Recently, a teen patient came to see me for follow up of her depression. Her mom expressed fear that her daughter, in a moment of despondency, might act on her feelings and hurt herself or commit suicide. We discussed making sure that all medications were locked up, and that there were no weapons in the home. This included guns.
Later that same day, I saw a 4-year-old with his mom. They were new to the practice. Part of my questioning included asking about the home environment. Who lives in the home? Does anyone smoke? Do they have any pets? Do they have a firearm or gun in the home?
As a pediatrician, these are the times I routinely ask families about guns in the home. Unfortunately, there are many more missed opportunities. Recently, UNC family medicine researchers and students surveyed 223 physicians in North Carolina. Only 25 percent reported having conversations with patients about firearms often or very often. Almost half reported NOT asking depressed patients if they had a firearm.
Questioning patients about guns is not easy. In 2011, in the state of Florida, where the Parkland school shooting just occurred, legislators passed the Florida Privacy of Firearm Owners Act. This law prohibited physicians from asking patients about gun ownership. That questioning, it was argued, violated the patient’s right to privacy. Subsequentlyin 2017, a panel of judges in the 11th Circuit Court of Appeals struck down most provisions of the law.
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Many more states, including North Carolina, followed in Florida’s footsteps. In April 2015, legislators in our state introduced and discussed a similar law. It never got passed. This was in part due to advocacy efforts by physicians opposed to the law.
According to the Brady Campaign to end gun violence, 17,012 children and teens are shot in murders, assaults, suicides, unintentional shootings or by police every year.
As a pediatrician, I continually encounter the children and families affected by gun violence. I’ve seen a teen shot in his neighborhood during a hijacking of his car, a young boy who suffers from anxiety after watching his father robbed at gunpoint, and the accidental injury of another boy when his cousin found a loaded gun in his home. These are the children that survived. I’m sure my colleagues in the emergency room or critical care can tell you about other heartbreaking stories where the outcome was much more tragic.
As a community,protecting our childrenmust be a priority. Children are our future, our legacy. We can and must do better.
To my medical colleagues, we must do a better job asking about guns and gun safety.
And to the public, please don’t get upset if we ask you about firearms in the home. We are not making judgments. We are just trying to avoid additional tragedy.
Caren Mangarelli,, MD, is an assistant professor of pediatrics at Duke Children’s Primary Care.