I’m not so sure. I really had not expected, and have not seen, much debate over the item in the op itself. With I think just one exception I have not heard anyone take the position that the right to bear arms extends into the right to not be asked about guns in private conversations, or extends into a right to limit others freedom of speech, whether one agrees with that speech or not, or believes it is rational to make that speech or not. I had been fairly confident that most here understand that asking about guns and even advising that guns should not be in a household with children (speech intended to influence a choice that others are free to make or not make) does not equal banning guns and in no way infringes on the right to bear arms. I had been fairly sure that most of the gun rights advocates here at least are also advocates of other freedoms as well. With rare exceptions those expectations were well founded. Specific to the op itself the subject really was more of rant to be vented than a debate to be had.
Off of that admitted rant there was an informative side discussion about whether or not the law would stand on appeal and why or why not, a hijack as to whether or not pediatricians should be discussing safety issues at all, about what is or is not a pediatrician’s “job”, a discussion of how significant or insignificant this particular issue is as a child safety concern, a discussion as to whether or not this NRA overreaching is or is not an understandable reaction to positions taken by various medical organizations, such as the AMA and the AAP, an explanation about the limitations doctors have over dismissing patients, and a compare/contrast to the circumstance regarding pharmacists refusing to fill the “morning after pill”.
While it contains some Pit degeneration to be sure, what other serious or interesting discussion would you have expected a GD thread to have brought to bear?
suranyi, thank you. I had wondered if it did become a major national item, by virtue of working its way up the courts, within the election season, how various factions would position themselves. There is always a need to pander some to Florida after all. Yet even (or maybe even particularly?) the Tea Party would likely have some who would feel discomfitted by this governmental restriction of speech. If it is stuck in lower courts for years then those speculations are of theoretical interest only. Or maybe not of interest until 4 to 5 years from now?
What is a physician’s job: Is a doc a mechanic of the body, or do they have some larger realm of interest that requires them to ask nosy questions. This wouldn’t have been an issue 100 years ago.
Branching off of (1): Is it ‘free speech’ to ask nosy questions of a patient or is there some other descriptor that is more accurate? Where does patient autonomy end, and actually working for the patient begin.
Hmm. In what way do you think it wouldn’t have been an issue 100 years ago. I mean I agree but I am not sure from the same direction. There would have been no question then that a physician is not just a body mechanic and that their job was to ask nosy questions. Actually 100 years ago there was little most docs could do, at least that did more good than harm, in the mechanic realm. Mostly they sat at the bedside and asked nosy questions. One of my friends, also a doctor, has noted that in past ages doctors had little they could do to cure so they sat and talked more and were very well respected. Now doctors can cure more but are respected much much less. Probably, he thinks, because we neglect that nosy questions bit.
How do “nosy questions” at all get in the way of, or conflict with, patient autonomy? The patient brings up issues and I do not ignore them. But I am also bringing up the issue that a child is moving up the BMI curves and asking about how many juiceboxes and snacks are part of the kids diet. I am also trying to find out if food is used as a reward and if there is a TV in the bedroom, how much TV is being watched, what kind of exercise. What do the parents do in terms of physical play with the kid? Some parents don’t want to hear that little Johnny is, well, obese. Or on a path to get there. And I will try to sell the behavior changes I think are wise in way that does not offend or come off as “nosy” because I am actually a pretty good salesman and know better. But my being “nosy” in that way ultimately is part of what the patient is buying. And that is true for any issue that has an effect on the health of my target population. I am not forcing any behavior on anyone; I am trying to sell them on it. And that sales pitch is speech that I feel should be protected speech, even if you aint buyin’ what I’m sellin’.
Quite reasonable. So long as you’re willing to accept “None of your business” as a response unless you have specific reasons to be concerned. The issue in Florida was physicians that weren’t reasonable. Instead of saying “Here’s some literature regarding gun safety in the home. Would you like me to go over any of it with you?”, some were saying, “Do you have guns in your home? Get rid of them.” And at least one said find another physician if you’re not going to answer my questions.
These are not reasonable stances. Thus an unreasonable law. You should note however that there’s nothing in the legislation that precludes the first, reasonable, conversation.
Do you have any actual examples of these things. In this thread I’ve yet to see any examples of doctors even going to far. I’ve seen someone claim a doctor told them them to find another physician but I’ve seen no statement from the accused doctor.
If things the doctors in Florida are overstepping there bounds so far and so often that they need to pass a law to curb that behavior then surely there are some verified examples out there right?
I’m sure that as hotly as this was debated that all the examples were checked and rechecked. First by the groups presenting them and then by the groups that would love to discredit them. I have no dog in that fight and I have neither the time nor interest in redoing their work. I am satisfied with the work as presented by the people that were there.
If you can locate any cites to discredit them, please do share though.
Untrue. Those conversations are explicitly outlawed. The law does not just say: “A physician must accept a response of ‘I would rather not answer that question’”; the pediatrician may not ask.
Secondly, for the sake of discussion assume the anecdotes are true exactly as portrayed with nothing more to the story - would this law be a proportionate response? Or would be, perhaps, more akin to making all guns illegal because 174 children were killed by accidental gun use?
And if the anecdote was true then the pediatrician who kicked out the family for refusal to answer the question is already violating legal standards against patient abandonment. A new law that actually addressed that and only that would just be superfluous. Patients can fire doctors on the spot but doctors already do not have the same exact privilege except under very constrained circumstances. Refusing to answer a question is not one of them.
Now I’ll admit - I can certainly see a circumstance in which I might suggest to a patient that they may want to seek care elsewhere if they are not going answer my questions to them, that another doctor might be more to their liking and work out better for them. I am allowed to do that. Would you have a problem with that?
