Gun Safety

Guns.

They're a hot topic these days, and why shouldn't they be?

According to the National Academy Press in 2013, there were 73,505 nonfatal firearm injuries (23.23 per 100,000 U.S. citizens); 11,208 homicides (3.5 per 100,000); 21,175 suicides; 505 deaths due to accidental/negligent discharge of a firearm; and 281 deaths due to firearms-use with "undetermined intent", included in a total of 33,636 deaths due to "Injury by firearms", or 10.6 deaths per 100,000 people. Of the 2,596,993 total deaths in the US in 2013, 1.3% were related to firearms. (Wikipedia: Gun Violence in the US)

Now, I know that by starting a piece on guns, half of the people reading may be getting their "no regulation, read the 2nd Amendment" arguments ready and the other half are getting their "a well-regulated militia isn't 'lone wolves' shooting up schools" arguments just as greased up.

But I don't want to talk about that. I want to talk about something related to guns:

Suicide.

Suicide is the 10th leading cause of death in adults in the US. Studies show that most people who have committed suicide have received healthcare services in the year prior to their deaths, and in nearly half of them, that care was within the previous month. More importantly, though, firearms are still the most common method used in suicide, accounting for 51% of suicides in 2006. (More info here)

As a doctor, my job is about wellness. In that job, I often screen for addiction, abuse, violence, risky behaviors, and yes, depression and suicide risk. When I see children, I assess the safety of their surroundings: do they wear seatbelts in the car, do they wear bike helmets, are they eating enough vegetables and avoiding too much sugar, does anyone in the home smoke, does the house have lead plumbing or lead paint, etc.

One question I ask many of my patients is "are there guns in your home?" If the answer is yes, I ask about where and how those guns are stored, who has access to them, how are they kept safe from others not authorized to use them, particularly children.

Most parents understand why I'm asking. Most adults, when I ask them, assume it's something political. Patients generally just raise an eyebrow when I ask about guns in the home, but some get very angry that I would even think to ask: What business is that of mine? How dare I ask such a question? Am I putting them on some sort of registry?

I sometimes hesitate to ask, frankly, but I always do. And today, I was reminded why.

A middle aged man came to my office as a new patient about an injury after a fall about a month ago. He smelled like booze. He admitted to me that he had been drinking heavily for about 6 months. We talked about his losses the last year--he had many-- and we talked about his coping skills--he had few. We talked about depression and anxiety and then I asked him, "Do you own or have access to a gun?" He looked surprised and said, almost sharply, "Well, no I don't."

Then I asked him, "If you did, would you still be here today?"

He paused.

For a long time.

This wasn't your usual couple of seconds type pause.

We sat in that room quietly, as he looked around at the ceiling, his hands, the smart screen behind me (it happened to be off today), down at the floor, back to his hands.

He looked up at me, open his mouth as if to answer, but nothing would come out.

Finally, after 2 to 3 minutes, he said, "That's the hardest question anyone has ever asked me."

We left it at that, for now.

We made a contract for safety, even though the data suggest that it is not likely to prevent him from taking his own life should he decide to do so. We talked about suicide hotlines and made a plan for his alcohol withdrawal. He left with phone numbers for AA, the ER and the local crisis help line. His housemate and I spoke about his risks and his diagnosis, and his local support (which is actually pretty strong), and safely managing his medications. We made a plan for his return and follow up, and as he checked out and got ready to leave, he turned and hugged me.

And then he thanked me for asking.

"Asking what?" I said.

"Asking that question about the gun," he replied. "I didn't really realize it until today, but if I'd had a gun 6 months ago, I probably wouldn't be here today."

Doctors aren't trying to assault your 2nd amendment rights. We're trying to assess your safety. It's part of our job. We ask about alcohol, smoking, seat belt use, sleeping habits, and sunscreen use. We recommend colonoscopies, healthy diets, and routine exercise. We would not be the caregivers that we aspire to be if we cut it off at that for fear of a political conversation. If you're a provider, don't be afraid to ask. If you're a patient, don't be too angry to answer.