So Your Doctor Has An Agenda. You Think The Government Doesn't?

You may also like...

204 Responses

  1. plutosdad says:

    actually I thought it was the insurance companies who want to know. After years of gathering information and seeing if there is any correlation with injuries, they may decide to raise rates. Or just decide to raise rates anyway.

    I have heard from doctors that they insurance companies require all those questions be answered, maybe they think that's true. But I think it's just as likely that the doctor thought the insurance company would refuse to pay if the patient didn't answer all the questions.

    AT least, that's the reason I've read before about this very issue.

    I always leave those weird questions unchecked and no one ever says anything.

  2. Kevin says:

    The only time my doctor has asked about guns I own was when I took my shirt off and he wanted to know what I was carrying and how I got it in brown in stead of black. I would not continue to use a doctor if his interest in me was beyond caring for my health, but I sure as heck wouldn't ask the government to intervene. That's asinine.

  3. Ben says:

    Ken,

    I can see a danger in telling doctors "You may not ask about this." I do not see a danger or at least a comparable danger in telling doctors 'you may not refuse care to someone for this reason'. Do you believe that a doctor ought to be able to withhold care for any reason which strikes their fancy? People in remote and rural areas – or even the destitute in urban areas – do not necessarily have the means to travel around finding an ideologically compatible doctor. As access to medicine is a lead indicator of socio economic mobility don't you think it behooves us to make sure some individuals are not unduly burdened by social taboo in their attempts to seek care?

  4. Wagnerism says:

    I agree with this opinion regarding restricting the doctor-patient dialog. I believe that something could be done about disclosure so that potential patients can make an informed choice.

    One tough scenario: A desparate young woman going to a clinic with some generic name that feels like Planned Parenthood, only to come out with a bible, a prescription for abstinence, and an insurance company form to justify a chastity belt as a necessary medical device.

    Determining what must be disclosed is far from easy, but some of us need protection from those that hide their agenda until you're in a backless gown.

  5. C. S. P. Schofield says:

    I have to say that I have always dealt with questions I considered intrusive on patient history forms by scrawling "None of your business" across the relevant areas. Nobody has even questioned me on it.

    I thought, and I may well be wrong, that the MD's asking about guns thing had started as a government initiative or program, and that that was where the "let the government fix it" idea came from; less having the government muzzle the doctors than passing legislation to stop an unpopular piece of government nosy-parkering. Anybody have any idea where I got this notion from?

  6. Jeremy says:

    I don't have a problem with doctors asking ridiculous questions.
    I don't have a problem with doctors refusing care for whatever their reasons are.
    I don't have a problem with consumer choice in health care, i.e., taking your business elsewhere if the doctor sucks.

    Why should the government be involved in this at all? Oh right, they need an issue to market to keep their job next election, silly me.

    Ken you missed a great opportunity for humor. You should have written in something open-ended such as, "I find that I like rabbits," near those questions.

  7. Ken says:

    @Ben: The short (busy) answer is that such a true anti-discrimination provision would present an entirely different set of issues not about pure speech. Note that the opinion here addresses that — despite the bill being pitched as prohibiting discrimination, it actually did not prevent doctors from firing patients.

  8. Longtime lurker here, but this one hits close to home. I am a family physician in Canada, so the culture is quite different, but the general principles apply…

    While I agree with Ken that this particular example re: firearms is quite ridiculous (akin to using a bazooka to swat a fly), I think there are many places where some governing body (either legislature or the professional college the physician belongs to) should exert some limits on what is appropriate. There is a huge power and knowledge differential between a physician and a patient, and so I don't think it's controversial to say that physicians should be regulated to be competent and give medical care within some reasonable standard.

    What that standard is, there's the rub, particularily around more 'controversial' areas like birth control (or abortion). It frustrated me to no end to experience in medical school that some physicians whould completely shut down a teenage girl who came to them to ask about contraceptives and refuse to discuss the topic. To me, that is a betrayal of a physician's duty to put the needs of the patient above their own, and the relatively new college policy here in Ontario (http://www.cpso.on.ca/policies/policies/default.aspx?ID=2102) agrees — you're not obligated to provide any particular service but you must discuss it with your patient and advise that they can see other physicians who may provide that service ("and in some circumstances, help the patient or individual make arrangements to do so.")

    It's easy to be glib and say, as Ken did, "I'd find a different doctor", but even in Canada with Universal Health Care, that is easier said than done, especially in rural areas or for disadvantaged populations. I can only imagine the USA with their byzantine insurance system, this would be even more difficult.

  9. Michael says:

    One thing I find interesting to note is that if a doctor asked you what your religious beliefs are (while a legitimate question that might have real implications regarding your diet and health habits that you wouldn't think to mention on their own), and then denied you or discouraged you from seeing him again, he'd be up a flagpole in no time. It seems to me the only fundamental difference is that political beliefs don't put anyone in a protected class on their own.

    It's really weird that while we have laws on the books that prevent doctors from kicking a patient to the curb for any number of reasons, nothing about this law actually disallows that for asking about gun ownership, etc. As long as the doctor doesn't ask you, and he finds out any other way, or even suspects without confirming, he can still "fire" you as a patient over it.

  10. Vomer says:

    As a physician I feel like I may be able to provide some insight here into why doctors ask these kinds of questions. In your story about your childhood doctor, he was attempting to gather what is known as Social history (As opposed to Medical or Surgical or Family history) Ideally this should be done face to face with your doctor so, if as in your case, sexual history is not relevant you can quickly move on to other more important things. That being said, many children of that age are engaged in sexual activity and it is important for physicians to know if a patient is sexually active, one of the hardest things I have ever had to do as a doctor was to tell a 14 year old that she was now HIV positive, if someone had spoken to her about condoms earlier that conversation might have been avoided.
    The problem with written questionnaires is that they are one size fits all, and cannot make that sort of differentiation. That being said, questions about pornography are not routine and I cannot comment as to why he might have been asking you about that.

    As for the firearm questions, one of the roles of a family doctor is to look out for situations and behaviors which might cause harm and to educate patients about those potential harms. The questions you ask depend on the particular situation of the patient. For elderly patients we ask about fall risks like loose carpeting, social isolation and memory problems. For adults we talk about things like diet, alcohol/drug abuse and seat belts. For children we talk about securing household poisons, un-gated pools and whether or not there are any loaded unsecured firearms in the house. We ask these questions not out of any institutional political agenda (although obviously individual physicians will have their own personal views) but because children die because of these issues. ~1-2 per day from firearms (double that if you include firearm suicides) ~9 per day from drowning and ~ 1 every 3 days from poison (although the number injured from poison is much higher.)

    It should be noted here that unlike government intervention, no one is under any obligation to follow a physicians advice. Our job is to educate people and inform them about risks. There are very few situations where doctors can compel people to act. In the example of firearms, if someone has young children and loaded guns lying around I will talk to them about trigger locks and gun safes and make a strong recommendation that they use them, but I cannot force them to change their behavior unless they are actively harming or endangering their child. Different physicians may have different ideas about where to draw the line for something like child endangerment but just because some physicians are overzealous does not mean that these questions are inappropriate.

  11. EarlW says:

    "restricted patients based on their voting record." This is not about voting. This is about how a person would treat the provider of their medical care.
    As a Libertarian, I don't care about a lot of personal choices people make, as long as they don't affect me. When they reveal that they think I should be enslaved by laws that they support, it's time to take a stand.

  12. Allen says:

    I have never been asked, by any doctor, any of these kinds of questions. If I had been I would have been out of there in a heartbeat. What I eat, what I drink, how much exercise I get, sure, that's directly in line with risk management that is medically related.

    But, would I go to a doctor to have my brakes checked? You would wonder about someone's sanity if they even suggested it. What the hell would a doctor know about gun safety, and would you even expect them to? Why doctors aren't screaming bloody murder about this kind of thing is beyond me.

    Good grief, next time I have a legal question maybe I'll ask a doctor, he's an expert.

  13. Dan Irving says:

    What about protecting me from governments with personal agendas. I'd get behind that in a heartbeat.

  14. Maz says:

    I gotta agree with Vomer on that one. That's the only reason I could ever see to ask the question and the only time I've ever seen an article about it was when pediatricians were asking about guns in the house, especially in regards to new parents.

  15. Narad says:

    The questions you ask depend on the particular situation of the patient.

    Ding! The first thing I wondered about this was the following: "after an Ocala couple complained that a doctor asked them about guns." This has pediatrician written all over it.

  16. Dwight Brown says:

    "What the hell would a doctor know about gun safety, and would you even expect them to?"

    One of my uncles is a (now-retired) doctor in Pennsylvania. He's also an active hunter and shooter.

    My sister is a doctor in the same city I live in. Her family has guns (safely secured) and I know she's familiar with the Four Rules.

    I've run into several doctors where, when the issue of guns has come up, the conversations have not been "guns are bad" but more along the lines of "Do you have a permit? What do you carry? What do you think of the new MasterBlaster2000 as a carry gun?"

    (I vividly recall running into a doctor while wandering around outside one of our local hospitals, trying to find a way into the building. He took a look at my "Celebrate Diversity" shirt…and started ticking off all the ones he owned or had shot.)

    Point: All generalizations are false, including this one.

  17. Deadly Laigrek says:

    I think that the questions about whether or not you have had sex are fairly routine- I've gotten them ever since I "graduated" to the glorious age of ten (still not sure I want to be older than that). However, the questions about masturbation and the like are totally irrelevant to a physical examination of you. The only thing I would have done differently is directly asked the doctor what any of that had to do with anything.

  18. princessartemis says:

    I have only once been asked if I have a firearm and if so how is said item stored and is there anyone I could trust to hold onto it should I have one: when I was being admitted to a mental hospital for strong suicidal feelings. But of course, at that time, it was eminently relevant information.

    If I was asked any other time, I'd find that strange to say the least.

  19. S. Weasel says:

    It gets more complicated when the government and your health care professional are the same thing. Socialized medicine makes the doctor/patient relationship feel really whack.

    (Also, FYI, a doctor's appointment is mandated at ten minutes. Oh, and we have co-ed hospital wards, brrrr).

  20. James H says:

    IIRC, the Florida law attempts to make exemptions for things like mental-health patients, but there are so many shades of gray in there that I'd prefer the physicians have the option of asking the question if they think it's needed.

    As far as a pediatrician, I'm still trying to figure out how in the world this kind of conversation can possible be invasive:

    "So, Tommy's 2 now, and he's starting to get into stuff."

    "Yeah."

    "Kids this age are very curious. Do you keep any guns in the home?"

    "Yeah."

    "Are they securely locked away and out of Tommy's reach?"

    "We haven't really thought about it … "

    "*Sigh* Alright. To prevent accidents, you should make sure your gun is secure. Here's some literature if you have questions."

    Oddly, I would think that even gun-rights groups would at least be on board with pediatricians asking about this sort of thing, and even provide some information that the pediatricians could share with their patients.

  21. @Narad — thanks for that link. Gives some perspective. That firearms question is on standardized forms for childhood visits. I wouldn't refuse to treat a patient if they didn't answer that question, but I probably would if they snapped and yelled at me or my staff. (Usually here in my urban centre in Canada that gets a laugh as 99% of people don't own any sort of firearm. The only other question that gets more laughs / awkward looks is the "are you related other than by marriage" quesstion for couples that are newly pregnant / planning to be)

    Also goes to show that knee-jerk laws drafted to deal with particular anecdotes are poorly thought out. Any physician, and probably most people, would feel that this is exactly a situation where the MD "in good faith believe[d] that this information is relevant to the patient's medical care or safety."

    Another depressingly common situation where asking about firearms in the house is medically indicated would be with a suicidal or psychotic / homicidal patient, as that can inform the urgency of more drastic interventions.

  22. Chris R. says:

    I've never encountered a weird questionnaire at the doctors, luckily. I am pretty sure I'd find another doctor before continuing on with my care that day.

  23. desconhecido says:

    A couple years ago there was a discussion on a blogging doctor's blog about the gun question question. That particular blogging doctor posted at least one comment on this blog within the last couple weeks — maybe he'll pop in and tell us all how it is.

    If I were to go to my doctor and get asked about guns, I'd be a little surprised. Sort of like if I went to the gun shop and the guy behind the counter snapped on some rubber gloves. But, if a medical person were to ask, I know the answer:

    Do you own a gun? No.

    Then the answer can be entered into their records and life can move on.

  24. Narad says:

    As far as a pediatrician, I'm still trying to figure out how in the world this kind of conversation can possible be invasive

    The wife would seem to have just flipped out the question and promptly started to babble about hiring a lawyer. She also whines, "Now my children have to suffer because of this and that's not right." It's very, very similar to the asymmetric entitlement I've heard from antivaxxers who wind up "fired" by their pediatricians.

  25. Narad says:

    ^ "flipped out at the question"

  26. marco73 says:

    Well, at least the Florida Legislature didn't vote to spend a bunch of non-existent money on a choo-choo to nowhere.
    http://sacramento.cbslocal.com/2012/07/05/california-assembly-approves-high-speed-rail-spending-plan/
    But, yes, sometimes our legislators really put the DUH in Flori-duh.

    Our family pediatrician asks our kids only once about guns – when they describe how to safely handle a 12-guage pump, the doctor typically leaves the issue alone.

  27. James H says:

    Sort of like if I went to the gun shop and the guy behind the counter snapped on some rubber gloves

    "There are some new requirements for the background check."

  28. Allen says:

    @Dwight Brown

    Of course some doctors will have this knowledge, and I could have stated that better. My main point is that I do not have the expectation that a doctor would have this knowledge.

    Now I don't mind discussing safety issues with anyone who is a regular practitioner of some risk associated activity, but putting doctors in the position where they are to be considered general risk management experts is not a very good idea IMO.

  29. @ S. Weasel — Are you overgeneralizing from your specific experiences?

    I'm a physician from Canada, and we have "socialized medicine", but I don't find that it intrudes on the doctor/patient relationship (at least, not more so than I imagine a myriad of difficult to navigate insurers would). And we certainly don't have mandated time-slots for appointment times, or co-ed ward rooms.

  30. Robert says:

    If doctors are really concerned about firearms safety, they would give the speech like this:

    "I'm not asking if you have any firearms in your home. I give this informational pamphlet to everyone in my practice about the safe storage of firearms regardless. Now, on to the next subject…"

    And that would take care of it. No need to ask any questions. Otherwise they do have an agenda other than safety.

  31. @Robert — If doctors are really concerned about heart disease, they would give the speech like this:

    "I'm not asking if you are overweight or eat at McDonald's every day, or checking your blood pressure or cholesterol levels. I give this imformational pamphlet to everyone in my practice about healthy eating and exercise regardless. Now, on to the next subject…"

    And that would take care of it. No need to ask any questions.

  32. Narad says:

    And that would take care of it.

    You mean aside from getting out the three-ring binder of all the other informational pamphlets that would logically follow from this approach? Why not just put them all in the waiting room and forget about such matters entirely?

  33. tsrblke says:

    @Vomer,
    The counter argument of course is that gun safety could reasonably be considered outside the bound of medicine. I think the problem of course is the ever expanding notion of "Health" (See the WHO definition.) This leads to a patchwork set of professional ethics where doctors tend to grab whatever they're interested in and push that (rather than a professional standard.)
    So you feel the need to educate people about gun safety, that's good I suppose, but why stop with trigger locks? Several people are injured improperly loading muzzle loaders each year, do you teach them how to do that (if they own muzzle loaders). Why focus on guns? You could ask if they cook (and educate them on knife safety and cutting techniques too) or perhaps they garden and need a lecture on not touching miracle grow with their hands. Where does it end and at what point does it become intrusive? (Granted that will vary per person I suppose.)
    A doctor isn't supposed to be an expert in all aspects of life (unless I guess you subscribe to that aforementioned WHO definition of health) there comes a point where you do have to step back and just trust that the patient is capable of educating themselves on the basics of what could be called "life safety."
    (I'd argue by the way that the elderly questions you mentioned fall into a different category. You ask those questions in part to ensure that the patient is having their needs met if you have concerns that they aren't able to actually care for themselves due to physical or mental constraints. The same can't really be said for a relatively healthy young to middle aged adult. Similarly you might ask a wheel chair bound person who lives alone if they have problems moving around their house, I doubt you'd just spring that question on an average patient.)

  34. Ben says:

    Ken,

    I read the full opinion and understand now, my apologies. Florida was attempting to "recast" the law from one that prohibited speech and incidentally impacted discrimination, into a law that prohibited discrimination and incidentally impacted speech. (I was on my phone before and it discriminates against .pdf's for some reason, of late :( )

    As a general question to any other readers that have more experience deciphering law, are the judges statements about standing, injury-in-fact and 'ripeness' a Florida concept or is that national? It seems inane that you may not challenge a law if it is not likely to be enforced or that a "favorable decision" would not "redress the injury".

    Or is this only used inside the scope of a 'summary judgment' and there is some other 'avenue' to approach absurd or antiquated laws?

  35. @tsrblke — I think we're in the same ballpark here. One tries to individualize care for the patient and meet their needs. And try to address common problems in that particular demographic (falls in elderly, drownings with toddlers, MVAs / drinking in young adults) I think it isn't out of bounds for physicians to bring this up, as drownings / gun shot wounds are very much a health issue, and prevention is key.

    By the same token, I'm a physician, not a gun expert — so beyond the initial "have you thought about the possibility of Jr. getting his hands on your gun and taking steps to prevent it?" I leave the specifics to the experts. Same way I would defer to a dietitian for nitty-gritty of meal plans for my diabetic patients, etc, or to a surgeon if my patient had a surgical problem.

  36. Luke says:

    People fire their doctors for much crazier reasons. My dad was once fired for telling a patients mother that the 13 year old patient was overweight (this was told to me by the patient, a classmate at the time, and not my father). If you don't like the questions your doctor asks you or his recommendations for you then find another doctor.*

    *You do not have grounds to sue your doctor after firing him over his recommendations after learning that those questions & recommendations were in fact correct.

  37. S. Weasel says:

    @DancingSamurai I don't know about overgeneralizing from my experiences. More like overgeneralizing from my country of residence.

    In other words, not a sample of one, but a sample of sixty million.

  38. Robert says:

    @DancingSamurai: Because a patient does not know what their blood pressure is, or their colesterol count, this is something that requires a physicians assistance to adequately evaluate the circumstances (and actually involves something the doctor *went to school for*). Not so with firearms safety. They know if they have a firearm or not. If you are only interested in safety, give your information to everyone and don't ask questions. Otherwise you are pushing a political agenda, no matter how you choose to sugar-coat it. Do you ask them if they have a swimming pool? 5 gallon buckets? Or any number of things that are statistically more dangerous than firearms? Are you a certified gun safety expert?

