Do you ask your patients about guns?

[rev ronin]

So let's do a bit of tongue-in-cheek database query work here.  A couple of assumptions:

1) All EMRs will eventually go national, data interchange everywhere,

2) the controls in 1) will be inadequate.

3) All mental health records will be cross-referenced to the National Instant Check System.

4) While currently prohibited by law, it's entirely likely that the extant NICS data destruction policies are inadequate, and a complete record of every NICS-mediated sale exists or can be reconstructed.

 

So, when The Powers that Be can cross-reference lists of people known to have purchased guns at one point (NICS) with people who answer questions on firearm ownership, what does it tell us?

 

Known to have guns, says they have guns?  Probably have guns.  Good place for a burglar to target, but also likely to turn their guns in when required by law.

Known to have guns, says they do not have guns?  Straw purchase, maybe?  Or liars.

Known to have guns, does not answer the question? See above, but also possibly to be right-wing domestic terrorists.

Not known to have guns, says they have guns?  Probably have guns, but got them through non-licensed dealers.  Maybe right wing domestic terrorists, or people who just inherited guns without needing to go through a dealer, whichever.

Not known to have guns, says they don't have guns? Probably don't have guns.

Not known to have guns, does not answer the question?  The most likely group of all to be domestic terrorists--they've been careful to conceal their firearms acquisition, but then tip their hand by being so principled they won't lie to their doctor.  Definitely Timothy McVeigh types.

 

More direct to the point and requires a lot less assumptions: criminals are stealing medical records, which include both the answers to the "do you have guns?" question and the recipient's home address.  Ooh, they also include demographic and health information.  So, once you have an EMR's data pile, it's trivial to find all those >65 years old who live alone and admit they have firearms for robbery targeting purposes. Or just for scam purposes--I can zero in on widows who might have guns who could be persuaded to sell them (defrauded) for far less than market value or to an ineligible recipient.

[Boatswain2PA]

Rev - Now you're just being ridiculous.  At no time, ever, in human history, has any government ever gone through such lengths to disarm their citizens.

 

Right?!??  

[medic25]

 

More direct to the point and requires a lot less assumptions: criminals are stealing medical records, which include both the answers to the "do you have guns?" question and the recipient's home address.  Ooh, they also include demographic and health information.  So, once you have an EMR's data pile, it's trivial to find all those >65 years old who live alone and admit they have firearms for robbery targeting purposes. Or just for scam purposes--I can zero in on widows who might have guns who could be persuaded to sell them (defrauded) for far less than market value or to an ineligible recipient.

 

I have a hard time figuring out what type of antibiotic my patient received during their last admission; if your band of roaming bandits/EPIC help desk consultants is able to data mine the EMR with a multiple-variable search to identify the homes of gun owners >65 who live alone, then I'd say they've earned it!

 

Of course, grandma is safe at home because she's packing her Desert Eagle, right?  I'm thinking the EMR bandits would be smarter targeting the old lady who's getting 240 tabs of dilaudid a month and has a medicinal marijuana card; better ROI  ;-)

[Boatswain2PA]

Medic - enough money thrown at it and the computer world could do it. This is the entire purpose of ICD 10.

 

Who would spend enough money? Bloomberg.

[PAMEDIC]

My parents and grandparents enjoyed more freedom than I do. Why was this given up? For what?

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Interesting. My parents and grandparents had far less freedom than I do.

[rev ronin]

Of course, grandma is safe at home because she's packing her Desert Eagle, right?  I'm thinking the EMR bandits would be smarter targeting the old lady who's getting 240 tabs of dilaudid a month and has a medicinal marijuana card; better ROI  ;-)

Little old ladies don't tend to have DE's.  They tend to have quickly fenceable assets in jewelry and firearms.  Their firearms are often higher end, old, and acquired by deceased husbands.  Very rarely are they used for self defense; using a gun requires three things: a gun, a will to use it against another human being, and the training necessary to do so effectively.

 

As far as folks being targeted by drug thieves?  All my chronic opioid patients are now getting their meds via delivery pharmacy.  Without worrying about hacking, I've had poor auditory privacy in local pharmacies result in my patients being followed out to the parking lot and accosted ("Can I buy some percs off of you, man?"), thankfully without violence so far.

