jsfelder0417 Posted January 18, 2013 Share Posted January 18, 2013 Asking if there is a gun in the home is denying someones rights? You may not see them for a psychiatric issue, but the provider requesting records from you might.... **added** and before anyone jumps on my case, I have no plans to have a gun in my home, but if my neighbors want to have legally obtained firearms with proper permits that's their choice No, I was alluding to what NY has done vs. the President. In New York firearms will be CONFISCATED from those that Psych sees fit. I don't know if it is on a single providers recommendation, or if the issue goes in front of a panel. Anyway, that is the one that I am wary of. If it is based off of the recommendation of a single provider, what is to stop someone that has a personal bias against firearms from disarming every pt they see? Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 18, 2013 Administrator Share Posted January 18, 2013 Understand that if gun ownership is in the medical record, then that creates an incentive for criminals to break into EMRs in places where the ownership of firearms is not public record. The one reason more EMRs aren't hacked into is that they generally don't contain anything of commercial value--most computer crime is motivated by illicit financial gain. Link to comment Share on other sites More sharing options...
Just Steve Posted January 18, 2013 Share Posted January 18, 2013 Understand that if gun ownership is in the medical record, then that creates an incentive for criminals to break into EMRs in places where the ownership of firearms is not public record. The one reason more EMRs aren't hacked into is that they generally don't contain anything of commercial value--most computer crime is motivated by illicit financial gain. EMRs carry birthdays, social security numbers, identifiers of familes who have vulnerable kids for easy targets, blackmail info (ie:STI from affair), there is large financial gain to be made by having access to all that personal information. Never mind the fact of the billing office having credit card numbers no such. In my opinion, the fear of a new onset of EMR hacking based upon the possible documentation of gun ownership is pretty far fetched. Especially when I can hang out a sporting goods store, observe who is buying my favorite caliber of bullet, follow them home and case their house. Or hang out near the parking lot of a local gun range, sign up for a shooting club, etc etc...very easy to find out who owns what sort of weapon just by observing their habits from afar. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 18, 2013 Share Posted January 18, 2013 Abortion kills and has killed more defenseless children than all the shootings combined. And yet it is promoted and considered a right. Strange I never see children in the commercials or ads , demanding preservation of "Pro Choice Rights" but they seem to be the focus of the current movement to protect them from harm. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 18, 2013 Share Posted January 18, 2013 Can anyone cite an example of these mass killings using a gun , that the person responsible was not previously identified as being........."odd" / mentally ill? Why didn't mental health /illness issues rank as a priority in addressing "gun violence"? Link to comment Share on other sites More sharing options...
d2305 Posted January 18, 2013 Share Posted January 18, 2013 When they closed most of the state mental hospitals, most of the paranoid schizophrenics now are on the streets. If they're having a bad day, they might end your life. Link to comment Share on other sites More sharing options...
drholmes Posted January 18, 2013 Share Posted January 18, 2013 What never ceases to amaze me is how many people seem to forget the principles that the United States of America are founded upon. It is us, the citizenry of this nation, that determines how they wish to be represented. During the interim determinations of this representations we publicly debate and discuss the issues and let our representatives know what our needs are. The original design was that most of this discussion/representation would happen at the level of the community, then the states, then (if necessary) the Federal level of government. For the President of the United States of America to assume that a national debate (asserting here that only a Federal solution will fix this) is necessary to come up with a "final solution" is arrogant and misguided based on our Constitutional principles. We have all seen what "final solutions" have produced by looking at what used to be taught in grade school. As far as insinuating that it is a medical providers responsibility to ask and/or record information about gun possession is far-reaching if not out of context of the care of the generalized patient. Mental-health issues, child safety/abuse issues, known history of violence, etc are appropriate areas for such questions. Having said that, discovering such information should be up to the individual providers medical judgement to ask (let alone record) for such information. We are all trained, are training, or will be trained to be medical professionals with the ability to judge the appropriateness of care for a particular patient. Why are we going to suddenly let someone else tell us our judgement is no longer sound and dictate how we are to make those judgements? Ask any Emergency Department provider about the inherent problems with EMTALA legislation! (as a small example about legislative mandates) It was not the intention of the formation of this country for our representatives to legislate from within a vacuum. We should not expect to practice medicine within one either. Public debate is essential for a healthy Constitutional Republic. Back to focusing on the issue of guns: Don't send me through appropriately credentialed and approved training and then dictate to me specifically how I will practice medicine (yes, I am aware some of that necessarily or already exists). Don't assume that your needs in Chicago, Washington DC, etc are the same as mine in North Carolina or Kansas. And, please do not try to forcibly pry my previously stated and drafted Constitutional rights (including the right to bear arms) while I yet have capacity to exchange air with the environment. Link to comment Share on other sites More sharing options...
jsfelder0417 Posted January 18, 2013 Share Posted January 18, 2013 ^Right there, folks. That is my take. Link to comment Share on other sites More sharing options...
