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Do you ask your patients about guns?


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My entire beef with the original question, which may be considered legit if it includes questions about pool safety, poisons, bike helmets and a host of other potential dangers to kids, is that it was ONLY about guns which makes the question seem to imply a judgement. That was confirmed by the other part of the post and subsequent posts that were all about judgement. So it was never an innocent or neutral question.

 

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My entire beef with the original question, which may be considered legit if it includes questions about pool safety, poisons, bike helmets and a host of other potential dangers to kids, is that it was ONLY about guns which makes the question seem to imply a judgement. That was confirmed by the other part of the post and subsequent posts that were all about judgement. So it was never an innocent or neutral question.

 

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Guess your beef then is with AAFP.

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  • 2 weeks later...

I just realized how horrible of a provider I am.  I do not ask about pools, helmets, guns, if the kid ties their shoelaces, or eats candy for breakfast. 

 

Crap, I'll probably fail PANRE. 

 

You have no clue just how bad you are and just how much you are contributing to the failure of our healthcare system. ;) Left-wingers agree with me.  Points in case:

 

(1) Are you asking patients about how much money they make?

 

(2) Are you asking your patients about gender identity and sexual orientation?

 

(3) Are you disclosing that the medication you are prescribing has or has not been tested on women and asking women if they have an unusual vaginal discharge (because we routinely ask all dudes that, right?).

 

(4) Of course, interrogating your patients over firearms is simply standard of care (see last paragraph of first page about providers being held liable for violating "standard of care" for NOT asking about guns).  Really.  That is a Medscape article.  I'm not kidding.

 

If you are not asking/reviewing things things with your patients, then you are a failure and generally suck at being a provider.  And you might not get reimbursement in the future.  And you could get sued.  But you deserve it (unless you are a leftist radical who does not yet know any better).

 

I guess I suck as a provider. I live in an area where poverty is common.  BUT. GU discharge isn't.  And everybody has a gun.  And people aren't confused as to who/what they are. And where violence basically doesn't exist.  How confusing and perplexing is all that to the leftist?

 

I don't ask these things of my patients because I don't need to. This fact, of course, is quite curious and perplexing to those living in/raised in certain urban bubbles (who representing a small minority of the country), and whom know nothing else and can't comprehend a world different than their dysfunctional own.

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You also need to ask patients about their favorite color. If it's red, you need to make notes about follow ups because these patents typically own too many guns, abuse women, and don't want to pay their fair share of taxes. If it's blue, you have a very intelligent patient who knows exactly how to manage their own health care and everyone else's so you don't need to worry about them. If it's pink, watch your wallet. They want to pick your pockets and give your money to PA students so they can graduate with no debt. Who could be against that? These are often younger millennials who, as they age, will generally come to prefer red or blue.

 

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http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif

 

Looks like unintentional injuries are a leading cause of death for children. Maybe we should ask if parents if they have any unintentional injuries laying around the house and if they keep them locked up. We also need to promote legislation for background checks for unintentional injury purchases. Also ask if there are anvils sitting precariously from  shelves, banana peels on hardwood floors, and any dynamite that may be laying around the house. If we can save just one life...

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http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_age_group_2014_1050w760h.gif

 

Looks like unintentional injuries are a leading cause of death for children. Maybe we should ask if parents if they have any unintentional injuries laying around the house and if they keep them locked up. We also need to promote legislation for background checks for unintentional injury purchases. Also ask if there are anvils sitting precariously from  shelves, banana peels on hardwood floors, and any dynamite that may be laying around the house. If we can save just one life...

 

It is 100%, purely political.  Not even debatable.

 

Gun accidents occur.  But so do bicycle accidents. And car crashes (lost two young family members that way, including a kid). Knife sets in the kitchen. Hot stoves.  Electrical outlets. Swimming pools. Hot water. Ropes. Tire swings (lost a childhood friend in one who strangled to death).  4-wheelers (lost another childhood friend on one who was crushed when it turned over).  Power tools. Nuts, olives, hot dogs, mini marshmallows, hard candy. Inflatable castles at the birthday party that get blown away with kids in them. Small objects in the home that are choking hazards. The list goes on forever.

 

The AAP's obsession with guns (It's for the children!!!) is 100% politics. Until they start advocating that providers spend 1 hour with every parent at every visit lecturing them on every possible thing that can kill or maim their child, then singling out guns is indisputably politics.

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In all seriousness, if pediatricians had their way, kids wouldn't be allowed to have fun.  I recall when we had a pile of Kosovar refugees arrive at my base in 1999, the peds folks from the local general hospital were losing their shyte because we were keeping the little un's amused with inflatable chicken heads made of our exam gloves...if they'd been with me in Croatia a few years before, they'd have considered it the lesser of two evils, since my box of gloves and Sharpie kept an entire village of kids out of the beer cache we'd brought with us for a hearts and minds soccer match with the adults that day.  Those kidlettes could drink that beer like it was orange juice and still walk...

