Ruling Threatens Patient-Physician Relationship

The medical community is up in arms about a recent Florida ruling that could negatively affect the patient-physician relationship.

The 11th US Circuit Court of Appeals in Atlanta upheld a Florida law that bars physicians from asking patients if they own a firearm when it is unnecessary to a patient’s care. After the law was signed in 2011, the Florida chapters of the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and other groups brought a lawsuit against the state of Florida for the law.

“At the very least, this ruling is destructive to the patient-physician relationship,” ACP President David A. Fleming, MD, MA, FACP, said in a statement. “Many doctors ask about gun ownership as a normal part of screening patients, including it on a long list of health questions about drug and alcohol use, smoking, exercise and eating habits.”

In 2012 a Miami federal judge had struck down the law because it infringed on doctors’ First Amendment right to free speech. Last Friday, in a 2-1 ruling, the appeals court reversed that decision.

The AAP condemned the ruling because it threatens pediatricians’ ability to counsel parents about how to protect children from unintentional injury and death.

"We strongly disagree with the 11th Circuit's decision," Mobeen Rathore, MD, FAAP, president of the Florida chapter of the AAP, the Florida Pediatric Society, said in a statement. “It is an egregious violation of the First Amendment rights of pediatricians and threatens our ability to provide our patients and their families with scientific, unbiased information. This dangerous decision gives state legislatures free license to restrict physicians from asking important questions about health and safety that are vital to providing the best medical care to patients."

However, the National Rifle Association (NRA) is hailing the ruling as a victory for gun owners across the country. The NRA had backed the bill signed by Gov. Rick Scott in 2011.

“Every gun owner in Florida and across the country is grateful for this common sense ruling,” Chris Cox, executive director for the NRA’s Institute for Legislative Action, said in a statement on the association’s website. “It is not a physician's business whether his or her patient chooses to exercise their fundamental, individual right to own a firearm.”

Since 2011, when Florida first passed the bill, at least 10 other states introduced similar bills. However, none have passed and Florida remains the only state with such a law.

“Parents who own firearms must keep them locked, with the ammunition locked away separately,” James M. Perrin, MD, FAAP, president of the AAP, said in a statement. “In this case, a simple conversation can prevent a tragedy. The evidence is overwhelming—young children simply cannot be taught to overcome their curiosity about guns, and to suggest otherwise is, frankly, the height of irresponsibility."

Beyond the issue of gun control and the dangers of firearms, many medical organizations are concerned about the implications this ruling has on the patient-physician relationship.

“Make no mistake—this issue is much bigger than guns or gun ownership,” Reid Blackwelder, MD, president of the American Academy of Family Physicians, said in a statement. “This is about governmental intrusion on the patient/physician relationship. Laws that infringe on this relationship put the patient and their family’s health at risk. Physicians should not be prohibited by law or regulation from discussing with or asking their patients about risk factors that may negatively impact their health.”

The American Medical Association (AMA) has also spoken out against the ruling, which prevents an open discuss between patients and their physician. According to Robert M. Wah, MD, president of the AMA, the law interferes with a physician’s ability to deliver safe care.

“Behind the closed doors of an exam room, physicians routinely ask patients many very personal questions and provide medical advice about their sexual behavior, alcohol and drug use, domestic violence, and other sensitive issues,” he said in a statement. “The AMA strongly believes the patient-physician relationship must be protected, because physicians provide appropriate treatment options based on open, honest and confidential communications with their patients.”