A Florida legislator wants to imprison doctors for practicing good medicine. "Really?" you ask. Is this another anti-abortion bill? Assisted suicide?
No, it's about guns. It is the policy of my professional organization and many others to inquire about firearm ownership and safety.
Is this a valid position, and if so, why?
Physicians are charged with prevention and treatment of human disease/injury. Prevention encompasses screening for risk, and preventative treatments such as vaccination. It also includes counseling regarding important health behaviors, such as seat belt and helmet use.
Are firearms an important, preventable health problem? If so, how do we intervene to prevent firearm injury and death?
The data regarding firearms and preventable injury is unassailable. The CDC and DOJ both track statistics, but as an example, homicide and suicide by firearm are the second and third leading causes of injury-related death in the US in the 15-24 age group. The exact magnitude of the problem can be debated, but its health significance cannot.
The American College of Physicians (in a 1998 position statement) has taken a two-pronged approach: asking patients about gun ownership and safety, and advocating for gun-control legislation. The first should be uncontroversial---who can argue with asking a patient if they own the means to end life rapidly and violently, if they know how to secure it properly, and if they keep it out of the reach of children?
The second point is, needless to say, very controversial, although not so much among physicians, who consistently poll favorably on the issue.
Lets add some science-based medicine to the cauldron. Is it plausible that doctors' interactions with patients and legislators can reduce gun violence? Certainly. To what degree can we physicians help reduce gun-related injuries? Studies have shown variable efficacy of firearms safety counseling in changing patients' behavior. Can this intervention cause harm? It's hard to see how.
Given the extent of the problem, even a small positive effect on patient behavior can have a large impact. The only negative outcome is having a patient ignore your advice. Most patients understand that the doctor has their best interests at heart, and that recommendations come from data rather than ideology. I don't tell my patients that the must remove guns from the house, although I do point out that they are statistically likely to be safer without them. I do recommend that they practice safe storage of firearms.
So what about this proposed law? What does it say?
1)(a) A verbal or written inquiry by a public or private physician, nurse, or other medical staff person regarding the ownership of a firearm by a patient or the family of a patient or the presence of a firearm in a private home or other domicile of a patient or the family of a patient violates the privacy of the patient or the patient's family members, respectively.
(b) A public or private physician, nurse, or other medical staff person may not condition receipt of medical treatment or medical care on a person's willingness or refusal to disclose personal and private information unrelated to medical treatment in violation of an individual's privacy as specified in this section.
(c) A public or private physician, nurse, or other medical staff person may not enter any intentionally, accidentally, or inadvertently disclosed information concerning firearms into any record, whether written or electronic, or disclose such 43 information to any other source.
A violation would be a third degree felony and could be punished with a fine “of not more than $5 million if the court determines that the person knew or reasonably should have known that the conduct was unlawful.” As the Palm Beach Post reports, the NRA has identified the bill a priority item on its agenda for this Florida legislative session. The legislative proposal would clearly invite a strong challenge as an unconstitutional prior restraint if enacted.
This is, in technical terms, a steaming crock of feculent idiocy (and, I would think, unconstitutional). For a legislature to decide what a doctor and patient may not talk about is a profoundly unconservative idea. What if the junk food industry lobbies a legislator next? No more proper counseling for my diabetics?
Even in the current insane political climate, I doubt this bill would pass or stand. But for someone to propose it, and for a major lobbying body (the NRA) to support it is equally sad and dangerous.
*One wonders what the Official Club for Wingnut Doctors would think of this proposed bill.