Gun violence a growing public health issue, internists say

A substantial majority of the nation’s internists believe that firearms injuries are a public health issue and that gun violence is a bigger problem today than a decade ago, but far fewer are willing to discuss gun ownership and safety with their patients.

Those are among the results to emerge from a survey of internists’ attitudes regarding prevention of firearm injury published in the June 17 issue of the Annals of Internal Medicine. The issue also contains a summary of an American College of Physicians (ACP) policy position paper, “Reducing firearm-related injuries and deaths in the United States.”

Among the 573 survey respondents, 85% believe “strongly” or “somewhat strongly” that firearm injury is a public health issue, and 71% think gun violence is a bigger public health issue today than it was 10 years ago. At the same time, 77% of respondents say they never discuss ways to reduce risks for gun-related injuries or deaths, 80% never discuss whether a patient uses guns, and 62% report never discuss keeping guns away from children.

Respondents came from all parts of the country and a variety of practice settings, with office-based practice the most common. Nearly all spend time in direct patient care. Slightly more than 20% reported having a gun owner in their own home, and 64% reported having a patient killed or injured by a gun. More than 80% favor banning possession of assault weapons and high-capacity magazines.

In general, more internists living in homes without guns favored stricter gun control measures than did those living in homes with guns. For example, 89% of those living without firearms favored mandatory registration of all guns, compared with 50% of those living with guns. Similarly, 91% of the former group was in favor of requiring safety features to make guns more child-proof, compared with 67% of the latter group.

On the other hand, respondents with guns in their homes more often reported asking patients about gun use than did those without guns in the home. The authors speculate that the difference may be the result of greater familiarity with guns and appropriate safety measures.

A related article summarizes the ACP’s position paper on ways that doctors can help to reduce the 32,000 deaths and 74,000 injuries attributed to firearms each year. Among the ACP’s recommendations:

• using a public health approach to firearms-related violence and prevention of firearms injuries and deaths;

• counseling patients on the risks of having firearms in the home;

• “appropriate regulation” of the purchase of legal firearms, including criminal background checks and proof of completion of an educational program in firearm safety;

• subjecting guns to consumer product regulations regarding access, safety, and design;

• training physicians and other health professionals to respond to patients with mental illness who might be at risk of harming themselves or others;

• enacting legislation banning the sale and manufacture of assault weapons or semiautomatic weapons;

• improving/modifying firearms to make them safer, including devices such as trigger locks; and

• conducting additional research on firearm violence and intervention strategies to reduce injuries caused by firearms