Should Docs Talk to Patients About Gun Safety?

This transcript has been edited for clarity. For more insights on physicians’ opinions about gun control, see this Medscape report.

Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine, where I run the Division of Medical Ethics.

Sadly, I don't have to remind viewers that we have seen an explosion of gun violence in the United States over the past year, and it really is worse than it was even 4 or 5 years ago. Children have been obliterated at a number of schools. There have been attacks on grocery stores and churches and, as many of you know, in hospitals and clinics. In Tulsa, Oklahoma, an angry patient went and shot a surgeon and others because he felt unhappy with his orthopedic back surgery. There have been many violent outbreaks against healthcare workers in many other places around the United States.

This has led to all kinds of debates, as we all know, about what to do about guns. Should we ban assault weapons? I lean toward thinking that probably is good policy. I understand fully it's a policy that we're not going to follow.

There are areas, though, where I think we could get agreement and get legislation at the state or federal level. One area is discussion by doctors about guns. Remember, most people killed and harmed by guns are suicide victims. Another significant group are children, where data show that it looks like the biggest cause of death for those under age 18 years is no longer car accidents or other diseases.

It's guns. I think all doctors — pediatricians and others — do have an obligation to talk about guns with their patients. There are a number of key questions I think they should be asking. There are 400 million guns in this country and many of the deaths that are taking place are due to improper storage, carelessness, and not talking to kids about what to do if they see a gun.

I'm fully aware that many of you have no time to talk about much of anything with patients. I hear complaints all the time that you've only got a few minutes and have to prioritize the ailment or problem that brought the patient to your care so that you can address that.

If you do have more time, I would urge some discussion of safe gun storage. Is there a gun in the house? Do you keep it locked? Do you keep it in a place where kids can't get it? Do you ask about whether the kids' friends have guns and whether they keep them safely stored?

Are you in a situation where you can talk to your kids about what to do if they see a gun — don't touch it — who they should notify and who they should tell? Those are all very important questions for gun safety. They may not stop a mass shooting at a church or an elementary school, but I think they go some way toward trying to reduce harm from guns.

The other major thing that we need to be thinking about very hard and weighing in on is that guns are a public health problem. I've seen too many discussions from emergency room and trauma docs saying that these automatic weapons are so powerful that when they're shooting children, they destroy them. You can't even recognize them anymore. These are weapons that make it very, very difficult, if you will, to repair wounds. If you get shot as a 60-lb or a 70-lb kid, you're going to die.

Doctors, I think, have an obligation to weigh in about the cost of doing nothing about gun policy — not trying to, if you will, ask for background checks, but trying to have laws that require reporting when people worry that someone might be violent and better mental health, surveillance, and education. Again, these are incremental steps, but we might be able to get them through if we really watch the toll attributable to gun violence.

What happens in terms of deaths, maiming injuries, time in the hospital that is taken up with trying to care for extremely badly injured people? The threat that these weapons pose to healthcare providers? The worry and fear that they instill if you're working in a place where you shouldn't have to worry about such things?

I do think there's a frontline role conversation, when you can do it, and a public policy role, just by saying, "Here are the deaths, here are the injuries, and here's the fear. These are the reasons we need to make some incremental progress on reducing gun violence."

That, I think, is the responsible stance to take. I don't think we're going to get bans. I don't think people are going to be asked to turn in all their weapons. That's not the United States. We can take some small steps, and I think healthcare, medicine, and nursing can step in and help us.

I'm Art Caplan at the Division of Medical Ethics at the NYU Grossman School of Medicine. Thank you for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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