  39. Narad says:

    Do you ask them if they have a swimming pool?

    Yes.

  40. tsrblke says:

    @DancingSamurai

    You've jumped far too specific though in there. Wouldn't it be simpler (and actually far more accurate) to simply say to the parents "you've looked into the possible common household dangers for young children I hope? If you have any questions I'd be happy to help answer them."
    When you pick and choose what you ask about you're pretty clearly playing your own bias hand by implying that X (guns) is more important than Y (5-gallon buckets.)
    Furthermore, if the article linked in the comments is correct, the American Peds Association doesn't suggest locks, they suggest "removal." That's an agenda, clear and simple.

    There's a difference between querying a patient to ensure their needs are being met if you're concerned about that and suggesting competent adults aren't capable of making intelligent decisions about their belongings and their children.

  41. SassQueen says:

    I am a pediatrician. Do I ask about guns and swimming pools? Absolutely. Is it a political agenda? Not once, in the 10 years that I have been practicing medicine, did I ever think that any reasonable person would consider I was asking from a politically motivated perspective. Guns fire and those bullets kill children (both self-inflicted and not). Pools have water, and children drown in water when unsupervised (I also warn people about leaving their kids in the tub unsupervised). It is my duty and obligation to make sure people are aware of the things that can harm children. Am I an alarmist? Nope, pretty laid back actually. But as much as I would like to rely on people's common sense, I deal on a regular basis with the outcome of people's lack of common sense.

  42. Gavin says:

    The only problem I have is with Doctor's abusing their position of trust and fiduciary responsibilities to get unnecessary information from me.

    The fact is, we tell doctors a lot of things we wouldn't tell anyone else otherwise simply because of that necessary trust. I don't think it's right for them to carry out non-health related agendas like that.

    That being said, like Ken I just wouldn't go to that doctor anymore. This isn't nearly as bad as them price gouging us for life saving proceedures when stores can't even price gouge on water if a storm is coming.

  43. Gavin says:

    @SassQueen,

    So… if people have guns you warn them that they're dangerous? I guess that's a valid reason but would you then refuse to see them if they refused to answer?

    What kind of reason would a doctor seeing adult patients have for this question, do you think?

    In a joking/quasi-serious manner (not meant to be rude to you at all, just a way of making a point): I also have knives in my kitchen and I do own a roof that I occasionally have to get up on to clean off. The draino under my sink certainly looks like blue coolaid mixed with jello, that's like a super awesome drink if I ever heard of one. I even drive a car multiple times a day and that's far more dangerous than any gun I may have at home (I actually don't have any firearms though I wouldn't be opposed to having one).

    Perhaps next I'll have to answer questions about how I dispose of plastic bags when I get back from the store? I naturally put them all over my wife's head and tie them off. Boy oh boy does she rush to get them off.

  44. @tsrblke — I agree with your sentiment that generalities are a better starting point than specifics (this is also basic medical history taking 101). However, having specifics as examples to reinforce the general is also good practice, so: "You've looked into the possible common household dangers for young children, SUCH AS [X] [Y] [Z], I hope?" is better. Some parents may not have thought of Y as a danger, and specifically listing them helps outline some common ones.

    As to what goes on that list, while some physicians may "grab whatever they're interested in", most of us do indeed go by professional standards — in Canada that is typically the Rourke Baby Record, which, among others, lists pool/water safety AND FIREARMS as standard risks to discuss with patients.

    Most of these items aren't pulled out of thin air but are included because of studies and statistics that show significant risks to the health and welfare of patients. Studies have shown that "the presence of a firearm in the home was found to be a strongly positive risk factor for completed adolescent suicide. Apparently, the adolescent without a firearm in the home is more likely either to use a less lethal method or to not attempt suicide." (Brent DA, Perper JA, Goldstein CE, et al. Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients. Arch Gen Psychiatry 1988;45:581-8. Brent DA, Perper JA, Allman CJ, Moritz GM, Wartella ME, Zelenak JP. The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study. JAMA 1991;266:2989-95.)

    By removing firearms, you decrease risk. The next best thing is to properly secure them (harm reduction strategy), but that doesn't change that the BEST evidence based option is removal of the firearms.

    My job is to inform my patient of this information. What they do with it is their business.

    So I admit it, physicians have an agenda — to promote the health and welfare of our patients, in an evidence-based manner.

  45. SassQueen says:

    @ Gavin,

    No offense taken. I do age-appropriate safety questions, so yes, I counsel parents about child-proofing their homes at the 6 month check-up (or earlier if the kid is more advanced from a gross motor skills perspective); this includes keeping chairs away from counters where they can climb up to get knives. I have also had to counsel my spouse on this after finding my 1 year old with a knife in each hand. True story.

    Most kids aren't getting up onto roofs, so I don't bother with that. I cover the draino thing with the mention of child-proofed cabinets (having treated more than one kid who has drunk anti-freeze or cleaners). Car seats get a nod.

    Do I have time to cover every single miniscule tiny thing that could possible damage fragile little Johnny? No. I haven't the skill nor the time for that. But, I try to at least make people aware of things they might not have ever thought of before having children.

    And something I had started to say in my earlier post but left out because I couldn't think of an coherent explanation, is that I don't know if I would ask an adult patient about the presence of a gun in his/her home. I certainly don't ask about it at my teenage physicals. I figure by then their parents have figured it out or not. But newly crawling infants and toddler are wily. For new parents especially, I try to educate about safety. My families w/ 8 kids? I generally gloss over or leave out that stuff altogether, especially if I already know them well and have asked that stuff with the older kids.

    I'm not trying to walk you guys through a day in my life, but I am asking you to try to see it from my (apolitical) point of view.

  46. Luke says:

    @DancingSamurai – So have you recommended all your patients be evaluated for bipolar disorder and affective disorder with comorbidity?

  47. Gavin says:

    I understand it pretty well with pediatrics. You guys are the best! I didn't find out that honey was bad for infants under 2 until 5 years ago. I was really happy that I only learned in passing but I can see how a lot of small things could be overlooked.

    I'm more talking adult patients or patients with kids who don't want to talk about these things. Is it a requirement in your practice or can they refuse to bring their homelife into it?

  48. @Luke — I'm not sure what you're getting at by that question. It is my job as a family physician to routinely screen my patients for mental health issues, and if there is concern I would recommend further evaluation. Furthermore, if there is an immediate threat to the life of the patient or of others, I am ethically and legally bound to force such a psychiatric evaluation upon them.

  49. Jimmy says:

    @ DancingSamurai and SassQueen

    Thanks for your comments from the "front lines" so to speak.

    @Gavin
    You seem to be imagining SassQueen's questions as some sort of interrogation. It's not like that, I'm sure. It's a conversation a person has with their doctor. There are any number of reasons a doctor might ask an adult patient about firearms -for example those who are soon to be parents. And yes, environmental exposure is on the list, too (Drano, fertilizers, pollen, etc.). Just because a patient can't understand why a doctor might ask a certain question doesn't mean they don't have a reason for it. They're not firearms experts, but the patient is rarely a human health expert. If a patient don't understand a question, why not ask about it? Again, it's a conversation, not an interrogation.

    Something doesn't need to be life-threatening to be unhealthy. There's all kinds of shit around your home and work that can impact your health, from lead paint to wood dust. A doctor's responsibility is to inform the patient and answer questions. Part of this involves a bit of guesswork as to what the patient already knows or doesn't, and I can't fault a doctor for erring on the side of over-information.

  50. angstela says:

    And now for something completely different: I know "him or her" is firmly entrenched in US culture (where the author isn't kind enough to use only "him"), but I hope to encourage more writers to use epicene "they". As in, "I'd consider myself lucky to know that the doctor is an ideologue whose political views outweigh their commitment to my care, and happily avoid them."

    And now back to your regularly scheduled programming…

  51. angstela says:

    Ack, I meant to say "is kind enough", not "isn't". Humbug.

  52. ZK says:

    Do you advocate as "removal" as the most effective method to deal with swimming pools, as well?

    Personally, I have no problem with doctors asking and discussing potential 'environmental' dangers, like guns. For a variety of rational and irrational reasons, however, I don't want the presence or non-presence of firearms to make it into any sort of medical record.

    @DancingSamurai: Does the answer to your pool and firearm inquiry get recorded in your practice?

  53. Luke says:

    @DancingSamurai – Those are the top 2 risk factors in the study you mentioned among suicide victims. Firearms are #4. I unfortunately can't read the full study only the abstract but from that abstract and your characterization it sounds like if someone suffers from the top psychological risk factors for suicide then the chances of a successful suicide go up if they have a gun. I disagree with the logic that therefore everyone should remove guns from the home as not all people are suicidal.

    If the prevention of suicide is the ultimate goal, then preventative screenings for bipolar and affective disorders would be more effective than advocating the removal of guns. Doing so would also reduce the third risk factor: prior health treatment.

  54. Anonymous says:

    @Gavin:

    You asked SassQueen: "So… if people have guns you warn them that they're dangerous? I guess that's a valid reason but would you then refuse to see them if they refused to answer?"

    I am not her, but my own answer, as well as the answer I'd expect out of most other doctors I know: Yes. I refuse to be held responsible for the medical care of patients (or, in this case, the parents of potential patients) that will not cooperate with me.

    Earlier today, a colleague of mine in the same practice was preparing to refuse a patient because that patient would not come in for a consultation but would rather discuss the issue over email. My colleague does not feel competent to work under that condition, and informed said patient that she "would not be an internet doctor" and said that she recommended the patient find a different doctor if he would not come in for a consultation.

  55. Grifter says:

    @angstela:

    The problem is "They" is a plural word.

  56. Narad says:

    Furthermore, if the article linked in the comments is correct, the American Peds Association doesn't suggest locks, they suggest "removal." That's an agenda, clear and simple.

    That the AAP has a policy position is not in question. I would also suggest that the question whether it is a preposterous one oughtn't to be in much dispute.

    However, one's pediatrician is not some sort of representative of the AAP. If you want to complain about the appropriateness of the recommendation to inquire about the presence of firearms, you need to provide some contextualized epidemiological data, not start rambling about agendas and "what about five-gallon buckets, huh, huh?"

  57. angstela says:

    @Grifter: In this case, it isn't. It's also called "singular they". It's been used in English for at least 400 years.

    http://www.editorscanberra.org/a-singular-use-of-they/

  58. John says:

    I've never had a doctor ask me personally, but they have asked me when I've brought my kids in for their check-ups. I assumed it was so they could try to help prevent an accident involving a gun (i.e. make sure it's not stored loaded, buy a trigger lock, that sort of a thing).

  59. David Schwartz says:

    You have to know this is a potentially sensitive question. So you have to be careful when you ask it. It's not hard to do it well. Start by asking a number of similar questions that make it clear that the issue is safety. Ask about a pool first, for example.

    Then, immediately follow the question (before waiting for an answer) with the rationale. For example, "Do you have any guns in the house? Because children can get access to guns at surprisingly young ages if they're not securely stored."

    And lastly, part of being a good doctor is dealing with uncooperative patients. If a doctor can't gracefully handle a patient's refusal to answer a personal question, he's a bad doctor. I don't think this doctor is a bad doctor. I suspect he could have gracefully handled this refusal, he simply chose not to. He just chose not to.

    My wife deals with the families of suicidal and depressed people all the time and has to ask the guns question. Unless both sides have an ideology or the profession is incompetent, it's not going to be a problem.

  60. Gavin says:

    @ZK,

    Exactly, I wouldn't want any of this stuff to end up on medical documents. I would not want insurance companies getting hold of stuff like this and making decisions on it, for example. That is exactly the problem I have with all of this.

    Not only is it not information we should be made to give up, but it can be potentially harmful if given to the wrong people.

  61. SassQueen says:

    I personally don't advocate for removal. That's a personal decision to keep a gun in your home or not. I just make sure parents are aware of the risks involved.

    As far as whether I would fire a patient for that: I wasn't avoiding the question, I just sort of forgot to answer it due to trying to juggle all the different responses and hitting on what I felt like were critical points. But it is a key component to this issue, you are right. On face, I don't think I would fire a patient for that. I can count on one hand the number of patients I have fired. But it would stick in my mind that they had reacted so strongly to what I (still) feel is a perfectly reasonable inquiry, and in the back of my mind I would be on the look-out for more reaction that would indicate a lack of trust. Without trust, there is no doctor-patient relationship.

  62. Gavin says:

    @Anonymous,

    So it's your way or the highway? Forgive me for saying so, but that is exactly the sort of doctor I'd like to avoid. I go to doctors for consultation, not to get bullied into doing what they want. This is why the almighty second opinion actually makes sense, because at the end of the day things need to be in the patient's control, even if that patient is a real dummy (but apparently just above the IQ line that says they're allowed to think for themselves).

  63. angstela says:

    Me, on topic for a change: It would also be nice if legislatures would also refrain from requiring doctors to _say_ certain things as well, such as South Dakota's law requiring doctors to tell women seeking abortions that it will increase their chances of suicide, such as Ohio laws requiring women who want abortions to talk to someone who can judge whether they "really really mean it", &c.

  64. SassQueen says:

    @ angstela

    Amen. I wish the gubment would GTFO of my job altogether.

  65. Gavin says:

    @angstela,

    If pastors can't publically back a political candidate then doctors sure as hell shouldn't be able to say anything they want.

    In reality, doctors stand the greatest chance of causing harm because of the fiduciary role they play. There are too many incentives that they can have (say, which medicine they prescribe even when there's cheaper over-the-counter meds that would do the same thing) that are a direct conflict. Laws need to be put in place to prevent the abuse of their position.

    As for abortions specifically, aside from what you or I believe, consider that some people believe fetus' are a human life based on actual "science" and not just religious belief. I was recently surprised by a member of atheists against abortion. The concept that it is consuming energy and growing organically (a.k.a. alive) and is genetically human and only human with the same DNA it'll have the day it dies regardless of age (a.k.a. human), it is a valid claim to say that you are destroying human life. I honestly don't know why we say it isn't human life and not just that it's not sentient yet. Perhaps that's just too hard of a concept for people to accept because of what it may mean. Interestingly enough, my mother-in-law survived an abortion and my wife (who is perfectly fine and HIGHLY intelligent) was recommended to be aborted because of possible mental handicaps. This has made me think about things a bit more lately from another perspective. I'm not happy with what I'm seeing.

  66. @DancingSamurai: Does the answer to your pool and firearm inquiry get recorded in your practice?

    @ZK, For pediatric patients, actually, no. I would just note that I discussed those things with the parents.

    In the case of a suicidal/homicidal patient — I would absolutely record all relevant details, including the ability of a patient to access firearms.

    @Luke — Point taken, suicide is multifactorial, and there are lots of risk factors. Firearms safety (and possible removal) is thus especially relevant in that background. However, we cannot always identify all suicidal people in advance, and intentional self-harm is not the only kind of harm that arises from firearms.

    My main point is to review with patients that firearms are dangerous. I think it's reasonable for physicians to remind patients of this fact — especially when they are at a life change (e.g. a new child in the house) and they may not even have thought about it in that way.

    As a physician, it is my duty to review the harm side of the question. There may certainly be some (non-health) benefits to having firearms, and everyone weights that risk/benefit ratio differently. Just as I don't get too upset about patients who continue to exercise their right to smoke despite harms from that, I wouldn't contest a person's exercise of their right to own firearms.

    Along that vein, legislators shouldn't try to get in the way of me asking relevant questions of my patients… or forcing me to tell them things that aren't true (amen @ angstela)

  67. @Gavin — maybe some of the more legal-minded among us could correct me, but I always thought the prohibition on religious figures endorsing politicians stemmed from their tax-exempt status. Am I wrong?

    I agree with your greater point — a physician shouldn't push their views (political or religious) on their patients in a medical encounter. There are already (at least in Canada) legal and professional rules around this, as well as limiting 'favours' by pharmaceutical companies, etc.

    On the other hand, physicians have every right (some would suggest even a greater responsibility) to be politically active and endorse change, just as any other citizen does — and groups of physicians do (The OMA for example was very active in banning smoking in vehicles with children present here in Ontario).

  68. SassQueen says:

    @ Gavin:

    "In reality, doctors stand the greatest chance of causing harm because of the fiduciary role they play. There are too many incentives that they can have (say, which medicine they prescribe even when there's cheaper over-the-counter meds that would do the same thing) that are a direct conflict."

    I would agreen with the spirit of this. However, I think we should agree to disagree on the follow-up:
    "Laws need to be put in place to prevent the abuse of their position."

  69. Tam says:

    Anonymous,

    "I am not her, but my own answer, as well as the answer I'd expect out of most other doctors I know: Yes. I refuse to be held responsible for the medical care of patients (or, in this case, the parents of potential patients) that will not cooperate with me."

    Good thing that, were you to ask me whether I owned firearms or any other constitutionally-protected object that is one of your business and has no bearing on my treatment, I would smile sweetly and lie to your face without so much as blinking.

    Shut up and treat me, with a side of fries, stethoscope monkey.

  70. Ben says:

    Tam,

    Even if you reduce a doctor to a machine, which is I think what you seem to be advocating, that machine's capacity to diagnose us corresponds directly with completeness of the information it possesses with regards to us.

    So unless we know all of the heuristics involved in diagnosing a particular pathology, the information we hide cannot but negatively impact the accuracy of the machines results. And if we are intimately familiar with the heuristics involved in that process, why bother using the machine?

  71. Jeremy says:

    If Doctors are asking questions like these though, I think a more 2-way street would be appropriate. For instance, if he can ask me about my coital activity, I can ask him about his adultery. If he can ask me about my income, I can ask him what was discussed as a good investment at the last country club meeting. If he can ask me about my stance on guns, I can ask him about his side of Sesame Street.

    /tongue-meet-cheek

  72. Tam says:

    Ben,

    "Even if you reduce a doctor to a machine, which is I think what you seem to be advocating, that machine's capacity to diagnose us corresponds directly with completeness of the information it possesses with regards to us."

    I am unaware of a single physical ailment that manifests by sprouting firearms like warts. Trust me, however, that if I were to suddenly break out in .30-'06s, I would let my primary care physician know (although the checkered walnut stock protruding from my epidermis would probably be a tip-off to an alert doc, anyway.)

    Also, why is being indignant at a doctor asking questions that are irrelevant to our professional relationship "reducing them to a machine"?

    If the counter jockey at Taco Bell responds to my request for a burrito and large Pepsi with "Do you have a Koran at home?" and I say "None of your goddam business and I'd like hot sauce with that, please," have I 'reduced her to a machine' or properly restored our business relationship to the footing on which it belongs?

  73. Grifter says:

    @angstela:

    I'm probably just too big a fan of Strunk & White.

  74. Narad says:

    or properly restored our business relationship to the footing on which it belongs?

