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Docs v. Glocks - Florida's Gag Rule on Doctors

By Dr. Mona Mangat
. 3 Comment(s)

"We take our children to pediatricians for medical care — not moral judgment, not privacy intrusions”.

This quote by an NRA lobbyist troubles me. The statement reveals degradation in a sacred relationship – the physician-patient relationship.

This sentiment was prompted by a Florida pediatrician that refused to continue seeing a child after the parents refused to answer whether they kept firearms in the home. Governor Rick Scott (FL) signed HB-155 into law this month. The law restricts physicians from asking families if they have firearms, prohibits them from discussing firearm safety with families and prohibits them from documenting firearm status in a medical chart. In a compromise to efforts made by the Florida Medical Association (FMA), physicians may ask about firearm status only if ‘information is relevant to patient's medical care or safety or safety of others’.

The physician-patient relationship is predicated on trust. There must be trust that a patient is being truthful when answering questions. There must also be trust, on a patient’s part, that a physician role is to empower patients to make informed decisions that will ultimately lead to better health.

Last month, in my allergy/immunology practice, a patient presented with acute onset of hives that morning. While hives is not unusual in my office, her presentation seemed odd to me. I asked her about life stress and she answered that she was under some stress but didn’t want to go into details. I then proceeded to ask her about what medications she may have tried to help with the hives. She casually mentioned that her primary care physician had given her a prescription for oral steroids that morning. I was surprised to know that she had seen him just three hours before her arrival in my office and asked how this could be. She then began to retell the events of the past 12 hours. She said that 12 hours prior she had been drinking wine and had drank a bit too much and her husband found her unresponsive. She was transported to the ER and had her stomach ‘pumped’. She was then admitted for observation and her primary care doctor discharged her in the morning after advising her to be more careful when drinking.

I found this story concerning for many reasons. She seemed anxious and tearful. I then asked her if she had tried to kill herself. To my surprise, she answered ‘Yes’. I asked her if she had any intention to harm herself or if she owned a gun. She said ‘Yes’.

Her husband spoke to me in private and recalled that not one health care provider, from EMT to ER nurse, to ER doctor to admitting physician to her own primary care doctor asked her these questions. I don’t know why no one else asked – maybe they were too busy; maybe they didn’t identify the unusual circumstances; or maybe they were afraid that the patient would feel they were making a moral judgment. I simply did what seemed natural. I listened to my patient and I heard a cry for help.

My patient was then escorted to the psychiatric ER for evaluation and treatment. She has since thanked me for taking the time to listen and for having the courage to ask her that simple question. She did not feel that my questions were thinly veiled moral judgments. She recognized that my intent was to help her.

I fear that HB 155 will further stifle this sort of honest communication. The law will cause many providers to take pause before asking difficult questions that impact patient’s lives. The law sets a precedent. As an allergist, I always ask my patients if they smoke and I ask parents of asthmatic children if they smoke. I don’t ask to pass moral judgment. I ask so we can have a dialogue. Parents need to understand that by smoking, their children have an increased risk of developing asthma.

In the course of a patient evaluation, I often ask if my patient has a tattoo or if they have ever used intravenous drugs or if the have ever engaged in high risk sexual activities. I ask these, sometimes uncomfortable, questions not to pass moral judgment but to help guide me when diagnosing and treating patients. And I use this conversation as an opportunity to educate and counsel patients on choices that may help to keep them healthier and safer. When will this line of questioning become illegal? HB 155 places us at the top of a very slippery slope.

This law will hurt Florida’s children and further degrade a fragile physician-patient relationship. That’s why Doctors for America, and many other organizations, are fighting to repeal the law. I am hopeful that the combined outrage of Florida physicians will be heard by our legislators.

Share Your Comments

 

  1. Linda Burke-Galloway, MD

    Permalink
    You need to do a media blast about this and also send Senator Nelson a copy. We, as physicians are supposed to be HEALERS. I can't tell you the number of times one question that I asked opened up the flood gates for patients regarding this individual pain and suffering. If we cannot touch the soul of another human being than our degrees are useless. Worthless. God, please help our healthcare system and physicians like Mona who really care.
  2. Franklin Sokrates

    Permalink
    First you misstate the Florida Statue. Your asking about her ER visit reason and medical/mental problems are allowed under the statue.
    2nd under Obama care doctors can not make records of firearms ownership. NRA got that made Federal Law.
    3rd as a medical malpractice insurance issue,few doctors are qualified to give firearms safety advice. It is not a medical school or medical license training. Only the NRA, assorted government authorities certify firearms training and safety. You do not give advice on how to safely change a light switch, because you are not trained or certified as an electrician, arms are no different.
    Ask your medical malpractice insurance if your firearms advice is covered if your advice is followed and it goes wrong.
    4th It is a boundary issue. "political power flows out the barrel of a gun" Chairman Mao communist China. Guns are a political issue, as my Doctor your political views are NOT why I am in your exam room. Imposing on your captive patient your politics is at best unethical. Do you impose your choice in political party's on patients? Do you make clear your views on abortion to all patients no matter what age or sex?
    You need to take a step back and consider this fact, doctors accidentally kill far more people than guns by a factor 3. If gun accidents only are used its more like 100 to 1 gun death.
    Suicide, of adults is both a mental and liberty issue. If an otherwise sane person desires to leave this plane, are you at liberty to make them stay here. Not sane is another issue. If you do not do free care of mentally ill, you are more a problem than guns. Slightly less than half of gun deaths are crimes. Mostly in cities with large minority populations and few jobs. Social issues, not medical issues.
    Fact; gun accidents have declined as the population and guns have both increased. suicides are not stopped by lack of guns. As Robin Williams proved belts are everywhere.
    Be anti-gun if you wish, but do not expect the thinking person to admire irrational prejudice or think well of you for yours.
  3. Katherine Bailey

    Permalink
    Franklin, you are an ideologue for whom every issue, every person, every facet of life is seen through one lens. Your 'facts' don't make sense (except to you) nor are they relevant to the doctors' concerns. You think, to put it simply, like an angry thirteen-year-old, as evidenced by terms like "anti-gun."

    Kudos to these courageous and compassionate professionals for refusing to bow down to corporate pressure from institutions that stand to profit immensely if there's more fear and more death out there.

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