Hemegroup Posted January 18, 2013 Share Posted January 18, 2013 Yup, I do. So ask it, if you decide your role is to be The shield of safety for kids. And ask whether or not there are pediphiles, alcoholics, drug addicts in the home. Two issues, the nanny state mentality of doing this, and The recording of having done it. If you do ask it, I would suggest keeping it off te official record... After all, if it is only for you and your zeal in protecting kids ( either parent ever had a DUI?), then merely keeping that info off he official record impedes.. Who? The answer is of course whomever it is that really wants the data.. The American academy of pediatrics, and any governmental organization which may decide this info warrants "prophylactic action" Got a swimming pool? Use sharp knives in the kitchen? How many hours a day is tv watched? Any climbing of trees? Where does it stop? Again.. Two issues: nanny doctors and Nanny doctor documentation. The first, tho intrusive, can be acceptable if the interest is truly and solely imparting safety info to the family, and not acting as a police state, or trying to enforce anything... The second is fraught with danger from the state. See the difference? Incidentally, most people say no. I plunge on ahead with the same little lecture about locking and safety regardless. Where does it stop? When I die as a provider, I suppose. Because yes, I DO ask about climbing, and swimming pools, and drinking in the home, and anything else I can think of or that the parent brings up. Paranoia will only get you so far, then it becomes boring ... it's not about you, it's about public responsibility as well as being responsible to the public in helping them get there. Link to comment Share on other sites More sharing options...
68W2PA Posted January 18, 2013 Share Posted January 18, 2013 What never ceases to amaze me is how many people seem to forget the principles that the United States of America are founded upon. It is us, the citizenry of this nation, that determines how they wish to be represented. During the interim determinations of this representations we publicly debate and discuss the issues and let our representatives know what our needs are. The original design was that most of this discussion/representation would happen at the level of the community, then the states, then (if necessary) the Federal level of government. For the President of the United States of America to assume that a national debate (asserting here that only a Federal solution will fix this) is necessary to come up with a "final solution" is arrogant and misguided based on our Constitutional principles. We have all seen what "final solutions" have produced by looking at what used to be taught in grade school. 1) Way to work in the Nazi reference. Godwin's law never fails. 2) Where on earth did you get the idea that the POTUS thinks only a federal solution should be proposed? You really think he is opposed to state, county, and local ordinances? So if a state passes an AWB or some new training and registration program, you think he would be angry or something? As far as insinuating that it is a medical providers responsibility to ask and/or record information about gun possession is far-reaching if not out of context of the care of the generalized patient. Mental-health issues, child safety/abuse issues, known history of violence, etc are appropriate areas for such questions. Having said that, discovering such information should be up to the individual providers medical judgement to ask (let alone record) for such information. We are all trained, are training, or will be trained to be medical professionals with the ability to judge the appropriateness of care for a particular patient. Why are we going to suddenly let someone else tell us our judgement is no longer sound and dictate how we are to make those judgements? Ask any Emergency Department provider about the inherent problems with EMTALA legislation! (as a small example about legislative mandates) It was not the intention of the formation of this country for our representatives to legislate from within a vacuum. We should not expect to practice medicine within one either. Public debate is essential for a healthy Constitutional Republic. Back to focusing on the issue of guns: Don't send me through appropriately credentialed and approved training and then dictate to me specifically how I will practice medicine (yes, I am aware some of that necessarily or already exists). Don't assume that your needs in Chicago, Washington DC, etc are the same as mine in North Carolina or Kansas. And, please do not try to forcibly pry my previously stated and drafted Constitutional rights (including the right to bear arms) while I yet have capacity to exchange air with the environment. I think you misunderstand something here. The recent executive order doesn't take away a provider's judgement. In fact it protects it. It is quite explicit: "16. Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes." He is saying that providers do have the right to ask about gun ownership if they feel it is clinically relevant. He is clarifying that the Federal government has not prohibited this line of inquiry and wants to assure providers that they are empowered to ask these question. It should also be pointed out that it doesn't require these questions be asked, either. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 18, 2013 Administrator Share Posted January 18, 2013 EMRs carry birthdays, social security numbers, identifiers of familes who have vulnerable kids for easy targets, blackmail info (ie:STI from affair), there is large financial gain to be made by having access to all that personal information. Never mind the fact of the billing office having credit card numbers no such. All of those things require *work* to exploit. That's why you see more hacking of automated payment clearinghouses. The difference with guns is that there is no other centralized way--for most of the country--where that information is at all centralized. As gun restrictions go up, however, the benefit to hacking such info does as well. South Africa has seen police officers ambushed and murdered for their handguns, since they have such tight controls... Link to comment Share on other sites More sharing options...