    Perhaps you should mutually establish in advance, when selecting a physician, that the relationship is to be one in which the doctor is a "stethoscope monkey," just so there won't be any confusion down the line.

  75. angstela says:

    @Grifter: Yes, a lot of folks (particularly in the US) are. It's a shame considering their advice is often dated or incorrect.

  76. Ben says:

    Tam,

    What first comes to mind is that we are not trusting a cashier at a restaurant to determine what we would enjoy eating. We are trusting a doctor not just to find out what is wrong with us but to alert us to probable harms. We would consider medical professionals remiss if they did not.

    In your example, if a cook is trying to determine your tastes, the question of "Do you have a Koran at home?" might well be a pertinent one. If you do, then the probability that you only eat halaal food increases. Many other (even non-Abrahamic) religious texts contain or are associated with dietary prohibitions.

    As to reducing individuals into machines; when we use an individual such as the cashier as a food preparation device, which we manipulate to achieve the desired result, we dehumanize them. We cease to acknowledge that they are humans, the same as ourselves and possessing the same inherent value, frailty and flaws, but instead view them as things which either function or do not function – broken or operational.

    There is nothing wrong, bad, harmful or mercilessly cold about asking people to make food for us in exchange for resources. It is only the expectation that this person ought to be something that we could never be that is harmful.

  77. John David Galt says:

    I can accept a principle that a doctor may ask me whatever he pleases, provided: (1) I am free to see anyone who cares to practice medicine (no state-enforced oligopoly), and (2) The government does not have any power to look at anything in my doctor's records about me without MY permission or a warrant based on probable cause (in other words, no HIPAA).

    But until I have those protections, I demand government not allow him to gather or use data in ways that I consider violations of my privacy.

    Neither a doctor nor any other professional is entitled to dictate the terms of his business with me if he enjoys even partial legal restrictions on who can compete with him.

  78. angstela says:

    @John David Galt – add "and neither can an insurance company (note: my buying insurance is not permission)" to your point 2, and I'm there.

  79. tsrblke says:

    @Narad

    While I recognize that a doc isn't a direct representitive, of the AAP (I always get the order of the A's and P's mixed up), the AAP is made up of doctors who decide the policy which gets filtered back down via training to new doctors. So it's not as if the two are entirely unrealted.
    In any case, you are correct I haven't made my point very articulately. In this particular case I would argue pretty much everyone over reacted, the doctor, the parents, the state legislature. I can't speak to the context of this particular case, but clearly something went wrong.
    Having said that, one of the principles of medicine is typcially to use the least invasive means that produce a postive result. Thus it seems strange to me for the AAP to have a policy, which presumably they try to teach to new pediatricians, (admittedly in the round-about fashion that goes through training hosptials) that skips over the simplier (and arguably equally effective strategy) of "locking them up" is nonsensical. So yes, the AAP policy is, I would submit, up for question because it shapes how doctors approach the issue.
    My ramble about five gallon buckets was that we don't take this approach with very many other items, it seems bizzare to call out guns specifically.
    Again, I can't speak to the context of this particular case. If you're a doctor and you're just running through a list of dangers (medicine, cleaner, cooking utensils, guns, pools.) it's likely a non-issue. I'm not sure dropping a patient because they refuse to answer your question is necessarily the answer. If we were to move it one step further down the line and say the doctor had dropped the patient because they refused to remove the guns, per the doctors advice, but instead choose to lock them up would it elicit a different response?
    My primary concern is when the practice of medicine becomes a sort of gateway to controlling social issues that, at best, are at the tangentially connected to what we consider the maintance of a "healthy individual." (Another way of saying this are "issues that fall more under "personal preference.) There's a fine line to walk here, admittedly.

  80. Mike K says:

    Since SD's requirement for doctors to tell patients seeking an abortion about elevated risk of suicide came up, assuming it's true, shouldn't that already be a requirement of the doctor? They are already required to mention all risks for treatments, hence telling people that they could die during surgery, why isn't elevated risk of depression relevant? It should be compared with the elevated risk of depression associated with normal births, but it actually made more sense to me than some of the requirements in other states.

    On the topic of doctors asking about firearms and other politically hot topics, if the patient doesn't understand why the question is relevant the patient should ask why. Asking for a person's religion, for instance, can be relevant along with asking if the person follows the dietary or other behavioral requirements of the religion (as mentioned above). I'm not a medical professional, but I imagine pregnant women would be another demographic that would be asked questions about guns along with tons of relatively common chemicals due to their situation.

  81. Narad says:

    They are already required to mention all risks for treatments, hence telling people that they could die during surgery, why isn't elevated risk of depression relevant?

    The reference is to what, Reardon & Cougle?

  82. Allen says:

    There is, and always has been, a problem when one presents aggregate statistics and then tries to craft policy around it. In my county gun ownership is very high, yet in the past 10 years 3 children have died due to accidental gunshots.

    Yet, every year, on average, 3 children die due to blunt force trauma where my county Child Protective Service has already deemed them at risk.

    Oh, and by the way many of those cases were referred to CPS by doctors. But it's the guns.

  83. Sarah Clever says:

    Practicing internist/primary care doc weighing in: In the context of the part of the visit that I term "keeping you healthy", I ask all my patients if they own guns, and if they do, how they store them, and advise them that statistically, homes are safer without them. I also ask if they wear seatbelts, get regular exercise, wear bike helmets, have smoke detectors, are sexually active outside their primary relationship, and are up-to-date on immunizations and cancer screening. All of these behaviors and choices have health implications, so I consider it part of my due diligence to find out and counsel my patients appropriately. I am truly astonished to find that asking about guns could be construed as pushing an agenda. I have friends with guns, and have been to the gun range a bunch of times and found it super-fun. Still, homes are safer without them, so I ask.

    I await the brickbats.

  84. Ken says:

    @Sarah: how do you, as a doctor, determine what range of potential risks are your job to talk about, and what aren't?

    I think the perception of agenda results from physician organizations deliberately involving themselves in the politics of gun control — for instance, when Richard Corlin launched his time at the AMA with a gun-control speech. I can understand their policy arguments for doing so — gun violence is a public health issue — but their advocacy has colored the perception of individual doctors' inquiries.

  85. Robert says:

    "Yes. I refuse to be held responsible for the medical care of patients (or, in this case, the parents of potential patients) that will not cooperate with me."

    A doctor with a God complex. Why am I not surprised?

  86. AlphaCentauri says:

    The fact is that kids do die or become permanently maimed because of accidental gunshot wounds, and that in almost all those cases their parents would have done almost anything to have avoided that.

    Ken's post http://www.popehat.com/2010/03/16/daddy-once-again-we-see-there-is-nothing-you-can-possess-which-i-cannot-take-away/ about his daughter is hilarious, but it also points out the fact that frequently parents learn about what their children are capable of after the children demonstrate a new skill. Parents do not completely anticipate to what lengths they need to go to childproof a home unless they are educated ahead of time.

    People who take gun safety courses get exactly that sort of education, but far too many people don't get that sort of training. They have some gun that they inherited from granddad and stuck in a drawer, or they've kept a loaded gun in the nightstand so many years they no longer think about it in terms of its future danger to the new baby in the family. The pediatrician goes through a list of all the most common preventable causes of injury to raise awareness.

    As far as insurers and government agencies, yes, they do audit charts to see if doctors are asking, but they don't audit for what the answer is or whether the patient answered at all. Handing a patient a form with the question on it and getting a blank form back is sufficient to satisfy the requirements. Insurers want some standards of quality to doctors who run "mills" — churning patients through with only a few minutes time for each — don't get paid the same as doctor who actually spend time.

    If you prefer a "stethoscope monkey" or a "prescription vending machine" who gives you whatever you request without wasting your time doing a history or physical, I'm sure you can find a charlatan you'll be very happy with.

  87. Robert says:

    There is no valid reason for a doctor to ask if a patient owns a firearm. If you are concerned about safety of children, mention that a firearm *if present*, should be safely stored and that children should also receive training on proper handling of firearms when they reach an age *deemed appropriate by the parents*.

    After all, they very well may visit another family's home that has firearms present, so your interrogation of if they happen to *personally* own a firearm has no bearing on the situation.

    There. That takes all of 10 seconds so you can get back to what Tam so aptly put it, doing your job stethoscope monkey.

  88. Unix-Jedi says:

    Thanks, Sarah:

    I ask all my patients if they own guns, and if they do, how they store them, and advise them that statistically, homes are safer without them.

    Which is exactly why this is a problem.

    According to.. who? And how "much safer"?

    I am truly astonished to find that asking about guns could be construed as pushing an agenda.

    It's surprising to find out that you're doing something you didn't realize that you were, I'll grant.

    But you are.

    This issue was a continuation of the gun rights debate into the "public health" realm – pushed by some bad stats, a lot of disinformation, and a misuse of the doctor/patient privilege.

    Ken might not be happy about the pushback – and like most political and legislative remedies, it's got a lot of flaws, but this wasn't the first shot in the battle, it was the counter.

  89. Unix-Jedi says:

    Ken:

    I can understand their policy arguments for doing so — gun violence is a public health issue — but their advocacy has colored the perception of individual doctors' inquiries.

    Except it's not a public health issue.

    That framing was largely meant to take weapons restrictions away from the Second Amendment arguments and onto the "Greater Public Good" side. Funny how that only works one way, and ignores anything that didn't lead to "Guns bad. Get rid. Well, not *our* guns, but yours, those are _bad_."

    http://en.wikipedia.org/wiki/Public_health

    Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" (1920, C.E.A. Winslow).[1] It is concerned with threats to health based on population health analysis.…. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services.

    Health. Disease.

    How do guns fit into that? Presuming, of course, that you didn't go to the range after cutting up chicken and then handed the heater off to lots of people, spreading salmonella?

    You might could stretch it – somehow – to fit into the framework of what public health used to be – but it means that literally nothing in your life wouldn't be "public health" excepted.

    And that's the systemic problem with the concept.

  90. Allen says:

    Statistically speaking, some doctores self-medicate, which might lead to poor medical outcomes.

    Doctor, are you self medicating?

  91. M. says:

    Man, people really don't like doctors, do they? They're like the new lawyers.

  92. Anonymous says:

    @Gavin
    So it's your way or the highway?

    Well… yes? Just like every other contractual relationship in a free country, I am free not to engage. It's YOUR way or the highway too – if you don't like the way that I dress, or address my secretary, or even the way I decorate my office, you're free to leave.

    I have patients who don't do as I say because they are unable, e.g. alcoholics who don't stop drinking. I don't hold that against them. I have patients who don't to answer certain questions because they are afraid, e.g. older immigrants who are having their children translate for them and while I think that's unhelpful, I can understand them.

    But if you don't answer my questions because you don't feel I'm qualified to ask them? What are you even doing in my office, go find somebody you trust.

    @Tam
    I cannot recommend making a habit of lying to your physician.

    @John David Galt
    I demand government not allow him
    And you with such a fine user title, too.

    @Robert
    A doctor with a God complex. Why am I not surprised?If not wanting to help people who don't trust me to help them gives me a God complex, then bring me angels and pearly gates.

    Robert, if a doctor gives you the impression that they believe they know better than you, that's not because they're arrogant (although they might be), it is because they know better than you. That's why I went to university all those years – because I wanted to know how the human body works so that I might help you. If you don't trust all those years of education and subsequent years of experience to have taught me better than you, why are you coming to me for a consultancy? If I don't know better than you, consult yourself.

  93. Unix-Jedi says:

    Anon:

    But if you don't answer my questions because you don't feel I'm qualified to ask them? What are you even doing in my office, go find somebody you trust.

    So quite literally anything you ask, the patient must answer, because you're qualified?

    Ken, do you see why your initial take was wrong, yet?

    If not wanting to help people who don't trust me to help them gives me a God complex, then bring me angels and pearly gates.

    It's for THEIR OWN GOOD, the FOOLS. RELEASE THE KRAKEN!

    Robert, if a doctor gives you the impression that they believe they know better than you, that's not because they're arrogant (although they might be), it is because they know better than you.

    You know, anon, I've met some outstandingly stupid doctors. Both my grandmothers were killed by doctors who were arrogant, stupid, and had god-complexes. (Paternal GM was declared to be in a "Persistant Vegetative State", because she didn't "respond to spoken questions". Standing at the foot of the bed, "How are you today". When I found that out (and thus she wasn't getting interventions with her problems, I confronted him, He insisted, and demonstrated, that speaking softly at the foot of her bed, she wasn't responding. I didn't try to hide my scorn. "She's 84. And she's ALMOST DEAF. Watch this. 'HEY, GRANDMA, HOW ARE YOU TODAY'." She raised both hands and gave a thumbs-up. The doctor left – but didn't change his "diagnosis".

    Yes, Anon, you've got a god complex, and maybe, just maybe, those idiots who come to see you, might know something you don't.

    Yes, you're fine to fire them if they fail to worship you correctly, that's your Anon-given right.

    But this is exactly the problem that this law was crafted to stop.

    Thanks for the demonstration.

  94. Anonymous says:

    So quite literally anything you ask, the patient must answer, because you're qualified?

    Quite literally anything I ask, I ask because I'm either making small talk or because I find it medically relevant.

    If you disagree with me on what is medically relevant, I may not be the doctor for you.

    I have a very hard time seeing how this can be controversial.

  95. Anonymous says:

    But this is exactly the problem that this law was crafted to stop.

    Missed that one: Maybe, but then it was poorly crafted, because the wording of the law would have changed not one iota of the questions asked, because, and I quote:

    The Florida legislature's reaction was swift and stupid: it passed a law telling doctors they "should refrain," on pain of disciplinary action, from asking patients about gun ownership or the presence of guns in the home, unless the doctor "in good faith believes that this information is relevant to the patient's medical care or safety."

    We're back at this: I ask questions because I in believe that the information is relevant to medical care. You are not required to believe me when you tell me that, but I am not required to treat people who call me a liar to my face – with certain exceptions that I like to think I handle with cool professionalism. A case like the one that inspired this law? Not one of those exceptions.

  96. Tango says:

    @Anonymous

    Quite literally anything I ask, I ask because I'm either making small talk or because I find it medically relevant.

    And a firearm in my home is not medically relevant. I have several butcher knives, too. There's a meat cleaver in one of the drawers. I've got a power drill and a jig saw in the basement.

    None of those items have squat to do with the best method of treatment for my runny nose.

    Therefore, it must be small talk. You yourself said those are the 2 reasons for communication in your office.

  97. AlphaCentauri says:

    Unix-Jedi, you've had some very bad experiences with doctors. But the solution isn't to give them less information so they do an even worse job. I'm sorry you've never had the experience of having a doctor who spends the time and effort to provide you proper medical care. But such doctors do exist, and they ask a lot of questions. When you've found one, your take on this discussion will be a lot less judgmental. If you don't trust your doctor to ask basic questions about childproofing your home, do you really trust that doctor to make proper decisions about you if you're gravely ill and unconscious? And do you think that doctor would follow their best judgment instead of second-guessing and playing defensive medicine if they know you don't trust them? The time to find a doctor you trust and respect is now.

  98. Anonymous says:

    And a firearm in my home is not medically relevant. I have several butcher knives, too. There's a meat cleaver in one of the drawers. I've got a power drill and a jig saw in the basement.

    None of those items have squat to do with the best method of treatment for my runny nose.

    Therefore, it must be small talk. You yourself said those are the 2 reasons for communication in your office.

    In this hypothetical I am a pediatrician and you're coming to me about your children. The guns, the knives, the meat cleaver, the power drill and the jigsaw are ALL going to come up as medically relevant while we talk about how to child-proof your house. I wouldn't ask about guns if you came in for a runny nose* but for child-proofing? Of course I would.

    *Full disclosure: I'm in Scandinavia, I would never ask about guns because my patients don't have any.

  99. Tango says:

    If you ask me immediately after I tell you that my left thumb is bleeding after going shooting, I will expect you to say "Don't put your left thumb behind the slide on a semi-auto."

    If you start your conversation with "Do you keep guns in the home? That's far more dangerous than without." I will know that not only are you a quack, but you are outside of your area of medical expertise.

    As some of our patients are undoubtedly firearms instructors, firearms hobbyists that spend lots of time in training, police, and firearms tradesmen (smiths, etc), I would say that just because YOU think you're all that and a bag of chips does not mean YOU are. That would make you the least knowledgable person in that particular conversation. However, you arrogantly assume that you are the end-all on gun safety right out of the gate.

    This issue is controversial because those that make firearms their livelihood know that firearms are only dangerous when someone is stupid. They're not only useful in dangerous situations (home invasions), but they're a necessity in lower income families for putting dinner on the table. Did you know that rabbits are 100% free of Trans Fats if prepared properly? Oh, that's medically relevant right there.

    When you interject your agenda into the lives of those when you are not an authority, you raise the danger level of the public sector because you've tricked them into believing that guns are always 100% of the time dangerous.

    No, you're wrong. You do not know. You only know that if you shoot someone, they get hurt. That's all that you SHOULD know.

  100. ZK says:

    I don't think that by "stethoscope monkey" that Tam's looking for a doctor who's an idiot. I think Tam's looking for a doctor who's very good at medicine and can council her on the things one might go to Medical School to learn about. I think Tam's *not* looking for a doctor to tell her about things you might learn as a firearms expert (which she is), an actuary, or a generic safety-inspector.

    I can certainly understand asking as a pediatrician. It seems, to me, like the expected roll of a pediatrician is to help manage lifestyle risks: Is there a pool without a fence? Are there unlocked guns? Does he play in traffic? I don't think that's exactly the same roll many people want for their doctors as adults. Tastes differ, but I don't think it makes Tam unreasonable to want a doctor that treats her shattered knee without telling her that biking is dangerous.

  101. Gavin says:

    @Sassqueen:

    I don't particularly mean new laws have to be in place to prevent doctors from taking advantage of their responsibilities. I just mean that many laws which are in place are necessary. The only laws I'd like to see added to the "books" are laws that expose the medical field to market conditions. Things that give patients a clear understanding of what competing doctors and hospitals in the area charge so that they can actually make a financially informed choice when they can. I'd also like to see laws that protect people who can't make that choice (example: unconcious and bleeding out of a few holes) from being charged much more than the going rate in the area.

    I mean, the medical field is technically one of the only businesses I know that can price gouge and people just make silly little jokes and cartoons about how bad it is when if a gas station or water seller does it they're thrown in jail. It is a clear example of taking advantage of one's position and their product's vital necessesity.

    @Anonymous:
    It isn't so much not answering your questions because you're not qualified to ask them. It's not answering them because we feel it's not your business, it has nothing to do with the kid's fever. Maybe if the kid had a bullet hole you'd say, "hmm, do you have a gun?" and that would make sense.

