Baby Bul­lets

Pe­di­a­tri­cians don’t talk about chil­dren and gun safety—but they should

Newsweek - - NEWS - BY MEGHAN BARTELS @meghan­bar­tels

we’re used to prob­ing ques

tions from our doc­tors. “Are you vac­ci­nated? Do you smoke? Are you sex­u­ally ac­tive? Do you own a gun?” Well, maybe not that last one.

We ex­pect doc­tors to talk about habits that may af­fect our health, and that’s also true of the pe­di­a­tri­cians who take care of our chil­dren by ed­u­cat­ing par­ents about how to min­i­mize risks. “Pe­di­a­tri­cians are com­fort­able talk­ing about seat belts and poi­sons and stuff be­cause we all, just through liv­ing, have ex­po­sure to those things,” says Garen Win­te­mute, an emer­gency room doc­tor and pub­lic health re­searcher at the Univer­sity of Cal­i­for­nia, Davis. Other risks, like smok­ing, physi­cians may not ex­pe­ri­ence first­hand but dis­cuss ex­ten­sively in med­i­cal schools so are com­fort­able bring­ing up with pa­tients. Win­te­mute says that’s of­ten not the case when it comes to another com­mon health risk: firearms. That dis­com­fort is clear in re­sults of a sur­vey of pe­di­atric emer­gency doc­tors pre­sented Septem­ber 15 at the con­fer­ence of the Amer­i­can Academy of Pe­di­atrics.

“I think there’s a po­lit­i­cally charged na­ture to it, and peo­ple get of­fended,” says lead re­searcher Sh­eryl Yanger, an emer­gency pe­di­a­tri­cian at the Ann and Robert H. Lurie Chil­dren’s Hos­pi­tal of Chicago. “There’s just a lot of emo­tions to think­ing about gun own­er­ship.”

Cur­rently, physi­cians don’t get much help nav­i­gat­ing those emo­tions. That’s de­spite the fact that gun deaths and in­juries are both pre­ventable and preva­lent. Ac­cord­ing to data gath­ered by the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, 33,594 Amer­i­cans were killed in 2014 with guns and 84,997 were non-fa­tally in­jured in 2015 by a firearm. Each year in the

Each year in the U.S., about 1,300 chil­dren

die and al­most 6,000 are in­jured by guns.

U.S., about 1,300 chil­dren die and al­most 6,000 are in­jured by guns.

The pre­ventabil­ity of gun in­juries is what par­tic­u­larly in­spired Yanger to look at how emer­gency doc­tors, who reg­u­larly screen pa­tients for dangers but of­ten do so un­der tight time pres­sure, han­dle the is­sue. So she asked 185 pe­di­atric emer­gency doc­tors about their po­lit­i­cal be­liefs (66.8 per­cent were Democrats), their gun own­er­ship (11.6 per­cent have a gun in their home), how they han­dle the topic when talk­ing to pa­tients and any ob­sta­cles they face dur­ing the con­ver­sa­tion.

Ac­cord­ing to the sur­vey, pe­di­a­tri­cians are more likely to talk to their pa­tients about gun safety if they be­lieve their ac­tion will pre­vent an in­jury, if they feel con­fi­dent pro­vid­ing the in­for­ma­tion and if they feel like it’s their re­spon­si­bil­ity to do so. On the other hand, ob­sta­cles in­clude po­lit­i­cal con­cerns, not hav­ing ad­e­quate in­for­ma­tion avail­able and wor­ries that talk­ing about guns isn’t le­gal.

Yanger hopes the sur­vey will en­cour­age schools and pro­fes­sional groups to give doc­tors the in­for­ma­tion and tech­niques (and mo­ti­va­tion) they need to start dis­cussing gun safety. The re­sults aren’t nec­es­sar­ily sur­pris­ing, but hav­ing hard data shows the need for more train­ing.

Win­te­mute, who wasn’t in­volved in the sur­vey, an­tic­i­pates gen­eral groups, in­clud­ing the Amer­i­can Med­i­cal As­so­ci­a­tion, as well as state-level and spe­cial­ist or­ga­ni­za­tions, be­com­ing more vo­cal in gun dis­cus­sions. That’s in part be­cause of a court de­ci­sion in Fe­bru­ary that over­turned a Florida gag rule that pre­vented doc­tors from ask­ing whether their pa­tients own a gun. That has re­duced con­cerns that such con­ver­sa­tions could re­sult in law­suits, which had been a key con­cern.

Gun risks vary with the pa­tient’s age, Win­te­mute adds. For chil­dren, typ­i­cally the risk at home is what doc­tors call “un­in­ten­tional ex­po­sure,” when they stum­ble on a firearm ac­ci­den­tally. As chil­dren grow up, sui­cide and homi­cide also be­come con­cerns. For adults, some­times a part­ner’s firearm is more dan­ger­ous than their own. All of those risks re­quire a physi­cian ask­ing dif­fer­ent ques­tions and of­fer­ing dif­fer­ent in­for­ma­tion de­pend­ing on the an­swers.

Those de­tails can make talk­ing about gun safety daunt­ing for those un­fa­mil­iar with guns. Be­tween 13 and 41 per­cent of physi­cians own guns, com­pared with 36 per­cent of Amer­i­cans as a whole. “For a physi­cian, if I have no per­sonal ex­po­sure to guns, and the peo­ple I so­cial­ize with don’t ei­ther, I’m walk­ing into another cul­ture” to ask about gun own­er­ship, Win­te­mute says of his col­leagues. “And they’re un­der­stand­ably re­luc­tant to do that.” Talk­ing about that hes­i­ta­tion is the first step to get­ting the train­ing they need to keep chil­dren safe. BABES IN ARMS The risk guns pose de­pends on age: For young chil­dren, the worry is un­in­ten­tional ex­po­sure in the home, when a child stum­bles upon a loaded gun owned by a par­ent.

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