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As a resident in a training program for primary care physicians, I ask my patients all sorts of highly personal questions aimed at understanding what’s needed to keep them healthy and prevent future disease. I ask how often a patient moves her bowels, whether he has had unprotected sex or used illicit drugs, and more. I never asked my patients if they keep a gun in the home — until the Las Vegas mass shooting prompted me to start.

I work in Philadelphia. Like many other large American cities, it is awash in firearms. I don’t know exactly how many, since there’s no gun registry for the city. What I do know is the toll that firearms take on the citizens of my city. More Philadelphians are harmed by firearms each year than develop three of the most common types of cancer: breast, prostate, and colorectal cancer. In terms of deaths, guns kill as many of the city’s residents as breast cancer, colorectal cancer, sepsis, and renal failure, three times as many people as HIV/AIDS, and 30 times as many as the flu.


This isn’t a problem just for the City of Brotherly Love. Firearms are used to kill more than 30,000 Americans each year. More Americans have died from gunshots in the last 50 years than in all of the wars in American history.

Physicians and physician-in-training can all play a role in advocating for our patients on a policy level. But it can be challenging to understand what to do one-on-one with patients in the office.

The U.S. Preventive Services Task Force advises me to periodically screen my patients to detect various cancers early, when they are still treatable. I check their blood pressure and cholesterol levels in an effort to nip heart disease in the bud. I weigh them and ask about exercise in an effort to keep them fit and ward off a host of health problems. The disease and death numbers tell me that I should also be asking my patients about their exposure to firearms in the home or on the street. So I decided to do just that.


The goal of asking is simply to create a shared decision with a patient to reduce the possibility of harm from firearms, the same way I would approach any other potential health problem.

If a patient owns a gun for personal safety, as many do, instead of citing statistics about how bad guns are for someone who feels unsafe at home, I point out that children, criminals, and those at risk of suicide get their guns from people they know or from people who legally own them. Guns are often stolen. So I promote firearm safety by recommending that owners lock their guns and safely stow them away. If an individual who owns a gun wants to get rid of it, I suggest turning it in at a local police station or gun buyback program.

Since starting to talk with my patients about firearms, I’ve learned that most of them do not own guns, but that many know a loved one who was shot or have been shot themselves. For these individuals, I express my condolences and still share information about the prevalence of gun-related injuries and deaths in the hopes of correcting the misconception that firearm-related injury is a random act of violence that should be accepted as par for living in a city.

We all have a part to play in reducing deaths and injury from firearms. How physicians talk with their patients — those who own guns and those who do not — about firearms matters for the social norms that drive public health.

A recent Journal of the American Medical Association editorial challenges physicians to help prevent firearm-related injuries and deaths by talking with their patients about guns, and offers a script for doing it. “Ask your patients if there are guns at home. How are they stored? Are there children or others at risk for harming themselves or others? Direct them to resources to decrease the risk for firearm injury, just as you already do for other health risks. Ask if your patients believe having guns at home makes them safer, despite evidence that they increase the risk for homicide, suicide, and accidents.”

This script encourages physicians to think about firearm-related violence as the public health epidemic it is. And then take steps to prevent it.

Priya Joshi, M.D., is a third-year medical resident in the primary care internal medicine track at the Hospital of the University of Pennsylvania. After completing her residency, she will work for the Philadelphia VA Medical Center.

  • I applaud the two comments below. As a fellow physician, I find this attitude toward firearms that I am being intimidated by the medical community to perpetuate to be condescending and counterproductive. Be warned physicians are being brainwashed just as high school children are to believe and say this same rhetoric.

  • I know doctors receive all types of training for their craft. What mandatory training do you have in firearm safety and firearms use? I feel you should have some sort of professional training in order to lecture or instruct others about firearms. Especially people that own firearms and have received safety training. I was a police officer for 30 years the last 13 of which I served as the chief of police for two towns in New Jersey. I did normal law enforcement functions as well as management functions and issued gun permits as part of my daily duties. In my 30 years, serving in Pennsylvania and New Jersey. I saw more dead bodies related to drunk drivers, drug overdoses and domestic beatings than with any AR-15 , AK-47 or any firearm for that matter. Stick to what you as professionals have been trained in and certified for. 51 people a day die due in alcohol-related crashes. We don’t see marches daily about that or questions if I like to drink and drive. The recent shootings in Florida disclosed monumental failures of the FBI, local sheriff and local law enforcement as well as school officials that failed to report numerous incidents with the shooter. They should be held accountable for their inaction and negligence of duty. If a physician should lose someone on the operating table, we don’t outlaw scalpels. God knows the lawyers will hold the surgeon accountable for his or her own actions. Recently, I changed physicians. She did not know about my employment history, I guess she did not read too far into my file. She reviewed family health history as well as my health history. Then, she started about firearms. Little did she know I was a chief of police and a range master. She was very embarrassed when I told her my position and first-hand experience with firearms. I understood where she was coming from. Let’s face it, you became physicians in order to help people not hurt people. She was also shocked to know that I was carrying a firearm at that time. I said doc, a firearm is an inanimate object. When I walked in here, it did not jump out of the holster and shoot you or anybody else in the office. But I am ready to defend you, your employees and those in your lobby if a problem should arise. The good doctor laughed when I told her I was going to use it as an excuse for the extra 5 pounds I gained LOL. She is a wonderful doctor and we are very friendly, and respect each other’s views. She knew where I was coming from as a police officer by asking what she would do if someone that owned firearms and had specialized training came back at her with some very pointed questions about her ability and training to instruct about safe firearms keeping. I feel a better way of dealing with this matter would be to offer printed material from a reliable source that covers firearms safety, the safe-keeping of firearms and what the local laws are pertaining to firearms. I see pamphlets for diabetes, heart disease, cancer and many other ailments that take good people away from us everyday. Maybe something like printed material would be better. People are very guarded about their ownership of firearms due to the demonization that is taken place due to the press that often fails to tell the whole story. Again, what would you do if a patient asked you where did you receive your firearms training and do you have a firearm?. With all due respect, as a police officer I would never tell a heart surgeon how to do a bypass surgery nor would I expect a physician or anyone for that matter that never had formal firearms training or owned a firearm lecture me about firearm safety. Many of the “statistics” shown in anti firearm publications also include the shootings of bad guys by police officers, the shootings of bad guys by good law-abiding citizens that refused to become victims. Let’s face it, satistics can be bent anyway we want them to go. I’m just offering you my suggestion as a retired police officer, from south Philadelphia during my early career in the 80s and across the river in New Jersey as a police chief with a total of 30 years of experience with some suggestions that I think may help with these issues. Most importantly, information sharing with regard to metal health issues must be addressed. As a police chief, that was one of our biggest stumbling blocks. I wish you all the best, stay safe and thank you all for the life-saving efforts you take on every day.

  • Where, exactly, did you obtain your qualifications to discuss firearms? I spent 16 years as a soldier, 13 years as a cop, and have owned guns my entire adult life. There is NOTHING you can teach me about guns. If you tried to discuss this with me, I would tell you to stay in your lane, treat me for what I am there for, and mind your damned business. You have neither the qualifications nor the right to demand that I tell you what I have in my house as a precondition of treating my cold symptoms.

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