    I do not go to the doctor for a PBS special. If I want that kind of crap I'll ask for a pamphlet. I understand that there are dumb people in this world that don't know proper child proofing methods, but those are also the dummies that reveal information they don't have to.

    The article above presents a pediatritian asking a teenager how often he thinks about sex, masturbates, and all other crap that really gives the indication that he gets off on reading that sort of garbage. Sure, as a doctor if patient's don't answer medically relevant questions then you can't correctly treat them, I understand that. But refusing to treat a patient because they don't want to talk about something unrelated means you're going outside the bounds of your job. At the end of the day, you provide a service and I give you money for it. You're my employee. Yes, you can walk away and I can "fire" you (I find it interesting that someone said they wouldn't "fire" a patient over this, that's hilariously absurd and backwords wording and indicative of the arrogance plaguing the field), but you shouldn't give me pickles if I said no pickles. That's simply bad business (of course, you also don't have to give unnecessary prescriptions even if I ask for them, but that's not the point of what I"m saying).

  102. Gavin says:

    @M. :

    It's necessarily that we don't like doctors themselves. I personally like my doctors very much and got straight A's through the joke that is pre-med up until I realized it bored me but until that point I was planning on being one.

    What it is is that we are becoming increasingly unhappy with the medical field as a whole. It grabs us by the financial balls just because it can. It's an entire field that whose product is the single most important product there has ever been aside from the more immediate need for food and water. This is generally the same reason why people don't like attorneys. They charge so much because they can, because they're necessary. But medical attention is even more so. Add that to the arrogance currently floating around in the field and you've got quite a combo to dislike. If they were all house it'd be bearable, but they only think they're house.

  103. James H says:

    One note about the doc firing his patient in the law that led to all of this. It seems to me that if somebody says, "I'm upset you ask me that question," there's little reason to fire the patient. But if the patient says, "I'm upset you ask me that question. I have constitutional rights! I'm calling my lawyer!!!" you're dealing with somebody who is potentially litigious, and it's certainly in your interest to get them out of your client base.

  104. angstela says:

    @Anonymous: If you don't trust all those years of education and subsequent years of experience to have taught me better than you, why are you coming to me for a consultancy?

    Because by law I have no other choice. Period. I have an autoimmune disease. It's not a difficult condition to understand, really, and regular lab work and dosage adjustments deals with it fairly well, but I'm never allowed to order that lab work or the treatment for myself. Law mandates I have to see some doctor who doesn't know me and, worse, usually doesn't trust my own opinions about my body and what feels normal and what doesn't. If they also start coming at me from a ideological motivation of some sort I'm going to get pretty irate. If doctors don't like being thought of a "stethoscope monkeys" in this vein, they should maybe advocate for the greater freedom of the public to treat themselves where they wish to. The law says a doctor is the gatekeeper for treatment of my condition, even though, after 40 years of living with it and educating myself on it, I understand it better than they ever seem to. Don't even get me started on the ignorant (and untrue) things a number of doctors have told me both about my illness and about its treatment. It's very hard to maintain high regard for a profession which is legally placed between me and my good health, and which also harbors such a high proportion of generalists who attempt to demand my respect while trotting out bad information on the specifics.

  105. MikeNH says:

    Wow – the straw men are out in full force in this comment section!

    For all those appalled at a doctor as soon as you walk in the door with a runny nose – THAT IS A STRAW MAN.

    Nobody is advocating that here. We're talking about health screening questions, MOST of the posts (and the original news article) were all SPECIFIC TO PEDIATRICS. Meaning if YOU (and adult) are going in for healthcare, the evil agenda driven monkeys will NOT ask you about guns & swimming pools.

    If you disagree about being counselled on child-proofing w/ regards to fire arms, fine… but can we at least agree to abandon the straw man?

  106. MikeNH says:

    Shoot – meant to say "..appalled at a doctor asking about guns as soon as you walk in the door…"

  107. Gavin says:

    @MikeNH,

    Who do you think fills out the paperwork usually?

    @James H,

    That's a great point, I'd want to avoid potentially litigious patients at all cost.

  108. ZK says:

    @MikeNH,

    I agree it's most likely brought up in the pediatric context (where I think it seems appropriate), but both of the non-pediatric doctors who have stopped by this thread have spoken about how they'll ask adults about guns, and provided their reasoning (risk of suicide, generalized risk).

  109. Unix-Jedi says:

    Quite literally anything I ask, I ask because I'm either making small talk or because I find it medically relevant.
    If you disagree with me on what is medically relevant, I may not be the doctor for you.
    I have a very hard time seeing how this can be controversial.

    That's because you've got the god complex you're saying doesn't exist.

    I ask questions because I in believe that the information is relevant to medical care.

    Yes, I understand that. But you refuse to acknowledge that you might well be wrong, and have decided that You Are The Arbiter. ANYTHING you ask SHALL BE ANSWERED. And you're the expert – on anything – after all, you went to Medical School!

    So, in the winter, does it really matter if you change oil viscosities?

    Hey, you went to medical school, you should know, right? Or is that outside the realm of your experience – unless you also happen to be a motorhead?

    I'll grant you it's a difficult area, and that's where the law had a problem. But it was directed at someone just like you, who sees "no problem".

    AlphaCentauri:

    Unix-Jedi, you've had some very bad experiences with doctors. But the solution isn't to give them less information so they do an even worse job.

    Yes, I have. My wife, who I met when she was in nursing school, said early on, "Boy, you have a low opinion of doctors." Now, after years of being an RN, some horrible experiences with OB/GYNs, she makes me look like a doctor apologist. (She gets mad when I remind her my answer was "Wait til you meet more of them.")

    I'm sorry you've never had the experience of having a doctor who spends the time and effort to provide you proper medical care.

    Where did I say I haven't? I've had some _superb_ doctors. None of them asked me anything about guns, or other things that didn't factor into my health.
    But the discussion is on the _bad_ doctors, and I have one specific example – and I have _lots_ more.

    When you've found one, your take on this discussion will be a lot less judgmental.

    Nope. See how you presumed I haven't, thus I'm wrong?
    Well, I have. Your entire premise is flawed. The excellent doctors I have met were very good – they also listened and didn't just dictate or insist that they were M-frackin-D's, so do this.

    I wouldn't expect the gun question to ever come up with them, because it's not appropriate.
    Yes, I'm "judgemental", because I've seen this being worked from the anti-gun side for years, and now that there's getting to be blowback, there's complaints. They're unfounded. You don't want to get mandates on behavior, then don't start behaving badly.

    If you don't trust your doctor to ask basic questions about childproofing your home

    I don't. How many hours did you study "Childproofing" in medical school? What kind of internship and residency did you have that prepared you for that?

    do you really trust that doctor to make proper decisions about you if you're gravely ill and unconscious?

    ….
    If they don't ask me about tubs, buckets, swimming pools, guns, electrical conduits, cyanide under the sink, pool chemicals in the nursery… That has nothing to do with their ability to treat me for something that's caused my unconsciousness. I'd hope. If I'm wrong, and that's all they've been paying attention to, then well, actually, yes, I wouldn't trust them to treat me medically, if they've been busy learning how to properly ground electrical circuits.

    MikeNH:

    It's not a ridiculous straw man if the guy's made out of dried grass.
    There's no point in asking that for pediatrics, oncology, or opthalmology.

    That it's "only pediatrics" doesn't lessen the issue – it turns it into an Orwellian one. (Seriously, there have been movements to ask the kids, not the adults, to find out the "real" answer.)

    Regardless, it's introducing medicine into politics – don't be surprised when the politics then introduces themselves into medicine.

  110. Unix-Jedi says:

    http://www.keepandbeararms.com/downloads/gundocform.pdf

    Notice the date. 2000. That's because this isn't a "new" issue.
    So those who are surprised that we gunnies are up on the issue – well, it's not a new one to us.

    Even if we didn't go to medical school.

    http://www.keepandbeararms.com/information/XcIBViewItem.asp?ID=1284

    One of the best games in town is litigation, and litigating against physicians is even more popular than suing gun manufacturers. Physicians and their malpractice insurance carriers are well aware that litigators are constantly looking for new opportunities to sue. …

    Nowadays, many physicians and other health care providers are engaging in the very risky, well intentioned, but naive and politically inspired business of asking their patients about ownership, maintenance and storage of firearms in the home. Some could argue that this is a "boundary violation," [Yes. It is. The fact that the doctors in this thread find it unimaginable that anyone would question it demonstrates why the law was crafted - and why doctors (demonstrated in this thread) why there must be boundaries placed on them.] and it probably is, but there is another very valid reason why these professionals should NOT engage in this practice — MASSIVE LIABILITY.

    Physicians are licensed and certified in the practice of medicine, the treatment of illnesses and injuries, and in preventative activities. They may advise or answer questions about those issues. However, when physicians give advice about firearms safety in the home, without certification in that field, and without physically INSPECTING that particular home and those particular firearms, they are functioning outside the practice of medicine.

  111. Gavin says:

    I think MikeNH meant Red Herring. Though that may be a strawman on my part.

    Mike, a straw man is where you misrepresent the opponent's position and then tear it down and say you've destroyed their side.

    A red herring is debating something unrelated as if it were part of the debate. It can really be anything unrelated or intended to misdirect attention from the issue at hand.

  112. Narad says:

    Health. Disease.

    How do guns fit into that?

    This is not even wrong. You want morbidity and mortality figures for unintentional pediatric firearms injuries? WISQARS estimates 1479 injuries for ages 0-9 in the 2001-2010 time period and reports 276 deaths.

    You can argue that these little-snowflake accidents don't rise to the level of meriting any prophylactic medical attention at all. You can argue that are better things to worry about. You can argue that they're probably mostly just scratches. You can argue that the intervention is not cost-effective. You cannot argue "well, that's not disease." You cannot argue "you have no right to think about that because it makes me asshurt and I want you to do what I say."

  113. Narad says:

    ^ Sorry, that's 2001-2009.

  114. Unix-Jedi says:

    You cannot argue "well, that's not disease."

    http://dictionary.reference.com/browse/disease

    Yup, you can, Narad. It's not disease.

    It may impact health. But if you define anything that causes injury to be of public health concern, then everything is in that scope.

    You cannot argue "you have no right to think about that because it makes me asshurt and I want you to do what I say."

    No, I just have to point out you're the one abusing the English language to try and force people to your way of thinking/acting.

    I don't care what you think. I care about what you do, especially as a protected, licensed professional.
    I care that your actions – under the color of authority – aren't abusive or directly political in effort or result.

    You're demonstrating why this law got a decent reception, and why I'm not against the concept, and why I hope that Florida does appeal this – and wins.

    Because it's not disease.

    If you want to stretch "health" to cover – and it's a huge-ass-stretch – fine. Then obviously, you'd cover them in order of danger, right?

    Right? So the firearm death/injury would be… where in the list?

    And, for the moment, presuming your assumption, that guns = disease, what then do you offer as advice, and what are you authorities for the advice?

  115. Narad says:

    And, for the moment, presuming your assumption, that guns = disease

    Given that that's not my "assumption," you could have saved yourself the always-devastating attempt at argument by online dictionary.

  116. Unix-Jedi says:

    Narad:

    You said: You cannot argue "well, that's not disease."

    So I said, giving you the benefit in the hypothetical: "presuming your assumption, that guns = disease " (and you didn't answer the questions.)

    You replied: Given that that's not my "assumption,"

    So what, then, is your assumption?

    "Disease. How do guns fit into that?"
    You cannot argue "well, that's not disease."
    So, guns = disease?
    Given that that's not my "assumption,"

    I might suggest that online dictionary rebuttals might be less devastating to you if you were less susceptible to demonstration by them.

  117. Christina says:

    @Unix-Jedi, is your challenge to a physician asking the question at all, or to giving impersonal recommendations for gun safety (i.e. removal, locked storage, etc.)? Because the link you quoted earlier about the definition of public health did include prolonging life as an aspect, within which gun safety would certainly qualify. (I understand that privacy concerns arise regarding potential reporting requirements to private or public institutions, which I abhor in healthcare unless completely anonymous. So let’s sidestep those – let’s assume that the physician is only asking vis a vis their private medical relationship with the client.)

    I commented at Popehat recently on the parent/kidnapper/law enforcement thread about the overwhelming tendency to professionalization in the United States, to abdicate personal responsibility in favor of a person who is deemed an expert in the field (for public safety on that thread, but here it is in healthcare; IMO it’s socially endemic). That not only demeans us but transfers unspeakable amounts of power, ripe for abuse, to those who gain the expertise. Most people have a relationship with their doctors wherein they fully expect the doctors to tell them how to keep from getting sick, how to get well if they are sick, how to prevent death from knocking. They hand off any and all power they have to be in charge of their own health destiny. And most doctors respond in kind, with a sense of entitlement that their recommendations must be followed because they are completely right (that god-complex you reference). And so it follows that doctors are sued for malpractice, and patients are dismissed as non-compliant, because neither accepts the mutual indemnity of the partnership. (It’s a chicken-and-egg paradox as to which was the original cause, but my primary point is that it’s wrong to direct all venom at doctors when people go in there as “patients” with their personal power gift-wrapped in a box to hand over.)

    A person who values gun ownership highly will not like hearing that “removal” is the preferred gun safety technique of their pediatrician or psychiatrist (or of that physician’s professional organization). They won’t like it any more than I liked hearing my dentist tell me I had to stop breastfeeding because I was going to ruin my child’s teeth. But a relationship that is based for both the client and the physician on mutual respect of knowledge and agency instead of expert authority has plenty of room in it for disagreement. (I simply explained to the dentist that while I appreciated his concern, I was considering my child’s complete health-and-well-being picture and not only their teeth; I asked what his recommendations were given that weaning was not an option and received information that was pertinent to my unique case.) There is the challenge of how to develop better a trend towards mutuality in medical care, especially in light of the limited options most people encounter in the system. But those of us whose options are less limited can use that privilege to promote a better relationship and work virally that way.

    The leading cause of accidental death for children is (I believe) motor vehicle accidents – but I’ve never heard a pediatrician recommend that we get rid of our cars, take steps to improve our driving safety skills or keep our child out of the car as much as possible as techniques to decrease our child’s mortality risk.

  118. Narad says:

    So what, then, is your assumption?

    I have no assumption. I advanced an assertion, which your reading comprehension apparently wasn't up to: The notion that public health only encompasses disease, based on another insightful reading, of Wikipedia, is not even wrong.

    I don't care what you think. I care about what you do, especially as a protected, licensed professional.

    If I gave you the impression that I am a medical professional, I apologize. I am not. I have cultivated and interest in epidemiology and public health as a result of dealing with antivaccine cranks.

    Anyway, let's get back to this:

    If you want to stretch "health" to cover – and it's a huge-ass-stretch – fine. Then obviously, you'd cover them in order of danger, right?

    Yes. Perhaps you somehow missed this element of what you were replying to, in which I gave you the morbidity and mortality figures and stated that evaluating whether they were worth doing anything about was a valid argument.

  119. MikeNH says:

    @Gavin – I did mean "straw man" actually – from what I can tell (and I admit, maybe I'm wrong here) only @Sarah has said she asks everyone about guns. All the other talk – and the original story this post is about – was specifically about pediatrics asking on behalf of their child patients.

    So yes, when someone says "None of those items have squat to do with the best method of treatment for my runny nose" unless they are asking their child's doctor about their runny nose, they are in fact misrepresenting the other side.

    Your point about whether pediatrics should be asking IS clearly within the context of the discussion. As pretty much every doc has posted, they ask b/c of child proofing. Saying that asking about one of the leading causes of child death is not related to medicine, is no different than saying asking about eating habits is not related to heart disease.

  120. Miranda says:

    Reading the comments, I see several things: (1) people assuming doctors who aren't pediatricians are asking this question, which I don't think has been established, (2) people very paranoid about being asked about their guns, and (3) people who seem to be visiting doctors they don't like or trust. I can be very paranoid about the government, and I have a healthy suspicion of medicine. But, when my pediatrician asked this question, I knew why she was asking. And if I hadn't, or if it made me uncomfortable, I would have asked her about it. I trust her and her judgment or I wouldn't let her treat my child. Some people may not be able to choose amongst doctors, but most people can. The woman in this article sounds like she either had no relationship with her children's doctor, or disliked and distrusted him.

    As for the proposition that the doctor should just address gun safety with everyone, instead of only addressing it with patients who own guns, well that would take a lot of time. That would mean no questions about lifestyle on the questionnaires. It would mean talking to all patients as if they owned guns, and pools, and don't lock up their cleaning products, or all have houses built in the 1970s, or smoke, or have pets, etc. It would take too long. It would mean medical care not tailored to the individual.

    The paranoia about agenda-pushing is over the top. My pediatrician asked if we bought our son organic milk. It wasn't an issue for me because I buy organic milk for my entire family, but I could tell by the way she approached the subject she was used to a negative response. She explained why she asked and why she recommended it for children drinking whole milk. I can only imagine what this crowd would think. She's beholden to the organic farmers! The FDA is butting into my medical care! People need to seriously calm down.

  121. Narad says:

    The leading cause of accidental death for children is (I believe) motor vehicle accidents

    Correct. Motor vehicles are number 8 on the list of injuries for the same period.

    but I’ve never heard a pediatrician recommend that we get rid of our cars, take steps to improve our driving safety skills or keep our child out of the car as much as possible as techniques to decrease our child’s mortality risk.

    You've never heard a pediatrician mention car seats and that they should be rear-facing for the first two years? The question remains cost-effectiveness of an intervention.

  122. Narad says:

    And since Yoonucks Yoda apparently needs its homework done for it, the intervention may not be particularly effective, although, like most such things, it depends. Perhaps generally heightening awareness is a better idea.

  123. Christina says:

    @Narad, actually my pediatrician never mentioned car seats although it might have been in a pamphlet I received. Most babies probably go into the office IN their carseats which may obviate the question (although mine never did, sling babies, and I didn't have hospital births so no newborn-release checklist, either).

    I was drawing a more precise parallel to the "gun removal" recommendation as opposed to something which decreases accident risk while simultaneously respecting the lifestyle choice. In any event, carseat use is a good thing but not by any means the only thing that parents can or should do to decrease the risk of accidental death from motor vehicle use.

  124. Gavin says:

    @DancingSamurai,

    Sorry for the delayed response, I hope you're still reading this:

    So, because religious organizations are tax exempt this means that leaders in those organizations must give up their freedom of speech? It sounds like two components of the first amendment being knocked down in one stroke to me. Just because they have justifications doesn't make it right. Not that you said it does. But I guess this is a topic for another day. Right website, wrong place. My main point was that it is the position of fiduciary responsibility that requires care in how information is presented.