 

SK

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It is 100%, purely political.  Not even debatable.

 

Gun accidents occur.  But so do bicycle accidents. And car crashes (lost two young family members that way, including a kid). Knife sets in the kitchen. Hot stoves.  Electrical outlets. Swimming pools. Hot water. Ropes. Tire swings (lost a childhood friend in one who strangled to death).  4-wheelers (lost another childhood friend on one who was crushed when it turned over).  Power tools. Nuts, olives, hot dogs, mini marshmallows, hard candy. Inflatable castles at the birthday party that get blown away with kids in them. Small objects in the home that are choking hazards. The list goes on forever.

 

The AAP's obsession with guns (It's for the children!!!) is 100% politics. Until they start advocating that providers spend 1 hour with every parent at every visit lecturing them on every possible thing that can kill or maim their child, then singling out guns is indisputably politics.

 

Or, you focus on the top causes of injury/death to a child in the limited time you have, which includes MVA/seatbelts, suicide, pools, and guns

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I have a better idea - let's make parenting training and licensing a requirement...I'm supposed to license my dogs annually, I'm supposed to update my driver's license and registration annually and even take remedial driver training if I'm driving like a retarded ice cube; here we have to pass training in order to get a license to posess a firearm or a hunting license.  I need to update my license to practice annually as well.

 

Then, if all else fails, then we can ban swimming pools and cars.  Pity we just can't ban stupid people...

 

SK

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Or, you focus on the top causes of injury/death to a child in the limited time you have, which includes MVA/seatbelts, suicide, pools, and guns

"Since most violent crime is committed by males ages 16-24, the “13 children” number includes adult gang members dying during criminal activity.  The proper definition of ‘child’ is a person between birth and puberty (typically 13-14 years old) and in 2013 only 1 child was killed on an average day nationwide, or about 0.02 children per state per day."

 

Source: Center for Disease Control WISQARS Fatal Injury Reports for 2013

 

I think you should be looking elsewhere if you really want to save the children..

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"Since most violent crime is committed by males ages 16-24, the “13 children” number includes adult gang members dying during criminal activity. The proper definition of ‘child’ is a person between birth and puberty (typically 13-14 years old) and in 2013 only 1 child was killed on an average day nationwide, or about 0.02 children per state per day."

 

Source: Center for Disease Control WISQARS Fatal Injury Reports for 2013

 

I think you should be looking elsewhere if you really want to save the children..

The number of unintentional deaths by firearm ages 0-14 is actually 69 according to the CDC for most recent data (2013). See page 41 at below link. There were 8 deaths of undetermined intent with a firearm, so I'm assuming a few where suicide/homicide couldn't be ruled out.

 

http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_02.pdf

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  • 2 months later...

On more than a few occasions, the topic of guns comes up in my practice mostly about what to buy or who is selling one........ I'd say 100% of the households out in rural Alaska have firearms in them. Some patients actually ask to see the  S&W 500 I carry, when I come in after hours and there are bears roaming the area.....I can't recall the last gun suicide out in my villages but the heroin, booze, hangings, and drunk driving of ATVs or falling off of fishing boats drunk or high has taken a good number of folks.

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Given that Alaska consistently / continuously has the highest suicide rate among states in the US, how are Alaskans killing themselves?

Stumbling into shallow ponds while too drunk to avoid drowning, light plane into mountain while disoriented in fog, "shotgun cleaning" accidents, auto accidents on icy roads, DUI auto accidents, fell off a waterfall, drug overdose, self-inflicted AK-47 to the head...

 

That's not a statistical sample, that's just what happened to people I knew before I was done with undergrad and left the state.

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I'm on a gun forum and a recent thread on this topic is 12 pages long. Mostly people saying if their pediatrician asked about guns they would lie (to keep their name off any govt list) and then find another doc.

 

Would you be willing to lose a pt over this issue? What is the nnt?

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Given that Alaska consistently / continuously has the highest suicide rate among states in the US, how are Alaskans killing themselves?

Take note of my post. I see a lot of hangings and drug overdoses as the mode of exit. Guns do play a role , but I can only address what's gone on in the six villages that I've  encountered suicides in.

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Cleanest, quickest suicides that I used to pick up were .38 shots right into the heart. Minimal blood loss. Hangings are clean but difficult due to having to cut/get them down and then staring at the thick, protruding tongue with the traumatic asphyxia discoloration on top. Traumatic decapitations not terribly messy due to vasoconstriction of major vessels in neck. Somehow avoided drownings and total body burns over several years. I'm sure there were some drug overdoses as well but I don't have any immediate recollection of one. Jumping off a water tower is not a good idea.

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