Also, by way of checking the examples. I am positive not. At least not legally. The patient family is free to tell their version but the physician may not (with only certain exceptions) discuss the medical care of the specific patient without the patient (or their parent/guardian in the case of a minor) giving explicit consent for them to do so. HIIPA.
Yup, but I knew I could get a thoughtful reply from you. It’s just that the pit doesn’t generally nurture calm discussion. The autonomy/authority issue seems to be part of the root of the gun issue, as ‘gun enthusiasts’ apparently would prefer that the issue of guns-in-the-house not be addressed at all, even in an appropriate medical context
The premise of the thread is that the law precludes discussing guns-in-the-house at all.
I have not seen the text of the law. Does anyone have a link?
Does that last bit render the law actually completely meaningless? The intent apparently is to put in an out for evaluating for emergent things like immediate suicide risk, but on review could a pediatrician use that to justify in his/her good faith assessment the information is “relevant to the patient’s medical care”?
Sure, but how much time and energy would you be willing to spend in court arguing about your “good faith belief”? You never know whose dad is going to be a gun nut with a chip on his shoulder, time on his hands, and NRA’s legal division on speed dial. Who is going to risk having to close the office for a couple of weeks and pay a lawyer out of his own pocket?
Better to just let parents keep on thinking that as long as the loaded pistol is on the top shelf of Daddy’s Forbidden Closet of Mystery, there’s no way Junior is ever getting to it.
Well, as part of a process to get the law stricken, maybe. Otherwise, no. IANAL (and I get shivers just thinking of being one) but wonder if the clear intent would be respected or the wording and how a local process would decide what was a good faith assessment of medical risk. What sayeth our legal types?
Also, for Projammer is this quote from the text of the law:
That’s a pretty wide brush, since the majority of gun enthusiasts who’ve posted here think the law is pretty stupid.
Actually, that last bit seems like it could easily be used to justify the only formulation of this kind of law that might make any goddamn sense, that is, “don’t talk about gun control unless you’re dispensing appropriate gun safety information in a doctor-advising-on-safety context”.
It’s still a stupid, stupid law that needs to die, but it’s much less harmful with that clause.
No, we don’t need a law, we just need doctors that will not ask questions that have no relevance on someone’s health.
As for what kind of ninny state we live in, the fact that a doctor chooses to be nosy about that which is not his business should tell you all you need to know. If my doctor asks me that I’m going to counter by asking him if he has a swimming pool, because that’s just as relevant.
I guess there is just a basic fundamental divide with one school of thought that believes a pediatrician should be able to ask about exogenous risk factors in the home (smokers, pools, guns, at risk for TB exposure, diet, etc.) and the other school of thought is that asking about guns in the homes of children is completely inappropriate (at best and should be legislated at worst).
Context, Airman. If the doctor asks you that AND about swimming pools in the context of “common in-home dangers for small children” while your 1-year-old is getting booster shots, you really think that’s a problem?
I mean, if a GP asked me that outside the context of a reasonable safety discussion, yeah, it’d be intrusive and merit snark. That’s not what we’re discussing here, as far as I can tell–we’re discussing the common and useful practice of pediatricians offering child-proofing and child-safety tips to parents of smaller children. Gun safety is a component of that.
The problem is that anticipatory guidance and safety counseling can be considered standard of care. In other words, if I fail to do it I am leaving myself open to liability.
When a kid shoots himself or someone else with an improperly stored gun, lawyers and agitators (who may or may not be well-meaning) are going to swarm the grieving parents and try to find out who can be blamed, and the pediatrician is definitely going to be on that list. If the chart says, “Inquired about guns in the home. Guns are present, may not be safely stored. Provided information about gun safety.” then he’s covered. If it says “Inquired about guns in the home. Patient’s father suggested I go fuck myself.” Then he’s covered.
If he documents nothing at all, his ass is going to court. Even if he wins it will cost him thousands to tens of thousands of dollars in lost revenue and legal fees, not to mention the hit to his reputation.
Now I’m sure the people here who take offense that a doctor would help parents understand basic safety issues for his child would NEVER, EVER sue over such a thing. Unfortunately, not everyone would have such steely resolve in the face of such promises of justice for Junior (not to mention the sweet, sweet Benjamins).
So be an asshole about it if you want, or lie if you want, or take a proud political stand against a guy who really just wants to get through this visit and the 30 that come after yours and who probably hasn’t voted for a Democrat since he got his first paycheck. But remember that the doc is setting himself up for some big-time bullshit if he doesn’t ask, so don’t hate the player–hate the game.
No, there’s an inherent difference between guns and the rest of the “exogenous risk factors”. You can fall into a swimming pool purely by accident. You can inhale second-hand smoke against your will. You can be poisoned by radon gas without ever even knowing it. But you cannot be killed by a firearm without actively, consciously pulling the trigger. The necessity of active participation makes it markedly different. Therefore, to my eyes it is not a question of concern such that it needs to be asked by a doctor. It smacks of agenda.
Now, should they be allowed to ask? Sure. They should also be allowed to ask if you changed your brake pads and rotors in your car, if you cheat on your wife, what you’re going to do with that $500,000 you won in Vegas and didn’t report, and how you buried the body of the guy you killed last week. Does that make it right that some of them evidently will no longer treat you if you refuse to answer? It’s not something that so dramatically affects health and wellness that it demands to be answered. Instead it looks like someone wants to know so they can determine something about you and your character. You might as well ask them how they feel about Obama or if they’re a God-fearing Christian man. It’s not any of their business, simple as that.