    @MikeNH,

    Ah, in the article it cites the starting event where a couple refused to answer and the doctor refused to see them anymore. There was no mention of children as far as I can tell.

    As for my point, I go to a doctor for a problem my child is having, not for them to butt into other areas of life. My child has strep, not a bullet hole. If the words out of the doctor's mouth isn't inane small talk/pleasantries or solutions to that illness then they're wasting my time and money, as well as invading my privacy. Especially if me not wanting to talk about it means I have to take my sick child to another doctor all because this one has to know shit that isn't relevant.

    Even a checkup is just to evaluate the overall health. Not to invade my home and parenting practices. I have all my children running around the pool with gun blades that shoot out arsenic laced lawn darts, so I don't want to get caught.

  125. Ktpick says:

    I have been asked by multiple health care professionals (nurses, doctors, etc) about various childproof ing risks when coming to them either as a new patient or after the birth of one of my sons. I have never felt like it was a political agenda, even from the doctors I didn't particularly like. They ask about pools, standing water (buckets), poisons, sharp objects, electrical outlets and devices, and power tools.

    I think it's a pretty reasonable argument that as the people who fix your mistakes with firearms, doctors are allowed to ask if you own them as a health related question. I also think its reasonable to "fire" a patient who threatens to sue after being asked a completely normal question at a newborn's pediatrician appointment.

    I just don't understand continuing to see a doctor that you don't trust. I trust my family doctor implicitly to care for my family and I always answer her questions with the truth even if I do t understand why she is asking. Because I trust her, I also trust that she has a health related reason to ask.

    All of that said, I once had a creepy doctor when I was 13 who wanted to give me a breast exam because that was how he "gets to know his patients" I refused the exam and never went back.

    As ever, gun control issues and health care issues make me unbelievably grateful to be Canadian.

  126. Ktpick says:

    *even if I don't understand, sorry typing on my iPad while my youngest is sleeping on me

  127. Narad says:

    I was drawing a more precise parallel to the "gun removal" recommendation as opposed to something which decreases accident risk while simultaneously respecting the lifestyle choice.

    But the removal recommendation isn't monolithic. If you look at a couple of the papers posted just above, giving out gun locks or discount coupons are represented in the approach. I don't really see "get rid of our cars" (not only devoid of effectiveness, but actively counterproductive if you need to get to the emergency department), "take steps to improve our driving safety skills" (no demonstrated prior plausibility), or "keep our child out of the car as much as possible" (and leave him where?) as comparables when one is talking about the task of making effective recommendations.

  128. Christina says:

    @Gavin, are you saying you don't take your children to the doctor for preventive health maintenance? I don't do that myself, since I consider it my responsibility and not my doctor's, although I do occasionally consult my doctor as a resource. But I think most people do expect their physicians to provide a total health package and not just disease or injury remediation, and that being the case, I think accidental injury prevention education is a perfectly acceptable space for discussion within the doctor/client relationship.

    I actually don't think I've had *any* of these issues (guns, pools, chemicals, carseats) actively addressed with me at the pediatrician's office in 35 child-years with the same doc. He's in a highly-organized and coordinated institution, not a solo private practice, so I assume it's not from lack of policies and pamphlets on injury prevention questionnaires. I don't think he discusses it with me because from the outset we've had a client/consultant relationship and not the typical patient/expert dynamic.

  129. AlphaCentauri says:

    Re: Whether "firing" patients indicates a God-complex –

    I know a doctor who had a patient who had an abnormal chest xray. The patient told him he was already seeing another doctor about it. He refused to give the name of the other doctor. When he died of lung cancer, the records showed he had told the other doctor that he had had a normal chest xray — but he wouldn't tell the second doctor where the xray had been taken or what doctor ordered it. Both doctors continued treating the patient out of respect for his right to make his own health care choices. But my friend was successfully sued for malpractice for failure to follow up the abnormal chest xray, with the plaintiff's attorney claiming that the standard of care would have been to fire the patient for failing to cooperate with medical advice.

    Fix that kind of absurd legal standard, and you'll see a lot more doctors willing to respect your right to self determination.

  130. Unix-Jedi says:

    Narad:

    I have no assumption. I advanced an assertion,

    Ah, much becomes clear when you say:

    as a result of dealing with antivaccine cranks.

    You've learned well from them.

    Christina:
    is your challenge to a physician asking the question at all, or to giving impersonal recommendations for gun safety (i.e. removal, locked storage, etc.)?

    It's recognition that this as a systemic issue began as a way to "backdoor" gun control in through "public health" and via other methods than direct prohibition.

    "Impersonal recommendations" – well, we'd have to know what they are, but as you can see on this thread, they're not really scientific. They're personal opinion.

    There's really no reason at all to be asking about guns in the course of routine doctors visits, unless you've got a political agenda, or have a heck of a referral deal from a gun safe company.

    Because the link you quoted earlier about the definition of public health did include prolonging life as an aspect, within which gun safety would certainly qualify.

    Not really. That's taking the assumption that "guns are fundamentally unsafe" as a given in the assumption. Guns aren't. People are.

    And people are driven by opinion, and mask it with rationalizations of logic and scientific thought.

    A person who values gun ownership highly will not like hearing that “removal” is the preferred gun safety technique of their pediatrician or psychiatrist (or of that physician’s professional organization).

    It's not a matter of "liking" it or "preferences". Why? Why would that be a preference? I'm going to my doctor to get scientific advice and treatment. Not opinion and religion.

    They won’t like it any more than I liked hearing my dentist tell me I had to stop breastfeeding because I was going to ruin my child’s teeth.

    Did your dentist have anything backing his opinion, scientific studies that proved/indicated/hinted that breastfeeding would "ruin" teeth?

    If so, that's worthy of discussion. If not, well, then that's exactly the same case, it's a preference, and he ought not issue those edicts from a position of authority.

    But even so, that's within a level of experience and authority that one might expect from a dentist.

    But as I asked before: "How many hours did you study "Childproofing" in medical school? What kind of internship and residency did you have that prepared you for that?" – what expertise does a pediatrician have in gun safety?

    And that's the problem. This law was a result of several anti-gun organizations trying to "educate" doctors and pediatricians into "gun safety" questionnaires and initiatives. And to large extent, it worked, because, well, most doctors don't have expertise in that area.

    Miranda:
    The paranoia about agenda-pushing is over the top.

    It's not paranoia. I gave you a link to something written in 2000 about this very same issue . It's lost momentum in most eyes, with the recovery of gun rights in most people's eyes, but that's why this was an insidious (but brilliant) idea, and why it's so dangerous.

    The brilliance wasn't that the people pushing the agenda were doctors, they were just using them, very effectively. As you can see by some of the doctor's responses in this thread.

  131. Christina says:

    @Narad, removal may not be the monolithic recommendation but it is referenced above as the recommendation of the AAP which is the main pediatric association in the USA, from which most pediatricians will draw their continuing education. If throwing out the gun is the preferred way to prevent gun injuries and deaths, why not throwing out the car for a tool causing far more trouble? The car is a lifestyle tool and not a necessity of life for most people; certainly the high-mileage lifestyle of most US residents is completely optional.

    Being in the middle of research for student driver training for my oldest child informs me there is plenty of research showing the correlation between training and improved driving safety, and although I haven't researched repeat training for older drivers I assume similar improved statistics are behind the implementation of "traffic school" continuing education programs in place in many states for violations. (If that's what you mean by "prior plausibility".) One can always call an ambulance for an ER trip and keep one's (and one's child's) logged miles as low as possible to decrease overall risk.

  132. Gavin says:

    @KtPick,

    Canada doesn't have gun control issues? You guys are nearly identical to us in accidental deaths per capita related to guns.

    @Christina,

    Yeah, the doctor is just for ouchies. If I need anything else I'll ask, grab a pamphlet, or google it. Then again, I've also studied up on child proofing and it would just irk me to have someone insist on rehashing stuff to me, like I'm having to sit through a time share sale. I want the doctor to do what I pay them to do unless I'm doing something glaringly wrong. I don't have a gun, but if I did I can tell you it wouldn't be obtainable by any children.

  133. Narad says:

    The car is a lifestyle tool and not a necessity of life for most people

    I'm quite curious what sort of scenario you imagine were this assertion to be taken to be correct? "Hey, honey, the pediatrician just recommended that we build a yurt close to the hospital, take up subsistence farming, and use their wifi to open an Etsy shop so we can get rid of the car. It's a lifestyle choice."

  134. Narad says:

    Narad:

    I have no assumption. I advanced an assertion,

    Ah, much becomes clear when you say:

    as a result of dealing with antivaccine cranks.

    You've learned well from them.

    Way to ignore everything, including the fact that I gave you an argument in your favor that actually holds water.

  135. Mike K says:

    Christina, vehicles are a necessity for a lot of Americans. I suppose I could have stayed at a minimum wage job in town, lived with my parents, and rode a bike to work. Otherwise, my current job requires me to be in a location where I would have to buy a house worth hundreds of thousands of dollars for it to be within reasonable walking distance. Mass transit is not available at all in rural parts of the country, so assuming that's slightly safer than personal driving, it still doesn't help. I will grant you that I do a lot of driving that is totally unnecessary. For instance, I drive several hundred miles every few weeks to see my parents. Strictly speaking, I don't need to see them, and could drive about half that distance if I wanted to pay for air fare to/from the nearest airports. Guns are not in the same category for almost any person. The hunters I know even admit that hunting is more expensive for the meat they get than going to a grocery store would be. The fish they catch might be a better rate, but guns aren't used for that.

    I imagine the reason car seats don't come up very often in a visit with a doctor is that it's a legal requirement, which parents are typically informed on long before their child's birth. That would, presumably, be the same reason seat belts never come up in a doctor visit, unless it's a seat belt related injury.

  136. Unix-Jedi says:

    Narad:
    Thanks for the "help". Really, I don't know what I'd do without someone as helpful as you. Oh, wait, have a meaningful discussion, that's right.

    I'd link you to what "assumption" means in the context of debate, but I don't think you'd learn anything, but you'd reply without reading.

    You said something, I replied, and then you said that wasn't what you said.

    OK. If you're going to twist, rend, spindle, and mutilate the English language such that it's useless, then have fun. (Maybe you should ask a doctor about that.) Once you get into the "I didn't say that yes I did no I didn't" that's well-nigh-endemic in the anti-vaxxer screeds (among other places), then there's really no point.

    Either you – that is, you, Narad – consider guns "disease" or you don't. You've claimed both. I'm not the one with a logical problem here.

    You haven't given me an "argument in my favor" because your assumptions are flawed from the start.

  137. Narad says:

    Either you – that is, you, Narad – consider guns "disease" or you don't. You've claimed both.

    Why, no, I haven't. Again, reading comprehension doesn't seem to be your strong suit.

  138. Ktpick says:

    http://www.cbc.ca/news/canada/story/2005/06/28/gun-deaths050628.html

    @Gavin, well actually Canada has much lower gun deaths the the US even when just taking accidental deaths into account according to stats Canada. To clarify, I didn't say that Canada doesn't have gun control "issues" but they're more on par with people grumbling about the gun registry than people defending their "right" to own a ridiculous amount of weaponry and ammo. In fact, I was just reading an article yesterday saying that most of the handguns used in violent crime here in Canada have floated illegally across the border from your country. That probably wouldn't happen if they weren't practically giving them away south of the border (in the USA)

    Not a single person I know (either in the southern ontario city i live in, or in the several northern towns i grew up in) owns a handgun. The few people I know who do own a gun own one or two hunting rifles and that's it. So it's not shocking that gun related accidents are significantly lower here than there. Like DancingSamurai said above, when asked if they own a gun, most Canadians laugh and say no.

  139. Jess says:

    The whole asking people if they own guns issue reminds me of an incident several years ago when I was temporarily on a medication that were I to become pregnant not only could but definitely would cause serious birth defects. I went to a pharmacy to fill the RX. The pharmacy technician asked me if I was pregnant in front of a whole group of people. I was a bit taken aback and said no. She then asked if I was sure – again in front of everyone. She in so many words basically called me an ignorant whore. That pissed me off and I had a long discussion with the store manager and wrote a letter to corporate complaining about her behavior. The way she SHOULD have handled it was simply to state “has your doctor explained the dangers of taking this medication while pregnant and the sever injury possible to a fetus?” That’s it. No nosy or inappropriate questions and yet the real issue is addressed. It’s a valid question and it’s not intrusive or insulting. It is the exact same way I believe any physician should handle concerns about guns, pools, chemicals, etc. Not by asking the patient if they own a gun – that is not the doctor’s business, but by simply informing them that a part of their care practice they hand out xyz brochure on child proofing to new parents. Issue addressed. They don’t need to ask intrusive questions and the parent gets the information which they can choose to study and use at their discretion.

    As far as questions like asking a woman if she having pain during sex – lack of lubrication, erectile dysfunction, lack of sex drive, etc. these are valid questions depending on the type of doctor and age of the patient because they can be indicators to underlying health issues. My Aunt got asked the “lubrication” question recently but the doctor explained why they were asking – it’s an indication of menopause, etc.

    As far as questions about how often you think of sex or if you watch porno – that’s none of their damn business.

  140. Mike K says:

    Actually there are conditions and toxins that would include increased libido as a symptom or side effect, so questions related to such things could be relevant. If the question is asking you what kind of sex or porno you prefer, that's more of a stretch, although changes in preference could indicate something too.

    Informing every patient in a certain group of the risks of guns and the need to keep them safely would waste more time than asking patients if they have them followed up with relevant information or a location to get the relevant information if they do.

    I do kind of wonder why some people are saying that the only time asking about guns is relevant is when there's a bullet hole in the patient. That's actually a case where I'd expect the doctor to treat the obvious injury and let the police or child service people handle the safety lecture. For gun caused injuries prompting such questions, I'd think more along the lines of burns, scrapes, or bruises caused by firing a gun.

  141. John David Galt says:

    @Miranda and MikeNH: Three different doctors I've seen as an adult, all non-pediatricians, have asked me this in their introductory questionnaires. So don't try to tell me doctors aren't asking it. At least in northern California, most of them are.

  142. jaed says:

    Actually there are conditions and toxins that would include increased libido as a symptom or side effect, so questions related to such things could be relevant.

    No. Asking "Has your sex drive changed recently?" is potentially relevant (although a bit of a fishing expedition, if the patient hasn't mentioned it and there's no reason to suspect a condition that could cause libido changes). Asking about porn, masturbation habits, or frequency of sex is a boundary violation because those things are both extremely personal and not directly relevant to diagnosis.

    Do most MDs even get training in interpersonal and professional boundaries and how to avoid transgressing them? Clinical psychologists, MCSWs, and so forth certainly do, but I am getting the impression, from this and other conversations, that boundary issues are an utterly foreign area to most physicians. The attitude displayed by the anonymous doctor who has commented several times here, who demands implicit trust from all patients, that they must answer all questions and obey without question, is setting off every this-is-an-abuser alarm I have in service. I doubt this is intentional, and this doctor probably isn't an abuser, but surely he or she realizes that the attitude is dangerous?

  143. M. says:

    @Mike K: I'm extremely interested to know what conditions and toxins create an increased libido.

  144. Ben says:

    M.,

    A cursory (about a half hour) investigation reveals that some of the most prevalent cases of a medical pathology associated with hypersexuality are adrenal tumors, bipolar disorders and certain forms of brain trauma.

    In terms of toxins, all I could find were that some drugs used in the treatment for Wilson's disease and Parkinson's have reported side effects of hypersexuality.

    Is that helpful?

  145. TC says:

    Every doctor on this thread has responded that it is such a reasonable question in a reasonable scenario, a part of normal doctoring. That’s not how I experienced it.

    My then teenage daughter was in the emergency room for some stiches, IIRC. She did not answer on the forms, so they asked her again. She said “none of your business”. They moved us into separate rooms, hand had each of us “counseled” by social workers for about 20-25 minutes. In her room, it was two on one, and the doctor, at a large public teaching hospital, had a protocol to not continue treatment until the social workers signed off on each of us having received and assented to procedures for handling guns that we did not have.
    The social workers were in their young 20s, students at the University, used verbified nouns frequently, and seemed clueless about anything outside their cocoon world, but very dedicated to DOING GOOD by eliminating BAD GUNS.

    Overall, it made me want to go out and acquire a collection of semi-automatics.

  146. Jess says:

    @Mike K –

    Informing every patient in a certain group of the risks of guns and the need to keep them safely would waste more time than asking patients if they have them followed up with relevant information or a location to get the relevant information if they do.

    Respecfully, no it doesn't. Handing out a pamplet and taking 20 seconds to mention it takes no more time than asking the question.

  147. M. says:

    @Ben: Yes, and very interesting. Making an effort not to stray into TMI territory, I've always been curious. I am unmedicated bipolar, so that fits.

  148. princessartemis says:

    Interesting that Anon-doc demands implicit trust in him because he has the degree. Based on my experiences with many, many people with medical degrees, implicit trust in people with medical degrees is a very good way to have them inadvertently inflict partial-medically caused life-long disabling movement disorders on one.

    I don't implicitly trust anyone who demands it just because they went to school. I learned the very hard way that to do so is to invite disaster.

    I do have doctors I trust, just not as authorities over me.

  149. Narad says:

    Three different doctors I've seen as an adult, all non-pediatricians, have asked me this in their introductory questionnaires. So don't try to tell me doctors aren't asking it. At least in northern California, most of them are.

    I take it then that there are no more than five doctors in northern California. Even better, I have a way bigger anecdata set than your N = 3; in something like 14 instances, I've never been asked such a question. Maybe it's just you.

  150. AlphaCentauri says:

    The doctors in my area seem to use a standard form that asks, "If there is a gun in your home, is it kept unloaded and out of children's reach? Yes No N/A" Most people get it wrong and circle "No" without reading as far as the "N/A," though. It's with the questions about bike helmets and seat belts, so it's clear that it's just general concern about accident prevention.

  151. OlivaQuinn says:

    I'm another Canadian who frequently reads this blog, but has never felt inspired to comment before. I tend to agree with and devour everything on this blog, but I have to say, this post is so telling of the difference between Canadian culture and American. You want to talk about agendas? Y'all are missing the biggest agenda of all, hidden in the lines of this post and the comments: for-profit health care. It's killing you, and you brag about it. It's better up here. Colder, but better :-) And get over your guns. Another thing one ought to not brag about. Why are you proud you all need guns? Try building a society where people feel safe without them. There's something to be proud of.

  152. M. says:

    Welp, I'm off to buy stock in Astroglide…

  153. Ktpick says:

    Round of applause for OlivaQuinn from one Canadian to another. I totally agree with everything you've said.

  154. flip says:

    Another round for OliviaQuinn – as an Australian, with no guns allowed and a similar health system.