[rev ronin]

if your band of roaming bandits/EPIC help desk consultants is able to data mine the EMR with a multiple-variable search to identify the homes of gun owners >65 who live alone, then I'd say they've earned it!

You're comparing apples and oranges.  They don't get the EMR front end, with its business logic, they get the underlying database, or an export from it.  While you have trouble getting real time data out of it, (and join the club!) it's actually pretty trivial to use search tools on an entire large database to get a single subset with multiple data points in common.  EMRs are designed to not LET you do that sort of thing, but the underlying database doesn't care what your business or audit rules are: it just serves up the numbers you ask it for.

[CAAdmission]

Interesting. My parents and grandparents had far less freedom than I do.

 

My dad used to be able to bring a 22 rifle to school (in NJ) leave it in his locker, and shoot cans in an abandoned quarry after school. Today if kids even try to play cowboys and indians they get jammed up to go through sensitivity training because it is violent and politically incorrect.

 

When someone in my father's generation got in minor trouble, the cops would smack you on the head, drive you home, and talk to your father (who would likely again smack you on the head.) Today, you are going to jail and getting a record.

 

When I had a problem with a school bully, I eventually said enough is enough and punched him in the throat. The problem ended. Today this would lead to expulsion and/or a courtroom.

 

We used to be a society where someone could oppose evil and be seen as a hero. Today such people today are violent/right wing/politically incorrect or whatever. The expectation is that you call the government to help you and expect them to arrive deus ex machina.

 

 

Half of this country has sadly been deluded into thinking that we can somehow legislate and regulate people into happiness, common-sense, kindness, safety or whatever. Half of this country has become so weak it has lost the ability to stand up for itself and needs the government to step in as a surrogate daddy to provide food, shelter and protection. We were a country built by rugged individualists who carved a society out of a wilderness. We have become a bloated, helpless, decaying stink pile.

 

My firearms are extremely safe unless someone tries to force entry into my residence. If they do so, the police are only going to be hearing my side of the story after the smoke clears.

[cbrsmurf]

Also in the past, we could smoke wherever we wanted, whenever we wanted.  Stupid gov't keeping us from smoking in restaurants and hospitals and forcing cigarette companies to put warning labels on their products.

 

times change.  mass shootings didn't happen frequently years ago, but they are now.  laws and mores change.  we can pine all about how things were this and that in the past, but it only leads to stagnation.  the issue is whether we should advise our patients to be safe.  Sometimes there will be a conflict between public health and personal rights.  asking whether there are firearms and firearm safety/training at home is NOT an infringement on personal rights, in my opinion.

[JohnnyM2]

 

 

I ask the child directly what they would do if they found a gun in someone's house - I ask right in front of a the parents. The overwhelming majority of kids say they wouldn't touch it and they would go get an adult.

 

Most kids tell me that if a friend took out a gun at their house when they were visiting that they would be uncomfortable and worried about a bad accident. One said he would just leave.

 

So, Kids AREN'T STUPID and we need to talk to THEM like people and not just adults. They get it most of the time.

 

I DO NOT believe automatic and high round weapons should be in the hands of civilians.

I wish I could put my hands on a TV program I saw some years back. It was about teaching kids about guns. In the video, a police officer spoke to a small group of children about gun safety. He told them, among other things, that if they ever saw a gun, they should not touch it and should immediately go tell an adult. The kids were able to repeat this information back to the officer and tell him what they would do and why. The police officer then left the room and a closed circuit camera continued to video the kids playing. After a short while one of them found a fully dysfunctional gun that had been planted in a toy box. The kids discussed getting an adult and not touching the gun. It didn't take long, however, for them to begin handling the weapon. Eventually, they took turns shooting each other. So, I doubt your instructions would do much good as their intentions are as short lived as their attention spans. People with children, or who have children visiting, should keep their guns locked up.

 

You are entitled to your opinion that civilians should not have high capacity magazines or semi-automatic weapons. The constitution guarantees you that right and you can shout it from the rooftops. I personally believe you should have that right. Fortunately, the constitution also guarantees the right to bear arms and says that guarantee "shall not be infringed." Using your reasoning, one could assert that no one should have a car that can go faster than 75 mph; that no one should have more than a few bottles of spirits in their house or any number of other things.

