What Can Physicians Do to Prevent Firearm Violence?

Physicians should routinely ask patients about firearms in their home and whether guns are locked and safely stored, writes James S. Kahn, M.D., a professor of medicine at Stanford University, in an editorial published today in the Annals of Internal Medicine. The editorial was published alongside a position paper from the American College of Physicians on reducing firearm injuries and deaths in the United States.

“Firearm-related violent death is an extraordinary problem made even more alarming by the prevalence of guns in the households of persons with dementia and the variation in firearm injuries related to racial disparities,” Kahn writes. “Yet, many physicians have been unengaged or silent during this epidemic. Why? Perhaps we think firearm violence is outside our realm of influence.”

Yet Kahn says physicians routinely ask patients about their unsafe activities, risky exposures, and addictions. “Nicotine abatement programs, alcohol reduction plans, and HIV prevention efforts begin with questions … about a person’s behavior and are successful when physicians provide information to empower patients, motivating them to prevent disease and avoid disability or death. Guns should be no different.”

Kahn recommends the following advice to patients about creating a safe environment when guns are in the home: 

• Remove the ammunition from the gun and lock the gun in a secure location.
• Lock the ammunition in a separate location from the gun.
• Store the keys in a different area from household keys and keep the keys out of reach of children.
• Lock up gun-cleaning supplies.
• Never leave a gun unattended after removing it from a safe storage place.

Kahn urges physicians to begin the conversation simply by asking, “Do you have guns in the home?” If a patient answers “yes,” the physician can follow up with a question such as “How or where do you typically store your guns?”

“If my patients say their guns are not secured or locked, then we can talk about how they might protect themselves and others from unintentionally finding and firing the guns,” Kahn writes. “We discuss what to teach children to do if they encounter a gun: Stop what they are doing, never touch the gun, leave the area, and tell an adult right away.” 

“It would be so easy to normalize this line of inquiry and add these questions to an electronic medical record along with questions about alcohol consumption, drug use, and sexual practices,” Kahn writes. “And it is not difficult to learn how to talk to patients about guns and how to counsel them about safety. We need to routinely ask, ‘Do you have guns in the home?’”

For related information, see the Psychiatric News article “Talking to Patients About Guns Necessary, But Examine Your Beliefs First.”

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