  155. M. says:

    Well, since none of the other Americans are up to the job apparently, I'll say this as an American who lived in Canada for 10 years out of 29:

    Sweeping societal change is actually really difficult to pull off, particularly in a country where the military is very well-armed and given a long leash.

  156. Ben says:

    M.,

    Ideally I think, as Americans, we should be using trite cultural prejudices to belittle other societies.

    Something like; "Well, if all we had worth protecting was snow and moose dung, we probably wouldn't need guns either!"

    Though they do have strategic maple reserves.

    See? Much more authentically American!

  157. Ktpick says:

    Public health care and gun registries are hardly "sweeping" changes. Just modifications on what you already have (Medicare and gun control laws).

    And I find it hard to believe that an armed military is your problem. Seems to me like your heavily armed populace is a much bigger problem. But that's just the opinion of an igloo dwelling moose lover ;)

  158. OlivaQuinn says:

    I don't think you're being fair, Ben. We have more than just maple. We should also be acknowledged for the beaver, our toothy and industrious mascot ;-)

  159. M. says:

    @Ktpick: With all due respect, they probably don't seem like sweeping changes to you because you're Canadian. Even if you look at such changes as simply making an inefficient system efficient, the amount of bureaucracy, naysaying by opposing voters, and slap-fighting in municipal, state, and federal governments to slog through makes meaningful change practically impossible.

    If you don't think our military would cheerfully put down any kind of real revolutionary attempt with brutal force, you have a great deal more faith in the U.S. military than even many patriotic Americans (among whom I do not count myself, at least in the generally accepted sense).

  160. M. says:

    @Ben: I recommend Three Dead Trolls in a Baggie – "War of 1812". ;)

  161. Mike K says:

    You know one of the funny things about healthcare reform in the US, is all the people threatening to move to Canada if the changes went through. I realize that all those people were morons, but it's still funny.

  162. M. says:

    @Mike K: I enjoy a giggle and eyeroll every time people trot that out. You can tell people are so amazingly serious by the fact that they're sitting in right in front of someone who did exactly that, but never ask "So, how'd that work out for you?"

  163. James says:

    This post and most of the comments other than those by physicians are just repulsive. I wish my insurance company would charge patients who don't think accident prevention counseling is a legitimate health matter extra so I don't have to pay for their stupidity.

  164. Unix-Jedi says:

    This post and most of the comments other than those by physicians are just repulsive.

    Why is that, James?

    Repulsive? Interesting term. I asked the doctors above for their sources, studies, and where they got their information from. They never answered.
    Now, I suspect they don't have any to point to. Just "repulsion".

    don't think accident prevention counseling is a legitimate health matter

    There's not enough money, or experience, in the world, to "counsel" you on everything that might be dangerous.

    All those "repulsive" comments asked for was authorities, proof, and some substance.

    Maybe even numbers, which is what Insurance Companies run on.

    Ken: See the problem, and why many of us are behind such a law, despite it's flaws, yet?

    (HT: SayUncle)
    http://www.spokesman.com/stories/2012/aug/12/a-matter-of-public-health/

  165. James says:

    @Unix-Jedi: Google is your friend; see pages 3 and 4 of http://www.jhsph.edu/research/centers-and-institutes/center-for-adolescent-health/az/_images/US%20Fact%20Sheet_FINAL.pdf E.g., "Figure 4: Percentage of Firearm-Related Deaths per 100,000 Juveniles, Ages 0-14, by Country," and compare Canada to the U.S.

    Would you be willing to pay the residual extra cost of treating gunshot wound patients in order to go to a doctor who would promise to never ask if you own a guns or if your kids have access to guns in your house? If not, why not?

    The value of preventative counseling is the mortality and morbidity times the risk times the preventability of the risk. There is still huge room for improvement.

  166. PalMd says:

    Someone up thread referenced, I think, my earlier discussion on this. http://whitecoatunderground.com/2011/01/24/practice-good-medicine-go-to-jail/

  167. James says:

    What is most repulsive is that our legal education system churns out lawyers who are more than willing to impose prior restraints on M.D. speech, and then ask others to pay for the excess medical costs. The savings potential of tort reform doesn't come close to the cost of excess gunshot wound treatment above the rest of the developed world.

  168. Unix-Jedi says:

    Would you be willing to pay the residual extra cost of treating gunshot wound patients in order to go to a doctor who would promise to never ask if you own a guns or if your kids have access to guns in your house? If not, why not?

    Again, why would the doctor ask, and what does the doctor know about guns? If the answer is "nothing", then no, the doctor shouldn't be asking about them, and the question is mooted, unless there's a political agenda here.

    There is. So the answer was political.

    Google could be your friend as well, for checking out John Hopkins, who sponsored the study and notice that "Bloomberg?" He might be working a non-disinterested political angle.

    OK, that said:
    and compare Canada to the U.S.

    And the difference is Canadian doctors ask about guns and US doctors don't?

    Otherwise, what's your point? The issue here is doctors -without training, scientific study, or reason – asking a question with a political motivation.

    The value of preventative counseling is the mortality and morbidity times the risk times the preventability of the risk. There is still huge room for improvement.

    And I keep asking, based on what?

    I know, the real answer, that nobody here will give is "get rid of guns". Funny that nobody will say it that blatantly, which is my point, and what I was trying to point out to Ken, and why this law, and others like it have been proposed, and more are coming.

    Everything is vague and handwaving and don't look behind that curtain.

    The value of preventative counseling … There is still huge room for improvement.

    What counsel would you have them give, then? What would you consider successfully "improved"?

  169. Unix-Jedi says:

    PalMD:

    Again, my point exactly to Ken. This is why MD's are being restricted from asking, because you have a political, not medical, agenda.

    homicide and suicide by firearm are the second and third leading causes of injury-related death in the US in the 15-24 age group. The exact magnitude of the problem can be debated, but its health significance cannot.

    OK. So what does that have to do with asking if people have guns/secured in the house? Murder and suicide are better if not committed with a gun?

    Your entire thesis rests upon a political argument, not a factual one. You're not talking about kid finding unsecured gun, you're conflating in kids old enough to commit suicide, and kids old enough to be in gangs.

    The first should be uncontroversial—who can argue with asking a patient if they own the means to end life rapidly and violently, if they know how to secure it properly, and if they keep it out of the reach of children?

    For smart people, doctors can be remarkably short-sighted. Aside from the issue of "So what will do do with the data once you have it", there's the issue of "Who else has access to this data", and the ever present "and how long will this data be kept". Off the top of my head, that's the issue I have with it.

    So, what do you do with the data, who has access, how do you secure it, and how long will you keep it?

    And what's your liability for "misuse" (I suspect your definition of that and mine might not match), and disclosure?

    PalMD: If you want to play in politics, prepare to have them play back.

    So what do you counsel your patients, and what is your training in that counselling?

  170. Grifter says:

    Unix-Jedi:

    Reading your replies, it seems, to me, that you are confusing philosophical with political.

    Political would be the government intervening (and the study may well be political, with the motivation of giving ammunition to political argument).

    The Philosophical debate is this: Guns are dangerous. Kids play with guns. Therefore, if you have a gun, you should do something to reduce the risk.

    It becomes political when the argument is that therefore the government should do something, but in this case, it seems the doctors aren't doing that, at least not on the "ground troop" level, they are telling parents that, if they own a gun, they should secure it, and they're doing it in a conversational way, as opposed to a droning "here's a pamphlet" way, which many people will ignore, even if it relates to them (vis. End User License Agreements).

    As regards to your "how long is the data held, who has access" question, I would presume that, as a question whose defense is its medical basis, it would be protected under HIPAA, and subject to those rules?

  171. Unix-Jedi says:

    Grifter:

    No, I'm not confusing them.
    I've been following this for over 15 years, and this was a _political_ attempt to "sneak in" gun bans, guns as public health "hazards" and various other ways around the Second Amendment and public preference.

    Philosophy factors in, it certainly does, but this effort wasn't a disinterested medical issue, it was driven by people with a political agenda, in an attempt to use the authority of the medical establishment as cover.

    And, as you can see here, it was somewhat effective at that.

    The Philosophical debate is this: Guns are dangerous. Kids play with guns. Therefore, if you have a gun, you should do something to reduce the risk.

    But the people aren't talking about kids playing with guns. Look at what they're citing. They're talking about suicides. Gang shootings. Criminals. "Kids" who are up to age 24.

    Is that what you think of when you think of the issues of a toddler accessing a gun? That's the _image_ that's presented, and the _data_ doesn't match that image at all. So either the doctor has _data_ to present – and presumably they'll be familiar with the pros and cons of what they're about to suggest, or else, they're pushing a philosophical agenda via their MD. Which is politics.

    "Reduce risk" – that's a huge undertaking. Again, on what basis does a doctor inform me about "reducing risk"? What does he or she know about it, and the various other risks involved? If they're talking about gangland shootings in Chicago and DC, what does what have to do with me and my situation?
    If your doctor started citing studies (and for the sake of this statement, we'll just accept them as a given), that cited the opposite sex, and radically different population as yourself in a treatment plan, would you say "Wow, they really know their stuff." or "Wait, I'm not a one-eyed purple people eater, and I don't think eating more people is going to help my stubbed toe."

    So what "reduces risk?" Trigger guards? Locks? How do you best "reduce risk" and allow for access for safety? When do you allow children access? Let's see some _data_, not just "Guns are bad, mmmmkay?"

    it seems the doctors aren't doing that

    Seems? Ok, according to who? Read the thread, the initial comments are "that doesn't happen", and then as more MDs and people who experienced exactly this chimed in it turned into "Well, OK, it does, but not like that"… and onto where we are now.

    Notice that someone commented that he was seperated from his daughter and she was "counseled"?

    "Seems?" No, what's happened is that's what you want to hope is happening – it may, or may not be what is – and we have statements in this thread disputing exactly that hope.

    at least not on the "ground troop" level, they are telling parents that, if they own a gun, they should secure it, and they're doing it in a conversational way, as opposed to a droning "here's a pamphlet" way

    Maybe. Or maybe more. The issue is when you classify it as "public health" you get to – or are mandated to – go farther than that.

    The father above who was separated from his daughter certainly wasn't done "conversationally". So if I refuse to answer, or I answer "wrongly", does the doctor have the ability, or the requirement (in their minds) to notify the authorities that a "child is in danger"?

    That's the philosophy behind the law – and it is a response by political activists. Who took what you want to see, and used it exactly as you don't think they did. Look at that .pdf from 2000? 12 years ago? When this wasn't really a _new_ issue?

    , I would presume that, as a question whose defense is its medical basis, it would be protected under HIPAA, and subject to those rules?

    Got a cite for that? You can presume it – but it can be – and has – argued that it wasn't "medical information", and/or has been collected as epidemiological info – again, "not medical, not HIPPA", and there were reports in the late 90s (sadly, passed into the ether with time, so I can't cite you), getting fliers from antigun groups about 2 weeks after doctors visits. Gee.

    But you can presume it, I can presume it. But the issue is what's the legal liability? (As a doctor, why would you want the liability?) And would your insurance protect you against a lawsuit? (Probably not.)

    So then, with all these presumes and ifs and seems…. This is why Florida (and other states, just FL gets noticed more for some reason) passed laws on this.

    The Philosophical debate is this: Guns are dangerous. Kids play with guns.

    And you've accepted the premise, which is the real crux of the problem. Which is what the MDs arguing here have. And how DARE we tell them what they can do, which is the subtext.

    Hey, stay out of politics, or don't complain when it decides to invade your practice.

  172. Grifter says:

    This is obviously a big deal to you.

    However, you continue to confuse terms.

    If I doctor tells me that I shouldn't own a gun, and that I'm a bad person for doing so, and in his medical opinion I'm a bad parent, then that is his opinion and his philosophy. It is no no way his politics. It becomes his politics if he argues for a law. Words mean things.

    If you want to say "this is a slippery slope, and will EVENTUALLY lead to a law", that is a point you could make, but make that, don't claim that we're there already.

    "Got a cite for that?" You want a cite, but can't give me one. That's being disingenuous. Either don't use things you can't cite, or don't demand a citation from me.

    "And you've accepted the premise," Which part don't you accept? Are you arguing that guns aren't dangerous, or that kids never play with guns?

  173. Unix-Jedi says:

    Grifter:

    Yes, it is. Largely because of the disingenuous nature of the argument from the other side.

    If I doctor tells me that I shouldn't own a gun, and that I'm a bad person for doing so, and in his medical opinion I'm a bad parent, then that is his opinion and his philosophy.

    Sure thing.

    It is no no way his politics. It becomes his politics if he argues for a law. Words mean things.

    Yes, they do. And you can see above a case that you're ignoring where your supposition means something. Regulation, bureaucracy is also politics, and when CPS gets involved – as they can, and will, at least in theory, even if you want to argue that it's never happened, it's politics.

    If you wan to talk about words meaning things, you should perhaps be less disingenuous about the slope we've already experienced – the pitfalls, and more importantly, the fact that the reason I spoke up was the categorization of "gun violence" to "disease".

    You may say that they're the same. I'll say you're slaughtering the language to get there, and wonder why you feel the need to do so.

    don't claim that we're there already.

    Ah, I see, I'm not allowed to claim things, even when people are in the thread attesting to them. Interesting.

    So you tell me what I think, what I'm allowed to argue, but, really, I'm somehow unimaginably concerned about being labeled by people who have the ability via the state to detain me "for my own good" or for "public safety".

    "Got a cite for that?" You want a cite, but can't give me one. That's being disingenuous. Either don't use things you can't cite, or don't demand a citation from me.

    I admitted I couldn't find it -because I looked, and it's gone. Hence my admission.

    However, your assertation is current law and if true, should easily be discoverable with current law, standards, and reporting requirements.

    I can tell you what was said in the past, and no, I can't cite anymore – admittedly it weakens my case. But you're talking present case, and what you "think" "might be the case", when it's actually verifiable. There is a difference, and you're on the weak end of this.

    Which part don't you accept? Are you arguing that guns aren't dangerous, or that kids never play with guns?

    There's no data on either of those presented to make this a issue worth discussing at the doctors, no. Guns aren't dangerous. That kids "Playing with guns" is a "epidemic" I likewise reject.

    And I ask for data – not about gang shootings, not about suicides (seperate issue, not relevant to toddlers, for instance).

    But more importantly, the risks posed by guns are not the proper purview of medical professionals untrained in risk analysis, and primed by propaganda.

    It's not a "public health" issue, it's not a "disease", and using those words – as you can look above is being done, is a slope we've already slipped down.

    It's a political slope, it is intended to promote a political agenda, and is has, today, implications of real and lasting danger to people's freedom and the integrity of their family.

    I'm not sure how much more clear you might want it. But that's the situation today. And it can get worse.

    Or, you know, doctors can, stick to medicine.

    Sure a lot of people who don't want that.

  174. Grifter says:

    @Unix-jedi:

    "Yes, they do. And you can see above a case that you're ignoring where your supposition means something. Regulation, bureaucracy is also politics, and when CPS gets involved – as they can, and will, at least in theory, even if you want to argue that it's never happened, it's politics."

    We aren't talking about regulation, or bureaucracy, except as regards to what we're preventing doctors from doing. The CPS example might be relevant, except that it was not the case in anything presented. Do you have evidence that "yes I own guns" alone gets CPS called on people?

    "If you want to talk about words meaning things, you should perhaps be less disingenuous about the slope we've already experienced – the pitfalls, and more importantly, the fact that the reason I spoke up was the categorization of "gun violence" to "disease"."

    You are the only one who has argued that guns equate to disase, because you saw disease mentioned in the definition of "public health". You ignored the rest of the definition. Narad already showed you wrong, but I'll use your own quote to help you out a bit:

    "the science and art of… prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals"

    I took out the bit that you focused on, since it was part of a list. The rest of the list relates to the point.

    "You may say that they're the same. I'll say you're slaughtering the language to get there, and wonder why you feel the need to do so."

    Nope. And no one has. If someone has, please show where they have. Otherwise, stop complaining about other people being disingenuous, when that's what you're being.

    "Ah, I see, I'm not allowed to claim things, even when people are in the thread attesting to them. Interesting."

    You can't claim that something which is not political, is political. You can claim that it could lead to political issues, but not that it is inherently political. Because doing so is logically incoherent.

    "So you tell me what I think, what I'm allowed to argue, but, really, I'm somehow unimaginably concerned about being labeled by people who have the ability via the state to detain me "for my own good" or for "public safety"."

    I don't even understand this. I can tell you're trying to insult me, but it falls apart. I haven't told you what you think, I've told you what I think you think, and I've done that in hopes you will correct me if I'm mistaken. And I've told you what you can honestly argue. If you'd rather argue dishonestly, that's fine, but I certainly won't engage with it, nor would anyone interested in the fair exchange of ideas. How dare I tell you you can't claim things which are logically incoherent!

    "However, your assertation is current law and if true, should easily be discoverable with current law, standards, and reporting requirements."

    If you can't cite a case where the privacy has been violated, I can't present a conclusive one where it was found to be covered under HIPAA. I would argue that the fact that you can't cite such an instance would be sufficient evidence that most physicians consider it PHI, but let's see waht the definition is from HIPAA.com.

    B) relates to the past, present, or future physical or mental health or condition of any individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.”

    Seems pretty clearly covered to me. Perhaps the doctors who've posted on here can weigh in on whether they think it's PHI?

    "I can tell you what was said in the past, and no, I can't cite anymore – admittedly it weakens my case. But you're talking present case, and what you "think" "might be the case", when it's actually verifiable. There is a difference, and you're on the weak end of this."

    I would defer to a lawyer who speaks up, but it seems obviously covered to me, so I am willing to assert it, if you'd like, if that's your issue.

    "Guns aren't dangerous. That kids "Playing with guns" is a "epidemic" I likewise reject."

    Well, disagreeing that guns are a dangerous item makes you an idiot. And twisting point 2 to being something it isn't seems dishonest to me. To be clear:

    Guns = dangerous. That is a factual statement. If you're going to disagree, you damn well better back that up. Please explain how guns are not a dangerous item.

    Kids play with guns. This has happened. I don't really think it's an "epidemic" either. But it has happened, and pretending otherwise would be dishonest of you.

    "And I ask for data – not about gang shootings, not about suicides (seperate issue, not relevant to toddlers, for instance)."

    Letting you bog down the debate in statistics is a problem, I think. Because in this context, whether statistics support the frequency of this or not is unimportant.

    "But more importantly, the risks posed by guns are not the proper purview of medical professionals untrained in risk analysis,"

    so you think doctors should be prevented by law from saying anything about any risks. That is your position based on your statements. Because that's what this debate is about.

    Should doctors be required by law to not say anything about guns?