 

It's unfortunate that bad things happen to people, especially kids. But they do, for any variety of reasons. You can't remove every danger and blaming guns just isn't helpful. Nevertheless, I will defend your right to disagree.

 

 

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[JohnnyM2]

And, why, might I ask, is our government so completely evil?

 

Do we not have running water, electricity, homes, schools, the ability to be PAs and many luxuries and freedoms not afforded in other places around the world?

 

Yep, there are things that are a pain in the butt and things that are stupid - but - we are pretty dang lucky and blessed to have what we have.

 

So, why the hatred?

We have all those good things because of that outdated constitution which limits government and allows for individual freedoms. If we throw it out, you will live in Russia, or Europe, or, perhaps, worse. Sorry you don't get it. Try reading the writings of Justice Antonin Scalia for some guidance.

 

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[JohnnyM2]

Why are you reading "hatred" into anything I write? I love my nation, and I served it for 20 years in uniform.

 

However I know that my government is as inefficient, and politically driven, as any organization on the planet (with the possible exception of the UN)

Rev Ronin recently asked for more civility in posts. This thread was contentious but civil until the word "hatred" was used to discount dissenting opinions. You are entitled to your opinions, RealityCheck, but you lost the argument when you threw out The Constitution.

 

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[Boatswain2PA]

Single biggest killer of children worldwide in past 100 years? Governments who had strict gun control (Nazi Germany, Stalinist Russia, Maoist China).

[medic25]

Single biggest killer of children worldwide in past 100 years? Governments who had strict gun control (Nazi Germany, Stalinist Russia, Maoist China).

That's quite the leap my friend; my vote would have been for diarrhea or malnutrition but I'd love to see your stats. Straw man hardly covers it.

 

By that logic kids should be safest in a country like Somalia with no government control over anything.

[Boatswain2PA]

And when the government has all the guns, they have complete control - including of who gets food and water.  Much of the starvation in the world isn't from lack of food, it's from lack of food distribution.  Much of the lack of food distribution is caused by government incompetence.  Oftentimes, in areas with rampant malnutrition, the people who get fed are the people with guns.  In Somalia there is no NATIONAL government, but there certainly are tribes that fill the role of local governments.

National holocaust memorial says 15-20 million people killed by Nazis.

There were a RECORDED 3 million people killed by the Stalinists, with best estimations of up to 60 million people killed - many were starved (back to the no guns often equal malnutrition)

 

The Mao regime killed approx 75 million people, many of them by starvation (government people with guns came to town and took all the food).

 

Of course, no good data on how many of these 150 MILLION people killed by JUST THREE GOVERNMENTS were children, but since children are at the greatest risk of starvation it is probably safe to say that children suffered a greater proportion of deaths.  

[gbook]

I'm just jumping in as a newbie, but I can't see how it would hurt to ask about guns in the home, or at least remind the parents of safety. For new parents, reminding them of any possible dangers to the kids is good, however you do it.

 

Maybe not asking them directly if they have guns, but phrasing it as "If you have any firearms, make sure they are locked up." It's the same thing as any safety suggestion... especially the things that pediatricians see in their office all the time and know to avoid them: "Keep cleaning chemicals out of reach, as well as matches, knives, tools, etc. If the baby has a 2 year old sibling, try not to leave them alone together. Don't let them play with coins, or beads. Keep your eyes and arms on them if you sit them on the bed. and so on"

 

It can't hurt to hit the high points of safety. Personally I don't have guns, I have powertools. But I wouldn't mind at all if someone reminded me to keep them unplugged and locked.

[GetMeOuttaThisMess]

Hey Rev or any other mod, how about we shut this one down.  All I was looking for was a simple answer as to whether or not folks made such an inquiry?  Now this thread is all over the place.  The answer that I have obtained is that the overall thought process is very similar to those on the GlockTalk thread.  Very well stated post just above this one though.  This is similar to how I handled the question.

[JohnnyM2]

I'm just jumping in as a newbie, but I can't see how it would hurt to ask about guns in the home, or at least remind the parents of safety. For new parents, reminding them of any possible dangers to the kids is good, however you do it.