Just Steve Posted January 18, 2013 Share Posted January 18, 2013 All of those things require *work* to exploit. That's why you see more hacking of automated payment clearinghouses. The difference with guns is that there is no other centralized way--for most of the country--where that information is at all centralized. As gun restrictions go up, however, the benefit to hacking such info does as well. South Africa has seen police officers ambushed and murdered for their handguns, since they have such tight controls... Life in South Africa is a far cry from life in the US. It is comparing apples to oranges. True, there isn't a convenient data base...unless of course the local paper decides to post the name and address of all Concealed Weapon Permit Holders in your local area, like the NY paper did. It doesn't take two brain cells to assume that those CCW holders have guns in the house. One of the main driving forces behind crime in our nation is the procurement of mind altering drugs. There are a lot of nefarious people who would love to get their hands on large stashes of narcs either for their own use, or for selling. Rightfully so, these meds are some of the most regulated, controlled, secured items we have in medicine (which isn't saying much). With the street value going about $1 per milligram of oxy, there is easy money to be made in finding out who gets their narcotics when. With some simple math you can quickly deduct how much profit there would be in visiting any number of houses and making off with the patient's month refill. The perp can even reduce the risk of your sneaky visit by only visiting homes that they know, from their health record, have the lowest number of occupants. Or occupants who are otherwise unable to ward off an attack. Imagine the cash that can be scored when not only do you make off with Grannie's narcs, but also her gold, diamonds, and whatever else you want. The perp knew that Grannie is an easy target because they saw she lives independently, hard of hearing, has poor eyesight and is visited by her family only every couple of days. Did I mention the bad guy also knew she takes a sleeping pill and probably won't even awaken during their visit? I don't need a major database to find out who uses what size of ammunition, which would indicate who owns what style of gun. Again, I can sit for a day at the local ammo depot (sporting good store) and see who owns what. The perp can't sit at the pharmacy and see who gets narcs. The transaction between the pharmacist and the patient at the pharmacy window is a much more private affair. There is no easy way to find out of Grannie is picking up Senekot or Exalgo. I agree with you, the computer systems takes work to exploit. These are blue collar criminals who I doubt would have the knowledge to even begin to figure out how to hack the medical computers. They are not dumb, they just use their minds in different ways. I back this up with my example above...there has always been a plethora of data in the medical records that would benefit bad guys if they decided to hack into them. Adding the documentation of the possible presence of guns is not going to be enough incentive for these yahoos to begin attending "Hacker 101" courses. They are going to go down to the local bar, chat up the patrons, buy them a round, get to chatting about guns and/or gun control and Viola! The perp knows that Larry the Lumberman has an AR, XD, and a Taurus Judge because guys feel so compelled talk about guy stuff. The perp also knows that Larry isn't going to be home tomorrow because he's gotta work. Nothing like an open invite to go steal his stuff. Personally, I don't care if you document the existence of guns in a health record or not. I just think that citing a possible increase in cyber crime against EMRs based on gun data is far fetched. I assume most patients lie if/when I ask them about their guns. Most of the patient panel that I have seen in this rural setting probably has a couple of guns tucked behind the door, couch, nightstand. It's the local culture. Of course I implore them to be mindful of safety issues surrounding their kids. Most of them believe it won't be their kid who gets hold of the gun, because their kid has already been trained how to handle them, or is too small to reach the drawer. They are wrong of course, but no one believes that an accidental discharge will happen in the home, especially with their kids, until it happens to them. Then it's just too late. Link to comment Share on other sites More sharing options...