    You can think a doctor is an asshole if you want, you can choose not to go to that doctor if he or she dares ask you a personal question during the assessment. But once you start advocating a law to prevent them saying things you don't like, we've entered a political debate, and I can say that I am of the opinion you've gone too far.

    A lot of people don't want laws restricting speech without a damn good reason.

  175. Grifter says:

    Aaaaaaaaaaaaaaand I messed up a blockquote. Should have known I would.

  176. Unix-Jedi says:

    It's OK, Grifter (or is that you, Narad?), because it's obvious where you're coming from, and you're just obfuscating/spamming to hide the point.

    Again, I'll ask, Ken, do you see the point in the law now?

    We aren't talking about regulation, or bureaucracy, except as regards to what we're preventing doctors from doing.

    Preventing untrained doctors from doing uninformed political advocacy.

    And yes, that is relevant, because doctors and medical professionals have requirements to report "unsafe" conditions to the authorities. Mandated reporting.

    If you want to insist that there's no possibility that it could possibly happen, fine.

    Nope. And no one has.

    Then what is the debate about?

    If they're not equating guns to disease, why would medical professionals ask?

    The very subject equates disease to guns – and several did above, as did PalMD with their link.

    Well, disagreeing that guns are a dangerous item makes you an idiot.

    Guns are not any more dangerous than any other object.

    It's a bit of a pedantic point, but that seems to be what you're trying to obfuscate with.

    But to cut through all of your chaff, I'll get back to my theme, and if you want to disprove it, feel free:

    This is a political attempt to subvert gun ownership via the authority of the medical establishment, using junk science, some bad statistics, and appeal to naked emotion.

    And it's worked, see above. Which is why I'm fine with politically it being halted.

    you can choose not to go to that doctor if he or she dares ask you a personal question during the assessment.

    We've already got one person who was detained and removed from authority over his daughter for failing to answer that question attesting here, in this thread.

    A lot of people don't want laws restricting speech without a damn good reason.

    Speech? Who's restricting speech? We're restricting data gathering.

    And there's plenty of laws about that now. All this does is add to it.

    Sorry if that offends your attempts to disarm the populace.

    so you think doctors should be prevented by law from saying anything about any risks. That is your position based on your statements.

    I have laid them out time and again, and yet you're trying to muddy the water.
    Wonder why that is.

    Well, in short, if doctors have no training in an area, I have no problem with the laws restricting them from practicing in it. It's almost like we've got those now, actually. Gee, what do you know, we do!

    But that's different, according to you.

    What I believe is what I have said, over and over and over again, despite multiple attempts to distort it.

    If doctors are going to speak as to risks, they should stick to the ones they have training and knowledge of, and the ability to refer to proven scientific studies of the risks, and benefits.
    There are lots of risks. Why would guns be singled out here?

    Unless there's a … political reason? Simple, there's a political reason.

    Sorry to break it to you.

  177. Grifter says:

    @Unix-Jedi

    Here's an analogy: You can be against abortion. You can argue it's bad. But you can still be in favor of the right to an abortion. Your political position is to defend the right, even if your personal, philosophical position is that it's bad.

    Not every doctor who asks this question wants to "disarm the populace", and implying otherwise is unfair of you.

    "And yes, that is relevant, because doctors and medical professionals have requirements to report "unsafe" conditions to the authorities. Mandated reporting. If you want to insist that there's no possibility that it could possibly happen, fine."

    I'm asserting it has never happened. Can you show where it has? I'm quite familiar with mandated reporting rules, and they only apply when you think there's an iminent threat. If someone says "Yeah, my 3 year old plays with my loaded pistol all the time", I might report them. If they say "I own guns, but I'm responsible", i'll have a hard time justifying myself.

    And more to the point, I said it was a debateable topic, but if we were debating it, I would say it's still not valid. Calling the cops is not political advocacy.

    Then what is the debate about?

    It's about whether it's okay to prevent doctors from asking a question. You keep trying to say it's about whether guns are a disease. No one has made that point. And you can't point to where they have.

    "If they're not equating guns to disease, why would medical professionals ask?"

    Because guns are a dangerous item, and in the context we're talking here, they're a dangerous item that children might have access to? Remember, the original case was a pediatrician asking.

    "The very subject equates disease to guns – and several did above, as did PalMD with their link."

    Nope. Guns were never equated to a disease. Please quote something that equates a gun to a disease, and we'll continue on that.

    "Guns are not any more dangerous than any other object."

    Bullshit. That is not a statement of fact. A piece of paper, for example, is less dangerous than a gun. A piece of paper is lighter than a gun. Harder to throw. A piece of paper is unable to fire a projectile using explosive force.

    "It's a bit of a pedantic point, but that seems to be what you're trying to obfuscate with."

    No, I'm making a statement of fact. Your response is laughable. You can try to defend it, but you will have a hard time defending the assertion that "all items that exist are equally dangerous".

    Buzzsaws are also dangerous items. And I think it would be okay if a doctor asked "Do you guys have a lot of power tools?" of new parents.

    But to cut through all of your chaff, I'll get back to my theme, and if you want to disprove it, feel free:

    This is a political attempt to subvert gun ownership via the authority of the medical establishment, using junk science, some bad statistics, and appeal to naked emotion.

    I have already disproved it. It is not, in the individual case, political. A doctor asks a person a question. Where, exactly, does politics come into play? Do a lot of doctors expound on their hatred of the 2nd amendment, or do they say "Okay, well, I'd like to know what you're doing to make sure your toddler doesn't blow his face off"?

    "We've already got one person who was detained and removed from authority over his daughter for failing to answer that question attesting here, in this thread.

    I agree that situation was bad. Were I that father, I would have refused their taking away my daughter. Had they forced it, I would have sued the shit out of the place. But I do not believe that was a good situation. It also wasn't the doctors entirely doing it. It was the social workers. "In her room, it was two on one, and the doctor, at a large public teaching hospital, had a protocol to not continue treatment until the social workers signed off…"

    But yes, that situation was bad. But that doesn't mean that a doctor asking about guns should be a lawbreaker. Which brings us to:

    Speech? Who's restricting speech? We're restricting data gathering.

    No, you're restricting speech.

    According to this :

    The bill specifies that
    a verbal or written inquiry by a public or private physician, nurse, or other medical staff person
    regarding the ownership of a firearm by a patient or the family of a patient or the presence of a firearm
    in a private home or other domicile of a patient or the family of a patient violates the privacy of the
    patient or the patient’s family members.

    So, yes, it is a problematic limit to what the physicians can ask.

    Sorry if that offends your attempts to disarm the populace.

    I am not in favor of that. Nor am I Narad, despite your earlier comment. But if you want to be an asshole, I'm sure Ken would just love if this devolved into the lobbing of insults. (I am, of course, being sarcastic. Our generous hosts do not want the conversations here to devolve).

    Well, in short, if doctors have no training in an area, I have no problem with the laws restricting them from practicing in it. It's almost like we've got those now, actually. Gee, what do you know, we do!

    Doctors DO receive training on risks and the management thereof, particularly pediatricians. The large professional organizations consider the question perfectly valid. They may be wrong, and that's an argument to have with the largest organizations, not to punish the frontline docs for listening to.

    If doctors are going to speak as to risks, they should stick to the ones they have training and knowledge of, and the ability to refer to proven scientific studies of the risks, and benefits.

    I don't think we need a study to say "unattended toddler + loaded, unlocked firearm = risk of injury". Do you think we need a study to prove that?

    There are lots of risks. Why would guns be singled out here? Unless there's a … political reason? Simple, there's a political reason.

    I had a dentist who hated Listerine. He said that it often dried out the gums (which is true, due to the alcohol), and that he was not in favor of its daily use as a general rule. He asked if I used it, and we talked about it. My current dentist doesn't do that. Does that mean the first dentist wanted to make Listerine illegal? I've known doctors who are willing to talk about honey for throat issues, and some who only prescribe meds. There will always be variation in care. So long as it stays within the bounds of reasonable care, as determined by their peers (which it does), I see no reason to use the law as a truncheon. Politicians should not be determining what medical care is. Doctors should be. And the doctors are saying it's a legitimate question.

  178. Unix-Jedi says:

    Grifter:

    Lots of virtual ink to obfuscate. I keep trying to simplify it back, you keep obfuscating. The point's been proven by you why this restriction needs the force of law.

    I have already disproved it. It is not, in the individual case, political.

    Yes, it was an organized campaign, by ideologues, with a political purpose.

    That there might be people ignorant of it, or independent of it may well be true. But nobody here has presented that, instead, sticking to the original political plan.

    Your response is laughable.

    Only if you impart magical abilities to items. A gun is not a deodand.

    Doctors DO receive training on risks and the management thereof, particularly pediatricians.

    Funny, I keep asking for particulars, and not getting them.
    What proof do you have they have training? I've yet to find what training exist – I've asked it in this thread multiple times.

    The large professional organizations consider the question perfectly valid.

    Which would be… Oh, I've made the point.

    Obfuscate away.

    They may be wrong, and that's an argument to have with the largest organizations, not to punish the frontline docs for listening to.

    Who's been punished? Nobody.

    It also wasn't the doctors entirely doing it. It was the social workers.

    Rather dense, aren't you?

    So we have a commenter, laying out exactly the sort of problem I'm describing – you tell me it's imaginary, you finally go back and read the actual comment, and rather than admitting that yes, there's a real problem here, you claim it's somebody else's fault.

    Nice.

    If you're trying to obfuscate, and cover up the political aims of the organized attempts to use MD's to register/restrict and harass gun ownership, you're doing well.

    Otherwise, you're without a point.

    Guns are not "dangerous". You sneer, but it shows what your agenda and experience is. They can be – and yes, just like a buzzsaw.

    Cept there's no organized efforts to outlaw buzzsaws. But as soon as there is, your analogy will fit.

    In the meantime, if doctors want to minimize political influence, they shouldn't agree to advance political agendas, and be surprised at the blowback.

  179. Grifter says:

    @Unix-jedi

    "Lots of virtual ink to obfuscate"

    Disagreeing with you is not "obfuscating". I'm beginning to wonder if you actually know what that word means.

    We're talking about individual doctors here, in regards to the legislation in question. The situations punished by the law are NOT "an organized campaign, by ideologues, with a political purpose." They are single doctors asking single questions.

    Are you talking about the decision that guns are dangerous to children, or are you saying that there is a secret cabal of doctors scheming to ask people if they have guns?

    "Only if you impart magical abilities to items. A gun is not a deodand."

    Couple things here:

    In the first case, guns HAVE been considered deodands. The Supreme Judicial Court of Massachusetts in 1721 declared a gun as deodand. But I'm thinking you don't know what a deodand is. Do you think that deodands are things with magical power to kill? I'd agree with the statement that guns are not magical. However, they have more inherent danger than a sheet of looseleaf paper. Their weight alone makes them more dangerous, let alone the fact that if they are loaded they have the potential to fire under certain circumstances, which would then propel a projectile using explosive power. I call it laughable to say that all items are equally dangerous.

    "Doctors DO receive training on risks and the management thereof, particularly pediatricians.

    Funny, I keep asking for particulars, and not getting them.
    What proof do you have they have training? I've yet to find what training exist – I've asked it in this thread multiple times.

    Here, let me google that for you .

    Now, you may not think it's enough training, and again, what makes you think you're qualified to make that determination over an above pretty much every medical professional organization? (Can you give an example of a professional association that thinks asking about guns in inappropriate?)

    The large professional organizations consider the question perfectly valid.
    Which would be… Oh, I've made the point.
    Obfuscate away.
    They may be wrong, and that's an argument to have with the largest organizations, not to punish the frontline docs for listening to.
    Who's been punished? Nobody.

    This is not a law directing professional organizations to change their guidelines. It's legislation punishing individual doctors for obeying basic standards of care. No one's been punished with it yet, but that doesn't matter at all in the debate on whether the law is just. You have a problem with the largest medical professional organizations.

    You change that by bringing the argument to those organizations. Trying to establish your point. Not by trying to punish doctors for practicing medicine.

    Rather dense, aren't you?

    You keep insulting rather than making valid points. It's getting tiresome.

    So we have a commenter, laying out exactly the sort of problem I'm describing – you tell me it's imaginary, you finally go back and read the actual comment, and rather than admitting that yes, there's a real problem here, you claim it's somebody else's fault.
    Nice.

    Actually, I said that single instance WAS bad, if you actually read what I wrote. I also said what I would have done differently, and pointed out that the social workers were as much to blame as the doctors, and I would point out now, since you seem unable to draw the connection, they aren't covered by the new law, so the situation would be exactly the same, and this law doesn't prevent the situation at all.

    If you're trying to obfuscate, and cover up the political aims of the organized attempts to use MD's to register/restrict and harass gun ownership, you're doing well. Otherwise, you're without a point. Guns are not "dangerous".
    You sneer, but it shows what your agenda and experience is. They can be – and yes, just like a buzzsaw.

    Couple things:
    My "experience" is owning several guns (but not as many as I'd like) and actually being in the medical field as a paramedic (where I received training on talking to folks about common safety hazards). I love guns. But they are dangerous, and it's perfectly appropriate of a doctor to say "Hey, do you have guns? Okay, well, let's talk about how to make them safe so little Timmy doesn't blow his face off", especially as part of talking about other hazards.

    More, though, you're objecting to saying something with the potential for harm is dangerous?

    THAT'S THE DEFINITION OF DANGEROUS.

    When the item actually causes harm, it's not just dangerous anymore, it's harmful. Potentiality is part of danger.

    Dangerous: Able or likely to cause harm or injury.

    Swords are dangerous. Buzzsaws are dangerous. It's hard to argue a piece of paper is dangerous, but I suppose a ninja can make anything dangerous. Are you a ninja?

    No MDs are registering or restricting or harassing gun owners. The poster in question wasn't a gun owner, they were harassed for not answering the question (which I don't think is
    right either), but not over their gun ownership.

    Cept there's no organized efforts to outlaw buzzsaws. But as soon as there is, your analogy will fit.

    To be clear, my analogy was that I didn't have a problem with doctors asking about guns, or about buzzsaws. Your response is to say that because there are some who are want to outlaw guns, something the doctors cannot control, therefore doctors can't be allowed to ask about them.

    In the meantime, if doctors want to minimize political influence, they shouldn't agree to advance political agendas, and be surprised at the blowback.

    You keep saying that asking a question is a political agenda. The doctors aren't trying to pass a law limiting the second amendment (not even those professional organizations you seem to hate so much), why are you in favor of a law that limits the first?

  180. Grifter says:

    Stupid blockquotes. Fuck you, html closing tags!

  181. Grifter says:

    And, just for the record, trains have been considered deodands.

    http://en.wikipedia.org/wiki/Deodand

  182. James Pollock says:

    Having reviewed the logs to this point, I'm afraid this court of public opinion will have to rule against Unix-Jedi, on his own pleadings.

    Suppose that his worst fears are true: There IS an organized, politically-motivated, opposition to the 2nd amendment amongst doctors, pediatricians in particular. Even if that were so, the correct response is NOT a restriction on their freedom to ask questions of their patients. Rather, the correct response is twofold: First, anyone offended has the right to not answer the question. Second, anyone offended has the right to select a physician with similar political views as their own.

    Using the power of government to silence a group of people with a political point to make is tyranny… whether the political point they want to make is valid or not. It's far more dangerous to freedom than is being asked a question.

  183. Unix-Jedi says:

    Grifter:

    Using the power of government to silence a group of people with a political point to make is tyranny

    Except they're not silenced, James.

    They're free to say what they want.

    (Thanks to grifter for getting me to clarify this in my head. I mentioned it above, and his meta-attempts to change the subject succeded in distracting me.)

    They can say it.

    Nothing in his "seems" and "I guess" and "I'd think" scenarios stops the doctors from offering pamphets, advice, or hiring Sarah Brady to preach in the waiting room under this law.

    It does, however stop them from asking the question and compiling data. And that is quite well established as a function of the law even about medicine.

    Here, let me google that for you .

    Grifter: Nice as it is for you to answer that for people? It doesn't actually answer what they're instructing/advising, and what their sources are..

    In other words, based upon what training are they relying upon?

    More, though, you're objecting to saying something with the potential for harm is dangerous?

    Every object has potential harm.

    That doesn't make them a health issue, nor does it give Doctors or Nurses, with no training, experience or knowledge experts on anything about them.

    But as I keep saying, all that aside, the problem is that you want to argue the argument, instead of looking at what the potential downsides and problems are – some attested to here, and you minimize them, and ignore the context.

    Thanks for your help, seriously, It's appreciated.

    The issue has been incorrectly framed as "Freedom of Speech" – and see, even I fell for it for a while.

    It's not. It's a issue over who gets to compile databases of gun owners, and what will happen with that, if it's allowed.

    James:
    First, anyone offended has the right to not answer the question.

    Did you not see the oft-cited example above? No, they might not have that "right".

    Grifter said he'd have sued. He'd not have made it past initial trial motions. (IANAL, but I've dealt with a lot of legal issues.) The problem here is that this situation is couched in terms of "safety", and reporting "unsafe conditions" to the authorities is something that courts are not going to abrogate.

    Even assume Grifter sues, and makes it to trial, and even wins.

    How many years and dollars later?

    Second, anyone offended has the right to select a physician with similar political views as their own.

    Assuming they know. Notice the froth over this issue in order to allow the data collection to continue, and in fact, be mandated. What then?

    When it's listed as a "public safety" issue and required? Where do you go then?

    It's not a public safety concern, it's an attempt to get information and databases in the back door, and it's amazing the lengths people will go to to insist it be allowed.

    It's political. And a political answer, as messy and imperfect as they always will be, is a proper answer.

  184. Unix-Jedi says:

    (Whoops, Sorry, James, replace my first line with James:. )

  185. Unix-Jedi says:

    Grifter:

    The bill led to the Fatal Accidents Act 1846, also known as Lord Campbell's Act. Campbell also introduced a bill to abolish deodands. The latter proposal, which became law as the Deodands Act 1846, to some extent mitigated railway hostility.

    I'm aware of no case where deodands were ever recognized in US law.

    And even if there were, I reject the concept as a matter of fact.

  186. Grifter says:

    @Unix-jedi:

    “Except they're not silenced, James. They're free to say what they want.”
    It does, however stop them from asking the question.

    You contradicted yourself. Your argument is invalid.

    Here, let me google that for you .
    Grifter: Nice as it is for you to answer that for people? It doesn't actually answer what they're instructing/advising, and what their sources are..

    I’ll give you the benefit of the doubt, and hope you didn’t see that was a clickable link, to search results, the first of which is a .PDF that discusses the training of residents in risk management. It’s hard for me to do that, but I will do that. I won’t deny being snarky, but I detest people who refuse to answer the requests for support, which is why I didn’t.

    In other words, based upon what training are they relying upon?

