On April 28th, the Florida State Senate, in a partisan 27-10 vote, approved a bill that would restrict the ability of doctors to ask their patients about the presence of guns or ammunition in the home. The measure passed along with a second bill that would decriminalize accidental display of a concealed weapon (Whoops, pardon me, my pistol slipped. What?) and a third that would prohibit localities from having tougher gun control laws than the state. HB 155, dubbed the “guns and doctors bill,” has already been approved by the state house and is expected to be signed into law by Gov. Rick Scott. State Sen. Greg Evers, sponsor of the bill, told James Rosica of the AP, “I don’t believe it says in the Constitution that you have the right to own a pool. This is about protecting and affirming our Second Amendment rights.”
Apparently, Florida’s pediatricians do pose a threat to the citizenry’s right to keep and bear arms. In the central Florida town of Ocala, a pediatrician is said to have told a mother that she would have to find another doctor for her child when she refused to answer questions about gun safety. The Republican sponsors offered no information about the frequency of this type of disagreement, but apparently with an affront to the Constitution of this gravity, once is enough.
The Florida law’s intrusion into the doctor-patient relationship and restriction on the ability of pediatricians to try to prevent injury seemed to generally fly under the radar of the national media (no coverage in the Times as far as I can search). Fortunately, Gawker.com was there to fill in the silence and get some clarification from NRA lobbyist Marion Hammer, “This bill is about helping families who are complaining about being questioned about gun ownership, and the growing anti-gun political agenda being carried out in examination rooms by doctors and staffs.” No wonder for the need for a swift legislative response. By the way, shame on the Florida Medical Association for collaborating with the NRA on the final wording of the bill so that a clause allowing a “good-faith exception for concerns about the safety of the patient or of others” could be included. Are not all physicians acting in good faith when they encourage families to take action that could prevent fatal injuries in their home? Florida physicians pay dues so that a medical association will fight for the health of the public, not for lawsuit-fearing capitulation.
Florida’s effort to prevent doctors from preventing unintentional shootings makes light of the significant public health risk posed by accidental gun injuries. A review of the CDC’s National Violent Death Reporting System, which compiles data from 16 participating states, identified 114 unintentional firearm deaths for 2007 alone. This represented 0.7% of the total violent fatalities, ~50,000 per year when extrapolated to the 50 states. The gun lobby would try to argue that fatal gun accidents are not a significant problem because they represent a small fraction of the total number of violent deaths. Of course, in reality, both of these numbers are unacceptably high and the availability of guns contributes mightily to the problem. By the gun lobby’s reasoning, the alleged harassment of one gun owning parent would trump the actual and preventable problem of more than 100 accidental gun deaths per year.
The Florida legislature’s action is farcically ill-advised. Will the home swimming pool industry next try to block the ability of pediatricians to discuss water safety? Can the soft drink industry keep pediatricians from cautioning against excessive soda consumption by children at risk for obesity? One commentator to the Gawker story, identified as a confused Brit, asked, “Will pediatricians still be able to ask, ‘Why is your child full of bullets?’”
The bill represents the worst in public policy because it takes a harmful approach in addressing a non-problem. Pediatricians and parents can work through disagreements when they happen. Anticipatory guidance, the effort to give parents a sense of what to expect as their children develop and to give families the tools to prevent potential health problems, is a fundamental part of every check-up visit and a cornerstone of pediatric practice. This crucial guidance happens when physicians and families form a relationship in an atmosphere of trust and open discussion. It will not happen when the physician-patient relationship is distorted to a physician-special interest group-patient relationship.