun violence prevention. If we succeed in normalizing and depolarizing conversations about firearm injury, this will have a rippling effect across sectors, lending further weight to our argument that this is a public health issue. Let’s make sure we get it right.

This is an opinion and analysis article.

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