    More, though, you're objecting to saying something with the potential for harm is dangerous?
    Every object has potential harm.

    A true statement. But some have more potential than others. A pool, for example, has more potential for harm than a grassy field. Which is why doctors often ask, particularly in my neck of the woods, if a new parent has a pool.

    That doesn't make them a health issue, nor does it give Doctors or Nurses, with no training, experience or knowledge experts on anything about them.

    Again, since they do receive training, and I’ve shown where you can find some of that training, you need to stop making such an invalid point.

    I will concede some doctors may get better or worse training on the subject, because there is variety in medical schools. But it is a standard part of the curriculum.

    But as I keep saying, all that aside, the problem is that you want to argue the argument, instead of looking at what the potential downsides and problems are – some attested to here, and you minimize them, and ignore the context.

    And you accuse ME of obfuscating. How dare I “argue the argument”!

    I don’t care what the downsides are. This law is a prior restraint on free speech, and the only reason you like it is because it’s in line with your political views. What other questions will politicians decide aren’t allowed to be asked by medical professionals, despite all the professional organizations agreeing it’s a legitimate question? No more asking your family history, because that’s a privacy violation of your family, and that doc might secretly keep a list and give it to the government!

    The issue has been incorrectly framed as "Freedom of Speech" – and see, even I fell for it for a while.
    It's not.

    Right, it’s not about freedom of speech, it’s just about what people are allowed to say. Gotcha.

    It's a issue over who gets to compile databases of gun owners, and what will happen with that, if it's allowed.

    The question itself is not allowed. It is ALSO not allowed to write it down anywhere, despite the information being covered under existing HIPAA rules.

    No, they might not have that "right".
    Grifter said he'd have sued. He'd not have made it past initial trial motions. (IANAL, but I've dealt with a lot of legal issues.)

    Sorry, you’ll have to back up that point a hell of a lot better. Parents control their children, and it takes a police officer to prevent that in the short term, and a court order for the long term. That’s the law. In reality, often parents are brushed aside and ignored by some professionals, but that doesn’t make it right or legal. If you can cite something, please do.

    …reporting "unsafe conditions" to the authorities is something that courts are not going to abrogate. Even assume Grifter sues, and makes it to trial, and even wins. How many years and dollars later?

    Reporting is different than separating a parent and child without authority.

    Also, that is a terrible argument. “You would be right, and you would win, but it might be hard, so therefore we need this whole other set of laws that restrict all sorts of other behavior.

    Second, anyone offended has the right to select a physician with similar political views as their own.
    Assuming they know. Notice the froth over this issue in order to allow the data collection to continue, and in fact, be mandated. What then?

    Mandated? Who’s saying that? Did someone say that, or are you once again misrepresenting? If you’re going to make that claim, you need to back it up. Who has said that?

    On a final note, I agree that deodands are not recognized in US law whatsoever. It's an archaic term, not used anywhere AFAIK. The concept of the deodand, as I understand it, is that if you hit someone in the face with a frying pan, you go to jail AND LOSE THE FRYING PAN. You seem to be thinking that a deodand is something else. I am under the impression that a deodand is an item that becomes forfeit because of its involvement in a crime. It isn't the idea that an object caused harm without intervention, just that if you use an item, that item is forfeit. I feel it's similar to when someone on my school bus would throw something….if it hit me, I kept it. A principle of civil damages.

    Can someone else clarify its meaning, please?

  187. James Pollock says:

    It's a simple problem with a simple solution. If your doctor asks you (or your kids) questions that you don't want to answer, pick a different doctor. Just like if you don't like the tone of discussion at the barbershop, or auto shop, or (gasp) lawyer's office. A couple of outcomes are possible, one of those being that if enough people agree with you, the loss of business will produce a change (without impacting people who aren't particularly troubled telling their medical professionals how strapped they are (or aren't)).

    Note: I am generally in favor of laws (including but not limited to the second amendment) that permit people of proven responsibility to own, carry, and use deadly weapons. This includes people of proven responsibility who are minors (I went to a summer camp that had a rifle range during my formative years; those same years, my mom would NOT let me have a BB gun because I would have shot my sister.)

    Should we switch gears, and instead consider whether or not doctors should be allowed to ask parents of small children whether they have a porn stash, and if so, how they keep the kids out of it?

  188. Narad says:

    But the people aren't talking about kids playing with guns. Look at what they're citing. They're talking about suicides. Gang shootings. Criminals. "Kids" who are up to age 24.

    You are being disingenuous for the sake of the joy of repeating yourself, Yoonix Ewok. I gave you the unintentional firearms morbidity and mortality numbers for ages 0-9 above.

  189. Unix-Jedi says:

    Grifter:

    As I said, I think this is clear enough.

    You can speak as to risk, but you cannot compile data about your patients.

    What can be, must be, and cannot be, and how it's protected is already here. Much as the use of MD's to perpetuate politics.

    And despite your commandments to me that I'm not allowed to think we're down the slope…

    http://www.sanduskyregister.com/news/a0941bc-us-guns-publichealtxml

    http://gulagbound.com/32612/supporting-the-2nd-amendment-is-a-mental-disorder-say-connected-physicians/

    It's politics/social engineering "for your own good" masquerading as a health issue.

    I don't think there's much more to say here until you're willing to admit the current status quo, issues, and why people wanted this law, and why it was passed.

    I agree that deodands are not recognized in US law whatsoever. It's an archaic term, not used anywhere AFAIK. The concept of the deodand, as I understand it, is that if you hit someone in the face with a frying pan, you go to jail AND LOSE THE FRYING PAN.

    You are using it in the archaic sense. The deodand was forfeited because it had caused the damage and was thus "evil".

    You didn't lose it because you were being penalized, you lost it because it had caused you to do something evil, and it must be destroyed.

    Which is pretty much what happens in most big cities with guns recovered from crime scenes. Melted down. Like that big metal statute outside the UN.

    That's the "deodand" philosophy, and it's what you're either wittingly or unwittingly defending.

    It's a outmoded and ridiculous concept, yet some people are wedded to it at all costs.

  190. Unix-Jedi says:

    Daniel Webster, co-director of the anti-firearm John Hopkins Center for Gun Policy and Research, asserts that “gun ownership—a precursor to gun violence—can spread ‘much like an infectious disease” and wants healthcare professionals to have influence over whether or not American citizens are legally allowed to possess firearms.

    But, yeah, nothing to see here, let's quote some John Hopkins in defense of doctors with little to no formal or scientifically backed training – other than, these sorts of studies.

    I ought to point you to the shredding of Wintermute that occurs whenever his "studies" are cited, but this is long enough and you apparently do know how to Google.

    So, in summation again: Ken, this is why we needed a law, as poorly crafted as it might have been, and as sad as it might be that people would be so distracted from the truth with handwaving and shuffling the ball under shells.

    This is why. And it's why the law is a good idea, and why it's not a "freedom of speech" issue, but a "data collection" one. You can advocate what you'd like. You just can't compile data.

  191. Grifter says:

    @Unix-Jedi:

    I won't try to deny that there are some anti-gun folks out there. And I won't deny that some are doctors. I don't think anyone's denying that.

    But this law didn't do anything to limit the things you don't like about policy decisions. It criminalized a question that numerous doctors have said is legitimate. It also criminalized data collection, but I think if all the law did was prevent doctors from keeping a record of your answer, fewer people would take issue with it.

    I stand by the statement that doctors shouldn't be told what's medically appropriate by politicians, but rather by other doctors. Can you point to any doctors groups who agree with the law?

    As regards to deodand: I haven't read anything about it being inherently an "evil" item, and I am under the impression that the deodand was forfeited, not destroyed. It's not something I can at all pretend to know too much about, though, so if I may request that you use different phrasing, in order to not confuse me, if confused I am? I believe I understand your point about blaming the inanimate object, but frankly I'm not entirely sure how it relates to gun safety in homes with toddlers.

  192. James Pollock says:

    OK, I understand now. U-J doesn't object to the fact that liberal doctors ask nosy questions which he somehow just can't summon up the willpower to decline to answer, and he can't seem to be bothered to locate and select a doctor with whom he agrees on social and political issues of the day.

    Rather, he objects to doctors keeping medical records. OK, I'll admit he's going to have a MUCH harder time finding one who'll decline to keep records of his visits. Perhaps what he should do is try to get some kind of law passed that makes what you tell your doctor inadmissible as evidence.

  193. Unix-Jedi says:

    It also criminalized data collection, but I think if all the law did was prevent doctors from keeping a record of your answer, fewer people would take issue with it.

    You stand athwart your answer, self-refuting it.

    I stand by the statement that doctors shouldn't be told what's medically appropriate by politicians, but rather by other doctors.

    And we're back to the original point. I shant reiterate what I have reiterated so many times.

    It's not a medical issue. It's a political one. It's not appropriate for doctors to be asking – and making recommendations and collecting data to be used for and by other sources, for routine visits.

    Not. Medical Appropriate. (And yes, there are several doctors groups who have campaigned against it – and notice they don't get quoted by the press, and after several groups pushed this, their membership dropped dramatically.)

    But that's neither here nor there, since you won't understand the base assumptions here, and you refuse to question your given stance.

    James:
    liberal doctors ask nosy questions which he somehow just can't summon up the willpower to decline to answer, and he can't seem to be bothered to locate and select a doctor with whom he agrees on social and political issues of the day.

    Or don't feel like being thrown into the nuthouse because the doctor doesn't like my stance on guns, or gay marriage or my dislike of Apple computers.

    But, hey, it's a free market – oh, wait, it's not. Oh well.

    Again, again, again. Ken: See why this was a needed law? To keep doctors in medicine, and out of these political battles.

  194. Grifter says:

    @Unix-Jedi:

    You understand that laws can do 2 things, right? They can both criminalize ASKING the question, and recording the answer? And that that's what this law did?

    Thus, 1 thing is awful, and the other is debatable.

    I ask, because you keep acting like because it does 1 thing, it doesn't do anything else.

    So, to be painfully clear:

    This law did 2 things, yes?

    You obviously support 1 of these things. I do not presently want to debate that one for the purposes of clarity.

    The other thing it did was criminalize even asking the question, yes? IN ADDITION to recording any answer?

    Are you okay with a law that prevents a doctor from asking a question (ignoring FOR THIS SPECIFIC POINT AND FOR THE TIME BEING the question of recording the answer) about child safety, taking into account the fact that they have received training on the subject that you have not?

    To move on from that, you then say that it is "not medically appropriate". You base this on your non-medical opinion, and in the face of medical practitioners disagreeing with you. You said some doctors groups were in favor of the law. I demand, by the strictures of debate, for you to provide at least one of these groups by name. Otherwise, I call your point out as invalid.

    If these groups exist, I'd like to hear their arguments for support of this law.

    Further, I want to know this:

    Do you think the government should limit a bar owner from asking people their political opinions before allowing them entry?

    Do you think politics or gun ownership are protected classes in the same way race is?

    And I once more point out the inherent intellectual dishonesty you are engaging in when you go from "I don't want them to be able to ask about X" straight to "And if they're allowed to ask X, they'll throw me in the nuthouse for refusing to answer X, or answering X with an answer they don't like". No one has been committed purely for owning guns.

    And I love your last line, even though I know the context you were trying to place it in: "See why this was a needed law? To keep doctors in medicine, and out of these political battles." So, doctors cannot participate in politics at all, is your point? That would seem to me as though you ignore the first amendment in your rush to the second. They have every right to participate in politics.

  195. Unix-Jedi says:

    So, doctors cannot participate in politics at all, is your point? That would seem to me as though you ignore the first amendment in your rush to the second. They have every right to participate in politics.

    Nope. The only way you can get to that is "rampant intellectual dishonesty".

    Just not while they're in the office, in the white coat and holding the prescription pad. Like many other things we require them to do, or not do, when serving as a medical professional. I think that's been rather clear. We're not talking about their down time/own time, we're talking about their work as medical professionals.

    Sorry, Grifter, the rampant dishonesty is how rabidly you're churning the waters. I've said what I believe, I've shown you it's not a new issue, I've shown you it's a political and politicizing issue, and you want to argue the politics – proving my point.

    It's why we need the law to make sure it won't impact medical advice, delivery, and trust. Thank you for your confirmation and help.

  196. Grifter says:

    @Unix-Jedi:

    I'll note you cannot back up the claim I requested you to. I assume that means you cannot. It was therefore a wildly dishonest thing for you to try to use in debate.

    For the record: I noted your context specifically, so, no, throwing the "rampant intellectual dishonesty" card against me fails. Nice try though!

    Maybe next time, if you bring your "logic" and "honest debate" stats up higher, you'll know when to throw a card like that so that it has an actual effect.

    You showed no care in how you phrased your statement, and you didn't qualify it at all. You said: "See why this was a needed law? To keep doctors in medicine, and out of these political battles."

    There is no dishonesty necessary to get to what I said. You made a flat statement, and now defend it on the basis of context, which I already acknowledged.

    I understood and acknowledged the context, I just also found it telling that you phrased it the way you did. I know, it's confusing, all these things that have more than one dimension to them, right?

    Because you don't actually know what you're talking about, have no ability to rigorously defend your position, and you are in no position to judge what pretty much every doctor agrees is a legitimate question. You have received no training in risk management, nor medicine. Yet you presume to tell doctors how to do their job.

    You argue in favor of telling doctors what they may or may not do based on political points that have no bearing on the individual doctor-patient relationship. You've provided no examples of times when it has, only referring to broader advocacy items. If you think that the broader advocacy of some doctor's groups against gun rights will magically stop because of this law, you're an imbecile. What will be prevented is doctors dealing with their patients freely.

    For the record, you keep saying we already have limits on doctors:
    Can you give me an example of anything similar in kind as regards to this limit by the legislature? Just one will suffice for now. Because to my knowledge there is nothing that doctors are, by law, prevented from asking.

    "It's why we need the law to make sure it won't impact medical advice, delivery, and trust." — That's just…ignorant. Here's a newsflash: Who the doctor is will always impact medical advice, delivery, and trust, laws or no laws.

    With a law like this, the douchebag doctors who hate guns and want to tell you how horrible you are for having them will still lecture you, except now they'll lecture everybody. They won't be any less douchey. And the nonexistant ones who would throw you in the nuthouse for owning a gun would find another illegal reason to do that anyway if they existed.

  197. James Pollock says:

    Unix Jedi defends his nonsense thusly:
    "Or don't feel like being thrown into the nuthouse because the doctor doesn't like my stance on guns, or gay marriage or my dislike of Apple computers."

    If you live someplace where doctors can throw you into the nuthouse because they don't like your stance on guns, gay marriage, or Apple computers, perhaps you should move to the United States.

    "But, hey, it's a free market – oh, wait, it's not. Oh well."
    Funny you should bring up a free market, since you're advocating against one. Without a law like this, you can select a doctor who won't ask you about guns (or gay marriage, or Apple computers, or how many hookers to patronize on a regular basis); a person who isn't offended by such things (either by virtue of the ability to speak the magic words "My firearms are not a threat to my children" or being too weak-kneed a liberal to possess any) can pick a doctor who asks about any and all possible threats to the health of the children… things like busy streets, household chemicals, and yes… weapons of all sorts.

    "Again, again, again. Ken: See why this was a needed law?"
    Still no. Even if there WERE a gigantic, politically-motivated, anti-gun-for-any-and-all-reasons movement amongst doctors, that still wouldn't justify such a law.

    "To keep doctors in medicine, and out of these political battles."
    The governor of my state happens to be a doctor. If guns (or gay marriage, or Apple computers) are that big a deal, then doctors on either side with either trumpet their alliegence to one side (if the majority of people agree with that side) or they'll keep it quiet (if the majority of people like the other side).
    You know, they way people decide whether or not to have a chicken sandwich for dinner is shaped by their political alliegences.

    Honestly, the more paranoid someone seems, the more edgy I get knowing (or imagining) that they're armed…

  198. Narad says:

    You said some doctors groups were in favor of the law. I demand, by the strictures of debate, for you to provide at least one of these groups by name.

    It wouldn't surprise me in the least if AAPS did. Of course, they're also HIV denialists and favorably view pretty much any crankery, given a desire for removal of any regulation whatever on the practice of medicine, aside, I presume, from that which would allow just anybody to compete. Properly embroidered lab coats required, perhaps, to keep out the riff-raff.

    (Oh, yeah, here we go. They've been on it, man.)

  199. Grifter says:

    @Narad:

    Granted, they have a view on the question itself, but they don't seem to be advocating a law…they overall seem to take a poor view of government intrusion. On a side note, they are based in Tucson. Aaps and Charles Carreon, all in one city.

  200. Narad says:

    Granted, they have a view on the question itself, but they don't seem to be advocating a law…they overall seem to take a poor view of government intrusion.

    They do not in fact seem to have taken a position on this one; that actually was an afterthought. However, as I attempted to point out, they're not so opposed to government intrusion that they would actually advocate jeopardizing their own privileged positions.

  201. Grifter says:

    @Narad:

    Very true.

  202. Sara says:

    I'm very late in the conversation, this is my first time on the site. While it is absolutely inappropriate for a patient to be refused or fired by a physician for simply not wanting to answer what appears to be an irrelevant question, the question holds more relevance to patient health than that of children. The physician should explain the purpose of such questioning to avoid these situations. In addition to the amount of deaths and accidents in children due to improper storage of a firearm a physician would be negligent for not asking such a prying question if there were a diagnosis or, suspicion of a diagnosis, of Major Depressive Disorder, Bipolar Disorders, Cluster B Personality Disorders, or suspicion of domestic violence in the home. If a physician is being reactive to a previous negative experience and has since decided rather than go through a similar situation, all patients need to answer these questions in order to be seen or for the physician to avoid very unpleasant surprises, that is something the physician first need to take up with a therapist, an ethical colleague, and possibly a supervisor who can shine some light on the self serving situation. Physicians currently have a very alarming rate of burn out and negative mental health consequences in relation to their careers, salary levels, prestige of the position, and amount of perceived personal fulfillment and meaning possible. A combination of societies expectations, the government, and insurance companies have fostered a situation in which physicians feel they must practice defensive medicine and fear creativity and innovation in their practice of medicine. It is very unfortunate. I hope that I may have provided some new insights. I am not here to say what is right or what is wrong. I do hope that more questions will be asked between patients and physicians rather than automatice defensive reactions from both sides, and more open and honest conversations between patients and their doctors, leading to more informed patients and doctors, better practice of medicine, more empowered patients who feel they have a valuable role in their own treatment processes, and patients that are treated as the one true expert on the patient.

  1. August 14, 2012

    [...] blogger and good buddy Will clued me in to an interesting post by Ken over at Popehat.  It's about Florida's appallingly stupid law that vaguely [...]