The Health Care Professional's Pledge: Protecting Our Patients From Firearm Injury
Authors: Christine Laine, Darren B. Taichman
Journal: Annals of Internal Medicine (2017)

Editorials19 December 2017The Health Care Professional's Pledge: Protecting Our Patients From Firearm InjuryFREEChristine Laine, MD, MPH and Darren B. Taichman, MD, PhDChristine Laine, MD, MPHEditor in Chief (C.L.)Search for more papers by this author and Darren B. Taichman, MD, PhDExecutive Editor (D.B.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2714 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail See who has committed to talk to their at-risk patients about firearm safety. Make your commitment now.Too many of our patients suffer when bullets maim or kill them or their loved ones. And those not yet personally harmed by guns worry about the potential for future harm presented by the ubiquity of guns in America. Regardless of whether one believes guns hurt people or that people hurt people with guns, we have a public health crisis and health care professionals have an obligation to do what we can to combat it.Annals of Internal Medicine has raised the alarm about guns since at least 1998 (1–3). More recently, we have published strong recommendations to reduce firearm injury from the American College of Physicians (ACP) (4) and another from the ACP with 7 other health organizations together with the American Bar Association (5). Improvements in public health require careful study. We've published rigorous reviews to help synthesize what is and is not known (6). The dearth of evidence to inform sensible gun regulation led us to solicit original research and work hard to help authors report it accurately to disseminate as much truthful information as possible for others seeking to learn from and build upon the findings (7–17). Firearms have also been the subject of On Being a Doctor essays (18, 19). We've repeatedly called on ourselves and our colleagues to examine the evidence, take action, and raise our voices (20–34). We've cried out that we must use our voices.Nowhere are our voices more important than in the privacy of the examination room. This is where our work is done, where all the research and learning come together. Of all the times and places where we might speak, this is where our voices can do the most immediate good. We must commit to using that time and place to help protect our patients from firearm-related harm.In this issue, Wintemute calls on each of us to make a commitment to ask our patients about firearms when, in our judgment, it is appropriate and to follow through (35). We know the factors that should alert us to the risk for alcohol, tobacco, and other substance use disorders; sexually transmitted disease; intimate partner abuse; suicidality; and other preventable harms to our patients. We ask about these risks and counsel accordingly. The risks for harming oneself or exposing others to harm from a firearm are also known. And we know we should speak up (34).While changes in U.S. gun regulations are sorely needed to address population-level threats presented by the availability of military-style firearms and unlimited ammunition, physicians and other health professionals at the frontline of patient care can help prevent firearm-related harm one patient at a time. Go to http://go.annals.org/commit-now and make the commitment to start doing this right now. By making a public commitment to ask our patients about firearms and counsel them to reduce this risk, we show our patients and their communities that we are committed to their safety and health.Feeling uncomfortable about how to talk with patients about guns is not a reason to shy away. Read when and how to do it (36). Let's start now. Too many of our patients are in danger. This simply cannot wait.References1. Davidoff F. Reframing gun violence [Editorial]. Ann Intern Med. 1998;128:234-5. [PMID: 9454533] LinkGoogle Scholar2. American College of Physicians. Firearm injury prevention. Ann Intern Med. 1998;128:236-41. [PMID: 9454534] LinkGoogle Scholar3. Cassel CK, Nelson EA, Smith TW, Schwab CW, Barlow B, Gary NE. Internists' and surgeons' attitudes toward guns and firearm injury prevention. Ann Intern Med. 1998;128:224-30. [PMID: 9454531] LinkGoogle Scholar4. Butkus R, Doherty R, Daniel H; Health and Public Policy Committee of the American College of Physicians. Reducing firearm-related injuries and deaths in the United States: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med. 2014;160:858-60. [PMID: 24722815]. doi:10.7326/M14-0216 LinkGoogle Scholar5. Weinberger SE, Hoyt DB, Lawrence HC, Levin S, Henley DE, Alden ER, et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med. 2015;162:513-6. [PMID: 25706470]. doi:10.7326/M15-0337 LinkGoogle Scholar6. Anglemyer A, Horvath T, Rutherford G. The accessibility of firearms and risk for suicide and homicide victimization among household members: a systematic review and meta-analysis. Ann Intern Med. 2014;160:101-10. [PMID: 24592495] LinkGoogle Scholar7. Anglemyer A, Miller ML, Buttrey S, Whitaker L. Suicide rates and methods in active duty military personnel, 2005 to 2011: a cohort study. Ann Intern Med. 2016;165:167-74. 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Laine C, Taichman DB, Mulrow C, Berkwits M, Cotton D, Williams SV. A resolution for physicians: time to focus on the public health threat of gun violence [Editorial]. Ann Intern Med. 2013;158:493-4. [PMID: 23277894] LinkGoogle Scholar21. Taichman DB, Bauchner H, Drazen JM, Laine C, Peiperl L. Firearm-related injury and death: a U.S. health care crisis in need of health care professionals. Ann Intern Med. 2017;167:824-5. [PMID: 29052714]. doi:10.7326/M17-2657 LinkGoogle Scholar22. Fisher J, Bonomi A. Firearm surrender laws: prompting promise for women's health. Ann Intern Med. 2017;167:591-2. [PMID: 28975259]. doi:10.7326/M17-2399 LinkGoogle Scholar23. Webster DW. The true effect of mass shootings on Americans. Ann Intern Med. 2017;166:749-50. [PMID: 28462426]. doi:10.7326/M17-0943 LinkGoogle Scholar24. Cook PJ. At last, a good estimate of the magnitude of the private-sale loophole for firearms. Ann Intern Med. 2017;166:301-2. 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Ann Intern Med. 2017;166:745-6. [PMID: 28265644]. doi:10.7326/M17-0489 LinkGoogle Scholar35. Wintemute GJ. What you can do to stop firearm violence. Ann Intern Med. 2017;167:886-7. doi:10.7326/M17-2672 LinkGoogle Scholar36. Wintemute GJ, Betz ME, Ranney ML. Yes, you can: physicians, patients, and firearms. Ann Intern Med. 2016;165:205-13. [PMID: 27183181]. doi:10.7326/M15-2905 LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Steven Kulback MD, FACPAlabama Internal Medicine22 January 2018 A Conservation To the Editor:In the December 19 issue of the Annals, Drs. Laine and Taichman recommend finding a way to have a conversation with our patients about guns. I have found a very effective way to initiate such a conversation with my patients who have firearms – I leave my latest copy of The American Rifleman in the exam room. I have had some very interesting talks with my patients about our favorite pistols, time at the firing range and the use of firearms for hunting and for self-defense. We also talk about firearm safety and safe storage. Those not interested in guns just ignore the magazine and look at People or Southern Living instead.Steven Kulback, MD, FACP Author, Article, and Disclosure InformationAffiliations: Editor in Chief (C.L.)Executive Editor (D.B.T.)Disclosures: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2714.This article was published at Annals.org on 17 October 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byComorbidity Profiles Identified in Older Primary Care Patients Who Attempt SuicideFirearm Injury Prevention: AFFIRMing That Doctors Are in Our LaneDarren Taichman, MD, PhD, Sue S. Bornstein, MD, and Christine Laine, MD, MPHGun Violence: A Biopsychosocial Disease 19 December 2017Volume 167, Issue 12Page: 892-893KeywordsAlcoholsDisclosureEmotionsFire safetyFirearm injuriesForecastingHealth careIntimate partner violencePrevention, policy, and public healthSexually transmitted diseases ePublished: 17 October 2017 Issue Published: 19 December 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...