 

Maybe not asking them directly if they have guns, but phrasing it as "If you have any firearms, make sure they are locked up." It's the same thing as any safety suggestion... especially the things that pediatricians see in their office all the time and know to avoid them: "Keep cleaning chemicals out of reach, as well as matches, knives, tools, etc. If the baby has a 2 year old sibling, try not to leave them alone together. Don't let them play with coins, or beads. Keep your eyes and arms on them if you sit them on the bed. and so on"

 

It can't hurt to hit the high points of safety. Personally I don't have guns, I have powertools. But I wouldn't mind at all if someone reminded me to keep them unplugged and locked.

Agreed. It can't hurt and I don't think anyone here would tell you it shouldn't be done. Just be aware of the downside. Reminding parents to keep rat poison locked up probably wouldn't raise any hackles but, as you can see from previous posts, gun ownership has become so politicized by folks who want to throw out the second amendment that the issue, understandably, brings out a lot of distrust.

[Boatswain2PA]

I don't get why people always want to shut down conversations. Everyone, even those with greatly different ideas, is being professional and courteous to each other.  

 

If you don't like the conversation, then don't be part of it.  If you don't want to ask questions about guns, then don't.  If you DO want to ask questions about guns, then do.

[GetMeOuttaThisMess]

Most of discussion has been a thread hijack. It isn't a political question, only a health screen question.

[rev ronin]

There are really two issues here, and I'm as guilty as anyone else of chasing the rabbit trail on the topic:

 

1) Is it a good idea to remind our patients to keep any guns they may have safe and locked up when not under the immediate, direct control of a responsible adult? Absolutely!  Thanks, gbook, for highlighting that.

 

2) Is it a good idea to record patients' answers to questions on gun ownership in the medical record?  I don't think so because the potential harms outweigh the benefits, while several other posters disagree.

 

This should never have devolved into a discussion of gun rights, the second amendment, and the like.  While we can argue over that one ad infinitum, nothing we do in our exam rooms (asking) or EMRs (recording) are ever going to change based on those conversations.  This goes beyond how we, as PAs, keep our patients safe.

 

However, it would be inappropriate of me to shut the thread down as I've also participated in it.  I'll ask the other mods to give folks another day to make closing statements as they desire and then close the thread... or sooner if they see fit.

[medic25]

Everyone, even those with greatly different ideas, is being professional and courteous to each other.  

 

 

One of the things I've always loved about this forum; with the occasional exception, it is generally a very professional discussion.  Even though we may have vastly different opinions on some big topics, I'd still very happily sit down with B2PA and Rev, enjoy a cold one, and swap a few war stories.

 

Back to the OP's topic, if I practiced in pediatrics I would ask my patients about guns in the house, just like I'd likely ask about car seat use and smokers in the house.  Thankfully I'm an EM guy, so I get to skip a lot of the preventative care stuff.   My gun questions are typically "how many shots did you hear?" and "how close was the shooter?".  We had yet another GSW at work yesterday and my mind actually drifted briefly to this thread :)

[AliB]

I'm currently a student, and I'd like to chime in here.  

 

While this thread has gone on tangents, overall, it has been thought provoking.  There are other threads on other controversial, highly polarized subjects.  I appreciate that almost every one of them has made me consciously re-evaluate my thoughts on the subject (even if I don't change my mind about my own stance).  Reminds me to keep an open mind and stay aware of the bias that exists in all of us - providers and patients.  

[ventana]

only if one is pointed at me.................

[sk732]

I don't know about you, but questions like "How's your ED going?", "Are you still beating your spouse or getting beat up by them?", "Are you sexually active?  With men, women, all of the above and or if none of the above please state?" or "Hey, how's that heroin habit/personality disorder/case of acute on chronic loseritis you're suffering from doing?" are considerably more intrusive than "Hey, how's your Zombie Apocalypse gun collection doing these days?  You showing the kidlets what to do/not to do with them?".

 

If you're worried about some Matrix spook finding out, use personal shorthand that you can identify and defend if need be or have a little code somewhere that shows gun owner vs gun nut vs no guns in house.  Place I used to work, since it was a farming area, so I was surprised if there WEREN'T any firearms in the house and would often ask why not.

 

If you're collecting data to satisfy some admin loser who couldn't make it in clinical medicine, well that's another story altogether - suggest (politely or not so politely) that they leave the big boy/girl games to those that actually play them.

 

SK