[Originally posted on SFGate: http://www.sfgate.com/cgi-bin/blogs/rchoi/detail?entry_id=88328]
Should pediatricians be punished for asking about guns in the home?
Far be it for me, a Bay Area pediatrician, to tell Floridians about how to keep their kids safe. But having spent half of my life in the south (and I don’t mean LA), perhaps I am only partially carpetbagging.
Florida’s Governor Scott is on the verge of signing into law a bill that would penalize doctors for asking about guns in the home. The original bill shockingly included a $5 million fine and a five year prison sentence if a doctor asked about a patient’s gun ownership, entered gun ownership information into a medical record, or refused to care for patients who declined to answer related questions. An unsatisfying compromise amendment between the NRA and the Florida chapter of the AMA limited the penalty to the possible revocation of a medical license and would allow questions about gun ownership and entry of that information into the medical record only if “medically necessary”.
Similar legislation is making its way through the Alabama legislature.
Particularly bewildering to me were claims made by state legislators that gun safety was outside the scope of a pediatrician’s practice. According to Marion Hammer, a past president of the NRA, “Families take their kids to pediatricians for medical care, not to talk about guns.”
I would beg to differ.
While there are several directions I am very tempted to go with this outrageous bill, I am coming to rest here: my scope of practice is health.
Scope of practice traditionally refers to a license authorized range of a provider’s services. Not surprisingly, the range of a scope is charged with turf battles between specialties and different health professions -like the time your neurosurgeon and orthopedic surgeon wrestled over who got to perform your back surgery.
The scope of practice I am talking about we all can own. I have a responsibility to ask about, diagnose, educate, and treat obstacles to health. For those who see children in their practice, discussing topics such as swimming pool safety and smoke detectors are routine at regular check ups.
But let me take it a step further. I would argue that nutritious food, safe medications, air quality, domestic violence, affordable housing, access to health care, sex trafficking, cultural factors, schools, safe neighborhoods, voting, human rights, international trade agreements, and the state budget, to the extent they impact health of my patients and communities, are also in my scope of practice.
Not only do I feel an obligation to explore these issues, my patients expect it of me. When my infant patient is drinking contaminated Chinese formula or if children can’t play in their front yard for fear of gun fire, it is my problem too.
Commonly called the social determinants of health, addressing only the downstream impacts of unhealthy and violent circumstances in the form of specific diseases (or even death) is addressing a fraction of the problem and woefully insufficient.
So yes, to ask if a device that is associated with over 30,000 deaths a year and over 50% of suicides is unloaded, locked up, and kept out of reach of children is also well within my scope of practice.
At issue is not only whether or not a gun should be in the home, but also the right of physicians, free of legal entanglements, to provide the anticipatory guidance for an environment where their patient can thrive.