s 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.