AAFP Joins Unified Effort on Gun Violence, Physician Free Speech

American Bar Association, Eight Health Organizations Partner on Initiative

February 23, 2015 05:06 pm Chris Crawford

About 300 million guns are privately owned in the United States -- a nation of about 320 million people. And each year, more than 32,000 people in this country die from firearm-related violence, suicides and accidents.

Family physician Andrew Carroll, M.D., of Chandler, Ariz., says he first began carrying a handgun when he became a medical member of the Phoenix Police Department Special Assignments Unit.

Those numbers -- both the highest among industrialized countries -- led the AAFP and seven other health professional organizations to join the American Bar Association (ABA) in a call for policies to reduce firearm-related injuries and deaths in the United States and to protect physicians' free speech rights to discuss gun ownership with patients.

The coalition's principles and consensus-based recommendations are outlined in a paper(www.annals.org) published online Feb. 23 in Annals of Internal Medicine.

The group supports taking a public health approach to reducing firearm injuries and fatalities while ensuring respect for the Second Amendment.

Academy EVP and CEO Douglas Henley, M.D., co-authored the paper. He told AAFP News that because firearm violence is a public health issue, it needs to be addressed from a public health perspective. He added that the paper is consistent with AAFP positions on firearms and safety issues and prevention of gun violence that the Congress of Delegates approved in the past two years.

The AAFP's patient education website FamilyDoctor.org also offers gun safety advice(familydoctor.org) for parents.

Story highlights
  • The AAFP and seven other health professional organizations joined the American Bar Association in calling for policies to reduce firearm-related injuries and deaths and to protect physicians' free speech rights.
  • The coalition's principles and consensus-based recommendations are outlined in a paper published online Feb. 23 in Annals of Internal Medicine.
  • The recommendations reflect the organizations' policies and integrate the multidisciplinary perspectives of medical, public health and legal professionals.

"The recommendations are intended to generate a discussion in the nation and the consideration to enact legislation or other efforts as appropriate based upon that conversation," Henley said. "With the American Bar Association on board, it appears the solutions we are recommending to be considered are entirely consistent with the Second Amendment of the Constitution. They're not meant to unduly restrict the purchase or possession of firearms."

Aside from the AAFP, six physician organizations -- the American Academy of Pediatrics, American College of Emergency Physicians, American College of Physicians (ACP), American College of Surgeons, American Congress of Obstetricians and Gynecologists, and American Psychiatric Association -- joined the American Public Health Association and the ABA in developing the paper and its recommendations.

"Along with our colleagues in law and public health, those of us who represent the nation's physicians realize that there are significant political and philosophical differences about firearm ownership and regulation in the United States," said ACP EVP and CEO Steven Weinberger, M.D., in a news release. "However, we strongly support a multifaceted public health approach and will not be dissuaded from advocating for the improved health of our patients and families."

Paper's Recommendations

The paper offers the following recommendations for reducing firearm-related injuries and deaths, which reflect the organizations' policies and integrate the multidisciplinary perspectives of medical, public health and legal professionals:

  • Support criminal background checks for all firearm purchases, including sales by gun dealers, at gun shows and private sales from one person to another.
  • Oppose state and federal mandates that interfere with physician free speech and the patient-physician relationship, including "gag laws" that forbid physicians to discuss a patient's gun ownership.
  • Support civilian restrictions on the manufacture and sale of large-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity.
  • Advocate research into the causes and consequences of firearm violence and unintentional injuries so evidence-based policies may be developed.

The ABA noted in the paper that the recommendations "are constitutionally sound."

"A significant part of the ABA's role was to help make it clear that there are several ways to reduce gun violence that are constitutional and are safely within the law," ABA President William Hubbard told AAFP News.

The health professional societies made two additional recommendations:

  • Support improved access to mental health care, with caution against broadly prohibiting all people with mental or substance use disorders from purchasing firearms.
  • Oppose blanket reporting laws that require physicians to report patients with mental or substance use disorders, because these laws may stigmatize patients and keep them from seeking treatment.

