Wednesday, August 31, 2011

Firearm Safety, Florida Law, Guidelines and.... Pools!

A leading health threat?
JAMA has fired off this editorial on the "chilling effect" of a recently passed Florida law that muzzles doctors from talking to patients about home firearm safety.  The law was apparently triggered by policy statements like this that recommend that physicians counsel patients about a leading cause of avoidable death.  Florida's physicians are prohibited from inquiring about firearms and recording it in the medical record.  Health insurers are also prohibited from using that information in the course of underwriting.

The Disease Management Care Blog isn't worried about this intrusion into the doc-patient relationship.  Doctors are notorious for not following guidelines, and the likelihood that a law passed in Tallahassee is going to change physician behavior in Miami is practically nil.  What's more, the wording of the statute is riddled with exceptions and the likelihood that any doc will be prosecuted is zero.  The DMCB thinks this is a cynical sop to gun-toting-voters. The legislators in their smoke-filled salons know it.  Too bad the JAMA editorialist doesn't.

That being said, the DMCB will raise three contrarian points that should give its anti-gun reader-enthusiasts pause:

Physician discrimination: The DMCB is aware of pediatricians who will discharge patients from their practice if the parents refuse to go along with basic immunizations for their children.  While many health care providers would be tempted to agree with that posture, should the same principled logic apply to parents who refuse to acede to the AAP recommendations that "existing guns [should be] no longer present in the environment of children" (see page 892)?  That's exactly what happened in Florida.

Law enforcement discrimination: Privacy breaches involving EHRs are not uncommon. The leak of the personal details of gun-ownership into the public domain could be thorny, especially since law enforcement would be tempted to use that information against persons who are otherwise law abiding.  This is potentially an important privacy issue.

Insurer discrimination: Last but not least, should health insurers be allowed to refuse coverage for persons with firearms in the house?  They have access to the medical record and, knowing that firearms pose extra risks, they might be tempted to to discriminate against gun owners.

Before you say yes to all three forms of discrimination, the DMCB would remind its anti-gun readers that firearms are not the leading cause of death among children in the U.S.  Check out the data from the CDC and you'll get this graphic:

Drownings are a bigger threat.  Guidelines on pool safety state  "parents, caregivers, and pool owners should learn CPR and keep a telephone and equipment approved by the US Coast Guard (eg, life buoys, life jackets, and a reach tool such as a shepherd’s crook) at poolside."  If parents with pools fail to meet these criteria, should 1) docs also discharge them from their practice, 2) should we risk the release of the data into the public domain for used in real estate tax assessments and 3) allow insurers to exclude these persons from coverage? 

Image from Wikipedia

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