What are your health risks? Sorry, can’t ask.

The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?*

The questions followed by asterisks may soon become illegal in a state near you.  Perhaps the other ones will too.

For example, Florida has made it illegal for physicians to ask whether there are guns in the home.  This matters.  People who live in a home with a gun are three times more likely to be murdered–most frequently from domestic disputes. As Arthur Kellerman showed in his 1993 paper “Gun Ownership as a Risk Factor for Homicide”, 70% of homicide victims are killed by people they know, after an argument. Having a loaded gun within reach makes people much more likely to kill each other in the heat of the moment.

In Connecticut, one of my patients was a middleaged woman living with her schizophrenic son. He occasionally muttered he wanted to kill her.  “Do you have a gun in the home?” I asked.  This was important.  It would change how likely he was to succeed in his wish.  A gun with bullets in the home would increase her chances of dying dramatically.

“Yes,” she said.  “I keep a loaded gun on me at all times.” She ignored my advice to get the gun out of her home. Or at least take the bullets out. “It makes me feel safe,” she said. That was her right as a patient, to ignore my advice.  It was my duty as a physician to let her know the increased health risks.

After violence escalated in the home, and her son stabbed her with scissors, undeterred by the gun, my patient decided for herself to get rid of the gun before he used it on her or she used it on him. Did my doctorly advice make a difference? Maybe. Or not. But it was my duty as a physician to provide the evidence-based information that could guide her in making a decision that could mean life or death for herself.

I don’t want a state legislator to prevent me from doing my duty as a physician to provide sound health advice–or curtail my patients’ freedom to ignore it at their will. State legislatures should not crowd themselves into the clinic room.

What questions does your doctor ask you?

6 thoughts on “What are your health risks? Sorry, can’t ask.

  1. I agree that personality profiles and job requirements play a huge role. There are a few factors at play. One is that we are told what to do for so long (with VERY set schedules that are hugely restrictive ie being on call every three days) we forget to think for ourselves what we want. Another–which I felt VERY strongly in medical school and residency especially–is that we simply don’t have enough time to get involved. The 80 hour work weeks that doctors-in-training are “limited” to prevent meaningful engagement at a time when we are developing our professional identity. So doctors are trained as individual-care-providers, rather than as societal-health-providers-via-policy-change.
    Full time practicing doctors don’t have time to run for office. We’re cogs being worn down in a medical industrial machine, rather than the makers of the machine.

    • Totally agree… it’s institutionalized personality profiling, if you will. The medical profession has implicitly endorsed the ‘overwork to death’ model of success such that it precludes engaging society through other means. I’ve jotted down a few thoughts as to a remedy (dreams) scheduled for 4 July. Hope to see you in LA.

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