drholmes Posted January 19, 2013 Share Posted January 19, 2013 rcjarrell, Interesting. Godwin's Law is loosely applied to "inappropriate use of Nazi analogies". My reference to the Nazi regime is quite appropriate and specific. Even a casual examination of the President's policies and public statements reveal a preference to centralized governmental control (the central aspect of the Nazi blueprint). Furthermore, he is such a narcissist (not completely unlike Hitler) that the above statement is especially true as long as he is at the top of the ruling class food chain. Yes, as long as we are steadily marching towards his "fundamentally transformed" America - he is happy as a fly on excrement. He is for local or state creating legislation to the extent that such legislation furthers the devaluing of the individual as sovereign or promotes his centralized nanny-state agenda. "16. Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes." On this point: The mere mention of this as a clarification on policy assumes encouragement of asking these types of questions - whether warranted or not. If a medical provider feels it is clinically relevant to ask such a line of questions, there is nothing in any law preventing that line of questioning previously anyway. Why do we suddenly need the seal of approval from the Executive branch to complete an appropriately thorough medical evaluation? Link to comment Share on other sites More sharing options...
andersenpa Posted January 19, 2013 Share Posted January 19, 2013 Strange I never see children in the commercials or ads , demanding preservation of "Pro Choice Rights" but they seem to be the focus of the current movement to protect them from harm. Probably b/c the unborn can't appear in TV ads. Link to comment Share on other sites More sharing options...
andersenpa Posted January 19, 2013 Share Posted January 19, 2013 Abortion kills and has killed more defenseless children than all the shootings combined. And yet it is promoted and considered a right. It's safe to say that most advocates that are pro-abortion rights are not "pro-abortion". Gun ownership advocates are not promoting gun related assaults, they are promoting ownership rights. Both are supporting civil liberties. To one, inappropriate firearm use has led to documented murder. To the other, abortion has led to presumed murder (depending on your defintion). One of the goals of reproductive rights is to limit the need for abortions while protecting the right to control your body. Just like the gun safety argument should be the goal to limit firearm injuries/deaths while protecting the right to own them. As far as I can tell this federal order as it relates to us as providers doesn't take away ownership rights. 16. Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes. 17. Release a letter to healthcare providers clarifying that no federal law prohibits them from reporting threats of violence to law enforcement authorities. Too bad #16 doesn't say Health Care Providers instead of Doctors. Perhaps we're exempt. Link to comment Share on other sites More sharing options...
andersenpa Posted January 19, 2013 Share Posted January 19, 2013 Can anyone cite an example of these mass killings using a gun , that the person responsible was not previously identified as being........."odd" / mentally ill? Why didn't mental health /illness issues rank as a priority in addressing "gun violence"? looks like it's included in this executive order 20. Release a letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover. 21. Finalize regulations clarifying essential health benefits and parity requirements within Affordable Care Act exchanges. 22. Commit to finalizing mental-health parity regulations. 23. Launch a national dialogue led by Secretaries Sebelius and Duncan on mental health. Link to comment Share on other sites More sharing options...
andersenpa Posted January 19, 2013 Share Posted January 19, 2013 rcjarrell, Interesting. Godwin's Law is loosely applied to "inappropriate use of Nazi analogies". My reference to the Nazi regime is quite appropriate and specific. Even a casual examination of the President's policies and public statements reveal a preference to centralized governmental control (the central aspect of the Nazi blueprint). Furthermore, he is such a narcissist (not completely unlike Hitler) that the above statement is especially true as long as he is at the top of the ruling class food chain. Yes, as long as we are steadily marching towards his "fundamentally transformed" America - he is happy as a fly on excrement. He is for local or state creating legislation to the extent that such legislation furthers the devaluing of the individual as sovereign or promotes his centralized nanny-state agenda. "16. Clarify that the Affordable Care Act does not prohibit doctors asking their patients about guns in their homes." On this point: The mere mention of this as a clarification on policy assumes encouragement of asking these types of questions - whether warranted or not. If a medical provider feels it is clinically relevant to ask such a line of questions, there is nothing in any law preventing that line of questioning previously anyway. Why do we suddenly need the seal of approval from the Executive branch to complete an appropriately thorough medical evaluation? An implicit encouragement, as enthusiastic as you may think it is, is not a mandate. You still have your medical judgment to exercise despite what you feel you are compelled (but not required) to do, and document it appropriately. And BTW all presidents are narcissists. How else could they have arrived at that position. Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 19, 2013 Share Posted January 19, 2013 first off those that are pro-abortion rights are pro-abortion you %&* moron, second off the right to control your body? keep your $%^&* pants on, dont murder an innocent child before he is born for your own selfish gains. D*&$%b$g Link to comment Share on other sites More sharing options...
