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Should Doctors Ask If You Own a Gun?


No one questions when a doctor asks if an older, cognitively impaired patient is still driving, and urges family members to take away the car keys for the safety of the patient and everyone else.

So why is it any different for a doctor to ask if a patient with similar problems has guns at home that could endanger him or others?

There is no difference -- it's simply the doctor's role in contributing to patient and public safety, argues a professor of medicine and law in a new paper published July 9 in the Annals of Internal Medicine.

Discussion: Guns Killing Children - An American Epidemic

Marshall Kapp, director of the Florida State University Center for Innovative Collaboration in Medicine and Law, writes that doctors have a professional and legal obligation to ask about guns in the homes of seniors suffering from depression or mental impairment.

He also urges family members to consider removing guns from the home, or storing them unloaded and under lock and key, to protect both the patient "and the rest of the population" from possible gun violence -- for example, the recent shooting of a caregiver by an Orlando, Fla., man with dementia.

It's not a matter of challenging gun ownership, Kapp writes, but of not allowing a person who's no longer capable of making sound decisions to have access to a weapon.

Kapp even goes a step further, writing that if family members are uncooperative in reducing this risk to a patient, it should be considered " a form of adult abuse or neglect," and physicians have a "mandatory" responsibility to report this neglect to authorities. The usual doctor-patient confidentiality restrictions do not apply in these circumstances, he adds.

The reasons for protecting older men, in particular, from unsecured guns are both sad and troubling: Not only are older men more likely than older women to commit suicide, they're also much more likely to use firearms, according to the most recent government figures. Among men age 65 and older who committed suicide between 2005 and 2010, nearly 80 percent used a gun.

Kapp acknowledged that this is a controversial subject. Most recently, the discussion has centered on families with young children. To reduce accidental gun-related injuries, such as the five-year-old Kentucky boy who fatally shot his two-year-old sister this past May, pediatricians have been encouraged to ask parents about whether guns are safely locked away from youngsters at home.

But Kapp said that guns in the home can also pose a lethal danger to older people. "We don't think about prevention and safety the way we would with children," he told National Public Radio.  "An older person who is seriously compromised by mental disorders is in many respects as helpless and vulnerable and dependent as a child would be."

While Kapp's paper focuses on the the issue of guns and suicide among patients over 65, suicide rates have also risen among the middle-aged, according to the latest figures from the Centers for Disease Control and Prevention. The suicide rate for adults ages 35 to 64 jumped nearly 30 percent between 1999 and 2010.

At the same time, encouraging doctor-patient discussions about guns has proven to be a politically dicey subject.

Last year, Florida passed a law, dubbed the "Docs vs. Glocks" law, restricting such discussions -- although as Kapp pointed out, it did include an exception for doctors concerned for a patient's safety. The law was struck down after an appeals court upheld the doctors' right to talk about this subject.

However, just as with the issue of car keys, the toughest part of the gun safety conversation may not be talking about it in the doctor's office. The really difficult part is getting an older patient or a family member to do something about it at home.



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