Doctors Asking Patients About Guns

Nobody, but nobody, including a president of the United States, can tell a doctor what to ask about in an assessments.

Assessments are supposed to be in the strictest confidence, for openers.  Anything else would be against the rules of medical confidentiality.  Patients have a right to be seen alone.  The doctor has a right to decide what needs to be said.

I can imagine the 2nd ammendment rights activists bursting a blood vessel if doctors are reqiured to survey patients about the guns they own and how they use them.  The requirement to have doctors do this would be — most everyone will agree — anti-American.

This being said, a question about firearms is and should be standard psychiatric practice.  When you are dealing with suicidal patients, which happens all too often in psychiatry, and the patient says that he or she is thinking about this, then it is absolutely essential to know if that

thought could move to action,

Depression is extremely frequent in folks who think of suicide (I have seen studies going up to 95%) and it remains treatable.  Death is the ultimate irreversible side effect of non-treatment here.  very early in my psychiatric training, I did an interview behind a two way mirror of a depressed woman I did not believe to have been particularly suicidal.  It was in a hospital.  My preceptor told me, “You always ask.  It doesn’t cost anything and you could save a life.”

Plenty of antidepressant medications (here I have seen estimates up to 85%, to the doubtless joy of the drug companies who make them) are given out by primary care doctors.  In our Holy American crusade to lower healthcare costs (even at the expense of providing actual quality care) we have deputized a host of medical professionals who are not trained in psychiatry as Honorary Psychiatrists.

Alrighty,k then — How about making them ask depressed people about firearms?  And of course, doing a bunch of other things that psychiatrists do that Family Practice, Internal Medicine, OB/GYN and other speicalists don’t do (and aren’t trained to do).

How about asking about firearms when antidepressants are given out?

The sad fact is, most doctors know how to write a scrip for antidepressents if a patient reports feeling down, or blue or depressed.  But they don’t necessarily know how to actually screen for a valid diagnosis of depression, and they usually aren’t going to waste time and money (mainly money) on things like blood tests to see if there is a medication reaction or an underlying problem (such as diabetes or thyroid) making people feel depressed.

In my years of a psychiatist, I was usually the first person to actually find such problems and send these poor patients back to their primary care clinics to take care of high blood sugar, low thyroid, or whatever.

So if a doctor can’t really diagnose a valid depression, how can he or she diagnose dangerous gun attitudes?  And why should the government care — unless there is some scientific data I haven’t seen (and there isn’t) that says the people who should get antidepressents are potential snipers and mass murderers?

As in all things, we need a little less blanket, even exaggerations of instructions to doctors, and more admonitions to doctors to hear what patients have to say and to ask them relevant questions, something difficult to do when you have to see a lot of patients in order to pay the rent.

Spend the time, please.  Get to know what the patient needs.  Don’t just consult the cook-book that tells you to write scrip X if the patients reports symptom Y.

Our media and our politicians have been riding a wave of anti-gun sentiment since the last school shooting (actually there have been others, I think — just not such a high profile).  Naturally there will be knee-jerk reactions and over-reactions.

But leave it to Texas to have the BIGGEST and most over-board reactions.  I don’t think their threat to arrest any Federal agents who are enforcing gun laws will either keep the Feds away or lower gun-related crimes.

Hoo boy.  We sure have a hot-button issue here.  The resolution for hot button issues seems to be on the field of states’ rights vs. federal rights.  Issues ranging from slavery in 1850 to more recently, euthanasia type stuff, are legal in states that choose to not to support federal laws.

I would love to see this logic applied to marijuana, which saves lives.  As I write this, I am trying t figure out why California has not simply refused to enforce federal anti-marijuana laws, so we can save some lives.

The government will eventually be dragged, kicking and screaming, away from enforcement of unenforcable and unpopular laws — and the will of the people will spread, just like it has done in every case from voting rights to legalized gambling.

You think they would learn. But then — we just shrug because “that’s the way the government acts.”