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