Physicians, patients may be reluctant to discuss gun safety at personal level

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Physician groups have called for laws and policies to address gun violence as a public health problem.

But doctors are not always comfortable discussing firearms with patients as a health and safety issue.

A new study examined willingness of physicians and patients to screen for gun ownership and discuss safety of patients and their families.

Researchers at Michigan Medicine, the University of Michigan, and the U.S. Department of Veterans Affairs Center for Clinical Management Research announced the new survey of 109 providers at 10 clinical sites. They asked about training in firearm safety counseling, physician comfort level and sense of responsibility about the issue, and whether patients responded to a screening question, “Do you have a gun at home?”

Beginning discussion

It appeared patients and physicians were resistant to discussing gun safety, though the researchers noted lack of training was a key barrier to that counseling.

“Our hypothesis is that patients are deliberately not answering because they don’t want to – maybe because they feel uncomfortable talking about firearms with their doctor or other health provider,” lead author Joseph Ladines-Lim, MD, ScD, said in a news release. Ladines-Lim is in his fourth year of residency in Michigan Medicine’s combined program for internal medicine and pediatrics.

“At the same time, our findings suggest there’s a lot of ambivalence from providers about asking their patients about firearms during the course of a routine visit,” he said. “A decent number want to address it, but an almost equal number don’t think it’s something for them to address. However, there is a consensus about addressing it with those at higher risk, but we also found a lot of providers did not feel well-trained to discuss this issue.”

Survey results included:

• 32% of physicians were unaware of the previsit screening question
• 89% had no related training
• 61% said they sometimes or never address firearm safety
• 36% felt comfortable doing so

Physicians were divided on importance of gun safety screening, with 39% saying the issue was at least very important to address, but 32% responding it was slightly or not at all important.

“Although 45% agreed firearm safety falls withing their role, 33% disagreed,” the study said. “Most felt more likely to address the issue in patients with mental illness and (substance use disorder).”

For patients, 44% answered the screening question. Among the 56% of patients who skipped it, 96% of them completed the remaining questions. That suggests “the decision to not answer was deliberate,” the study said.

The researchers noted the issue is complex.

“Studies have shown that many patients aren’t as resistant to discussing this topic as providers might suspect, especially in people with higher risks – but I suspect firearm use may be a sensitive topic such as obesity or substance abuse where asking permission of the patient to discuss it may be a helpful first step," senior author Jennifer Meddings, MD, MSc, said in the news release.

Safety measures in place

The researchers noted the state of Michigan is strengthening laws requiring guns to be stored securely in homes or other places where young people may be present. University of Michigan researchers last year showed guns as the leading cause of death for people aged 1 to 19 years in the nation, and national figures show suicide rates are approaching record highs.

To learn more, the University of Michigan Institute for Firearm Injury Prevention has published “Firearm Injury Prevention Among Children & Teens,” a massive open online course available free.

The study, “Firearm Screening and Counseling in General Medicine Primary Care Clinics at an Academic Medical Center” was published in the Journal of General Internal Medicine.