The following originally appeared on The Upshot (copyright 2014, The New York Times Company).
A few weeks ago, I had my yearly physical. As part of her history-taking, my doctor asked if I was sexually active with my wife. Then she asked if I was sexually active with anyone other than my wife. She does this every year.
She’s not asking to be intrusive. Nor is she a voyeur. She knows that having multiple sexual partners significantly increases one’s chance of contracting a sexually transmitted infection. Asking about that allows her to see if I’m at risk, and then to address that risk with me.
I’m not offended that she asks me. Asking me is part of what makes her an excellent physician. Doctors are supposed to ask about sensitive things in order to help keep us safe. This is especially true for pediatricians. This kind of exchange is how we engage in prevention, sometimes called anticipatory guidance, and study after study shows it can prevent harm.
When pediatricians ask you about using car seats, they’re trying to prevent injuries. When they ask you about how your baby sleeps, they’re trying to prevent injuries. When they ask you about using bike helmets, they’re trying to prevent injuries. And when they ask you about guns, they’re trying to prevent injuries, too.
But not, perhaps, everywhere. In Florida, in 2011, a law was signed that made it illegal for doctors to ask patients if they owned a gun. If doctors violate this law, they can be disciplined, leading to fines, citations and even a loss of their license.
A lower court struck down the law in 2012. But last week, a panel of judges on the United States Court of Appeals for the 11th Circuit upheld it. In their ruling, the judges declared that the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.” The clear assertion of the judges is that there is no legitimate health reason to be asking about gun ownership.
Almost 20,000 people committed suicide in the United States with firearmsin 2011. More than 11,000 were killed by firearms that year, and more than 200 were killed in accidents with guns. In 2009, almost 7,400 children were hospitalized because of injuries related to guns.
Doctors who ask about guns aren’t doing so because they’re nosy. They’re doing so because the vast majority of those deaths and injuries are preventable.
It’s entirely possible to keep a gun in your home safely. But studies show that the majority of people who keep guns in their homes do so in an unlocked space. Few have any kind of trigger locks. More than 10 percent report keeping their guns loaded or near ammunition, in an unlocked area.
That’s often how children get hurt. Few people argue that young children should have access to guns or ammunition. But that’s what’s happening in far too many homes in the United States. Research shows that guns kept in the home are more likely to be involved in accidents, crimes, or suicides than in self-defense.
When I ask patients and parents whether they own guns, if they tell me they do, I immediately follow up with questions about how they are stored. I want to make sure they’re kept apart from ammunition. I want to make sure they’re in a locked box, preferably in a place out of reach of children. Doing so minimizes the risks to children. That’s my goal.
When we, as physicians, ask you if you drink or smoke, it’s not so that we can judge you. It’s so we can discuss health risks with you. When we ask you about domestic violence, it’s not to act like police detectives. It’s so that we can help you make better choices for your health. When we ask you aboutwhat you eat or whether you exercise, it’s so we can help you live better and longer. We’re doctors; it’s our job.
Please understand, you can calmly refuse to answer any of these questions. You can tell your doctor you’d rather not discuss this topic. You can choose to lie. You can even just not come to the doctor in the first place. There’s nothing stopping you from preventing us from helping you.
Of course, rejecting discussion of a risk-laden topic isn’t much different from rejecting discussion of what you eat, or what’s physically ailing you. You’re hurting only yourself. What this now-upheld Florida law does is prevent doctors from helping other people, who might want the assistance. Anticipatory guidance is about stopping injuries before they happen. This law, passed in the name of protecting privacy, prevents doctors from practicing good medicine.
Physicians are supposed to cover topics that can make patients uncomfortable. It’s why what you tell your doctor is confidential. Your privacy, your medical records and all your privileged information are still protected by the same laws that have always been there. None of that changed with the Affordable Care Act.
If the courts decide that people have the right never to be asked sensitive questions, they’re interfering with the relationship between doctor and patient. They’re deciding that some health risks are worth minimizing and others are not.