Docs asking: Is there a gun in the house?
When Dr. Brad Fuller asks the parents of his young patients whether they have guns in their homes, they are sometimes taken aback.
But for the Westerville pediatrician, the query is standard protocol — just one on a
list of routine safety questions akin to whether parents place safety gates on stairways.
“Parents buckle their children in car seats to protect them in cars, lock up their cleaners to protect them from poisons and vaccinate them to protect them from illness. Gun safety should be no different,” said Fuller, who practices at Central Ohio Primary Care’s Associated Pediatrics.
Like Fuller, physicians across the country are viewing firearms violence as a public-health threat and asking patients and parents about guns as they would any other safety issue, said Dr. Michael Munger, president of the American Academy of Family Physicians.
These conversations aren’t new, but Munger said the topic is being brought to the forefront by mass shootings.
“Every time you turn on the news, you see another incident has occurred. That certainly brings it to everyone’s awareness, physicians included,” he said. “That’s a reminder that you’ve got to keep up on this. You’ve got to make it part of your care for the overall patient.”
On its website, the academy offers physicians guidelines for talking about guns with patients who might be at risk, such as those who live in abusive situations, have substanceabuse disorders or have been diagnosed with depression.
The matter was thrust into the spotlight this month, when JAMA (Journal of the American Medical Association) Pediatrics published an editorial titled “Death by Gun Violence — A Public Health Crisis,” calling on doctors to respond. It pointed out that nearly 100 people die in the United States from gun violence every day.
“Physicians and other health-care professionals can do more,” the editorial said. “As with any epidemic, prevention is important. Physicians and others should ask about guns in the home, especially for high-risk patients, and advise about removal and safe storage.”
Fuller said research shows that safe storage of guns can prevent injuries, and he agrees it’s important to discuss the issue with parents.
“Parents may choose to follow my advice or not,” he said. “However, I believe that if the parent understands the why behind the recommendation, as well as the objective research that supports it, they are more likely to respond positively.”
Yet the Sandy Hook Promise initiative to prevent gun violence has found that only a small percentage of families report that family doctors have spoken to them about guns, said spokeswoman Stephanie Morris. What has changed in recent years, she said, is that trade associations for medical groups and specialties have begun urging doctors to ask patients about guns in the house.
Locally, a pilot program of the Ohio chapter of the American Academy of Pediatrics preliminarily shows that parents are open to receiving information about gun safety from their children’s doctors.
Through the Store It Safe initiative, a core group of pediatricians address gun safety with parents during well visits for 2- and 3-yearold children. They discuss the best way to store firearms and offer free lock boxes, said Hayley Southworth, the chapter’s director of program management and training. The program is a partnership with firearms groups, concealed-carry instructors and others.
So far, about 170 families have been surveyed as part of the project, and roughly half said they wanted to hear about gun safety from their health-care professional, Southworth said.
Further, 94 percent said someone talked to them about firearms safety, and about half of those learned something new, she said. About two-thirds also accepted a gun box, and about 75 percent of those were using the boxes to keep guns or other items (such as medication) safe.
The early results are promising, said Dr. William Cotton, medical director of the primary care network at Nationwide Children’s Hospital.
“This is a new way to address a safety issue, a public-health issue that may have some impact,” said Cotton, an advocacy chairman for the Ohio AAP.
Southworth said the project can serve as a learning tool for other doctors.
“We’re hoping that all pediatricians, and then eventually all health-care providers, can learn something about how they can
talk to their patients about firearms safety,” she said.
While Store It Safe is focused on toddlers, similar measures could focus on keeping guns out of the hands of vulnerable teenagers, Cotton said, noting that 90 percent of children who attempt suicide with a gun are successful, compared with 10 percent who use other means.
The Ohio AAP also is part of a wide-ranging physicians’ coalition that has worked with Sandy Hook Promise to raise awareness in Ohio about issues such as mental wellness, social isolation and safe gun storage. Physicians’ groups also have created articles and tip sheets for doctors wishing to address these issues with patients and have promoted Sandy Hook Promise programs in schools and among youth organizations.
The sheer number of gun deaths in central Ohio shows that it must be looked at from a systemwide, publichealth approach, said Nancy Bechtel, chief nursing officer at Columbus Public Health.
Of the 106 homicides in Franklin County last year, 90 were firearms-related, Bechtel said. Of the 141 suicides, 67 involved firearms.
She said that 400 people, including some health-care providers, recently were trained through a Columbus Public Health coalition to recognize trauma in others and understand how it can lead to firearms violence. They also were given ways to intervene to prevent that violence.
“This affects everyone in our community, and we have to start talking about how important it is for us to intervene with each other, with our adolescents and with our children around gun safety,” Bechtel said.