Contrarian Posted January 19, 2013 Share Posted January 19, 2013 first off those that are pro-abortion rights are pro-abortion you %&* moron, second off the right to control your body? keep your $%^&* pants on, dont murder an innocent child before he is born for your own selfish gains. D*&$%b$g Ummm.... NO A$$Clown... I'm "Pro Choice" and seriously DO NOT believe in abortion {except in your case}... Thing is... I don't believe that the government or any other individual has the RIGHT to tell women what to do with their own bodies... MUCH MORE than my opposition to abortion... so I'm pro-choice. Link to comment Share on other sites More sharing options...
andersenpa Posted January 19, 2013 Share Posted January 19, 2013 first off those that are pro-abortion rights are pro-abortion you %&* moron, second off the right to control your body? keep your $%^&* pants on, dont murder an innocent child before he is born for your own selfish gains. D*&$%b$g .......................................... Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 19, 2013 Administrator Share Posted January 19, 2013 Life in South Africa is a far cry from life in the US. It is comparing apples to oranges. The point was, (and I apologize for the brevity of my last post; I was posting during a break in ATLS) the more restrictive gun ownership becomes, the more egregious criminal acts become to obtain them. South Africa's handgun laws would be like an entire country of Washington D.C., as I understand it, so the thugs can't just go to VA and steal a handgun. True, there isn't a convenient data base...unless of course the local paper decides to post the name and address of all Concealed Weapon Permit Holders in your local area, like the NY paper did. It doesn't take two brain cells to assume that those CCW holders have guns in the house. In the vast majority of states, that is privileged information, not subject to FOIA laws. New York has just proven why. If you haven't been following the stories, at least two burglaries have happened at listed addresses resulting in the loss of firearms. Whether or not that exceeds the baseline rate by a statistically significant margin is immaterial--apparently the newspaper has finally pulled the map, not for a sudden attack of common sense or human decency, but on the advice of counsel. (snip comparison with drugs, which I'm not going to address--that's a topic bridge too far... ) I agree with you, the computer systems takes work to exploit. Actually, this is not the case. Most computer systems are woefully under-defended: people are susceptible to insider social engineering compromise, important systems are connected to networks in ways that are just plain stupid, and people are allowed to run Facebook and read email on systems connected to internal resources like EMRs. Virtually all hacking attacks are made into point-and-click (or close to it) toolkits within a matter of hours or days of release, and thus usable by your average 12 year old... but even that's really not very relevant, because corporate networks are full of unpatched, undefended systems for a variety of reasons, the biggest of which is the illusory (delusional?) idea that networks have 'inside' and 'outside' and that the good guys are the only ones on the inside, and thus fall prey to decades-old attacks. ... and I could go on for hours about this. Heck, if I get sick of medicine, I can go back to Information Security and make 50% more than my current PA salary. Link to comment Share on other sites More sharing options...
drholmes Posted January 19, 2013 Share Posted January 19, 2013 An implicit encouragement, as enthusiastic as you may think it is, is not a mandate. You still have your medical judgment to exercise despite what you feel you are compelled (but not required) to do, and document it appropriately. And BTW all presidents are narcissists. How else could they have arrived at that position. Of course modern Presidents are narcissists! It has become part of the pre-screening qualification. For now, we still have the freedom to be able to practice as we wish. My worry is that the slope is becoming mighty slick and we are being issued cheap flip-flops with which to navigate the practice environments. (Vis-a-Vis Mayor Bloomberg's recent announcement...) Link to comment Share on other sites More sharing options...
Nostraadms Posted January 19, 2013 Share Posted January 19, 2013 If I do become a PA, I will not ask my patients if they own a gun or not because that is not my concern and that is a private matter. After all, if a person is mentally unstable,he/she will use anything to harm others, if that is their intention. To single out guns shows that our current monarch, Obama I, believes that government should be the sole proprietor of guns. No healthcare official should be bound by law to ask if a patient is a gun owner because that is a clear violation of a person's privacy and not related to medicine. On the other hand, I would advise anyone who has young children at their to take precautions to avoid serious injuries. This includes keep sharp objects in out-of-reach areas and also keep guns, ammunition or any other weapon/firearm in a safety box. Link to comment Share on other sites More sharing options...
CAdamsPAC Posted January 20, 2013 Share Posted January 20, 2013 Probably b/c the unborn can't appear in TV ads. The unwounded, non-threatened can..... Link to comment Share on other sites More sharing options...
Hemegroup Posted January 22, 2013 Share Posted January 22, 2013 Interesting piece: http://www.cnn.com/2013/01/22/opinion/kozachik-gun-buyback/index.html?hpt=hp_bn7 Link to comment Share on other sites More sharing options...
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