Henley added that the group looked to the American Psychiatric Association for its leaders' expertise and guidance on the additional recommendations.

"We have to be cautious of making sure we deal with mental health issues appropriately as they relate to such issues," he said.

"Docs With Glocks"

AAFP member Bernd Wollschlaeger, M.D., of the Aventura Family Health Center in North Miami Beach, Fla., is a gun owner and concealed weapon permit holder who has been directly affected by the free speech restrictions the joint paper opposes. He grew up with firearms in his home in Germany and later served as a medical officer in the Israeli Army.

"The first thing I learned about guns was to use them properly, specifically, how to not injure yourself or others," Wollschlaeger told AAFP News. "Gun ownership and gun safety should go hand in hand. This is not an either/or discussion. The physician can play a role in guiding the patient in introducing gun safety measures in their home."

But Wollschlaeger practices in Florida, where in 2011, the governor signed into law the Firearm Owner's Privacy Act(www.leg.state.fl.us), nicknamed "Docs vs. Glocks," which prohibits physicians from discussing firearm ownership and safety with their patients, among other restrictions.

In response, Wollschlaeger, Judith Schaechter, M.D., and Tommy Schechtman, M.D., last year filed a petition(media.ca11.uscourts.gov) with the backing of the Florida chapter of the AAFP and other associations against the governor and related state offices, saying the law violated their First Amendment right to free speech when consulting patients.

The case is still up in the air as the group awaits the decision of the U.S. Court of Appeals for the 11th Circuit on whether to grant the petition for en banc review.

While the decision is pending, Wollschlaeger said Florida doctors can continue to discuss gun ownership and safety, which he does.

He said gun safety fits naturally into an overarching safety discussion, especially with parents of young children.

"When I discuss child safety with parents, I first ask about pool safety, then cleaning materials safety and then my third point is a question about gun safety," Wollschlaeger explained. "I make them aware that I safeguard my gun at home because I have children. Then I ask, 'How do you do that?'"

He suggests inviting patients to share their experience instead of asking, "Do you own a gun?" to avoid a confrontational response.

Wollschlaeger said he also routinely asks patients who have a psychiatric history or history of substance abuse about gun ownership because the use of guns in suicides is higher among these patients than in other groups. "So I inquire about the intent or potential intent that this patient has to use this gun," he said.

The third population of patients Wollschlaeger discusses gun safety with is gun owners who have a psychiatric history and anger control problems. "I may inquire about their gun ownership for the safety of their family members and my own safety," he said.

"These are routine public safety discussions to have with patients that have everything to do with preventive medicine and nothing to do with infringing on the rights of our patients to bear arms," Wollschlaeger said. "Both sides should move toward each other, not away."

Andrew Carroll, M.D., of Renaissance Medical Group in Chandler, Ariz., is another gun-owning family doctor who believes that all physicians should have the freedom to discuss gun safety with patients.

Carroll first began carrying a handgun when he became a medical member of the Phoenix Police Department Special Assignments Unit (their version of SWAT -- Special Weapons and Tactics), where he was trained to use the weapon.

"Because I brought a gun home, I educated my family on gun safety, showed them how to render my weapon safe and also took them to a professional range to show them how to use a gun safely," Carroll told AAFP News. "The gun remains locked up separate from the ammunition, which is also locked up."

Carroll said guns are abundant in Arizona, where concealed weapons do not require permits. So he assumes that many patients own guns. But he doesn't broach the subject with adult patients unless he thinks there may be issues with a patient using a gun for reasons other than as a hobby or for hunting or self-defense.

Carroll also discusses gun ownership when doing childhood exams and when he knows there are children in the home of a gun owner.

"I think it's important that state legislatures recognize that physicians typically only have the interest of their patients as well as those around the patients when we ask about the availability or presence of weapons," he said. "Legislative bodies should not gag physicians ever on any subject, since all we're trying to do is help our patients and those around them."

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