Researcher calls for improved firearm safety counseling by physicians

Marian "Emmy" Betz, MD, MPH, associate professor of emergency medicine, and Garen J. Wintemute, MD, MPH, professor of emergency medicine at the University of California Davis, write that physician counseling about gun safety is a key component of preventing firearm injury and death. Recent legislative efforts to restrict such conversations are concerning and controversial, and national medical organizations support physician discussions about firearm safety. But Betz and Wintemute contend that physicians should also reconsider how they discuss such issues with patients.

"It is time to address cultural competence related to firearm safety counseling," Betz and Wintemute write. "This includes recognizing that there are actually multiple subpopulations of gun owners whose perspectives and preferences may vary based on their reasons for owning firearms."

Respectful counseling behaviors and providing nonjudgmental firearm safety information can improve the quality of interaction between physicians and patients. While physicians may be uncomfortable talking about firearms, they should recognize there are many reasons patients may own guns.

"The solution is not for every physician to purchase a firearm or become a gun expert," they write. "Rather, physicians who own guns should be asked to provide leadership developing cultural competence in firearm safety counseling, rather than being marginalized or silenced within the physician culture."

They note than an estimated 13 percent to 41 percent of physicians themselves own guns.

In addition to improved counseling, public health interventions, such as a model collaborative suicide-prevention project adopted by health professionals, firearm rights advocates and firearm dealers in New Hampshire, can help. That project, which is now being replicated in Colorado and other states, uses social marketing approaches to encourage friends, families and gun dealers to recognize warning signs for suicide and to help individuals in crisis safely store their guns.

"Physicians are entitled to their own perspectives and political opinions, but to serve patients and protect them from disease and injury, it is important to counsel them in ways that are respectful, meaningful, and effective," they write. "At times, clinicians may feel uncomfortable or uninformed when discussing certain subjects, and may disagree with a patient's choices or beliefs. However, this discomfort or disagreement cannot justify either offensive condescension or silent inaction."