Majority of doctors do not counsel patients about firearm violence

In the first survey of its kind, UNC School of Medicine researchers led by Adam Goldstein, MD, MPH, show that a majority of physicians are unlikely to counsel patients about firearms or firearm safety, but that more continuing medical education on the topic would increase physician counseling behaviors

Adam O. Goldstein, MD, MPH

CHAPEL HILL, N.C. – January 3, 2018 – More than 33,000 people die in firearm-related deaths in the United States every year, including over 21,000 suicides. Major firearm-related mass shootings have only heightened the issue of firearm violence. Counseling patients about firearm safety, including depressed patients at high risk of suicide, is an important medical concern. Yet, despite a widely held belief in the importance of firearm counseling, few physicians report counseling patients.
 
A recent survey from the University of North Carolina at Chapel Hill examined this disconnect, including what factors might predict when doctors counsel their patients about firearm violence, including asking depressed patients about access to firearms. Their paper, “Continuing Medical Education and Firearm Violence Counseling,” was published in the January issue of the AMA Journal of Ethics.
 
A team of UNC department of family medicine researchers and UNC School of Medicine students surveyed 223 physicians registered with the North Carolina Medical Board, including psychiatrists, family physicians, and internists. The questionnaire addressed physician attitudes and behaviors about various issues related to firearm safety. The results found that:

• Most physicians (80 percent) agreed or strongly agreed that gun violence is a serious public health issue that should be included in medical training.
• Only 25 percent of those surveyed reported having conversations with patients about firearms or firearm safety often or very often, and almost half reported not asking depressed patients if they had a firearm in their home. 
• Very few physicians (12 percent) reported attending continuing medical education (CME) seminars or lectures on gun violence in the last five years
• After adjusting for other factors, the study found that those who attended CME classes on gun safety were three times more likely to engage in counseling patients on the subject.
• More than twice as many providers who attended CME classes on gun safety counseling indicated they counseled patients often or very often (59.3 percent) compared to those who did not attend CME (20.4 percent). 
• Almost twice as many providers who attended CME classes on gun safety counseling indicated they asked depressed patients about firearm access (85 percent) compared to those who did not attend such CME classes and did not ask such questions (48 percent). 
• After controlling for all factors, physicians reporting CME attendance about firearms and firearm safety were more than three times as likely to report providing patients with gun safety counseling and more than four times as likely to report asking depressed patients about firearms than were doctors who did not attend CME courses.

“This issue is particularly important considering the unique role doctors can play in educating patients and preventing firearm violence,” said Adam Goldstein, MD, MPH, senior author of the study and professor at UNC Family Medicine. “The ethical imperative to discuss firearm safety in clinical situations is particularly relevant to doctors who work with depressed patients, as suicide by firearms accounts for half of recorded suicides”.
 
The survey also asked physicians their sex, age, political affiliation, and whether they were a gun owner or had ever shot a gun. None of these factors were associated with a difference in frequency of counseling on firearm safety.
 
“These results emphasize the importance of CME for providers on firearms and firearm safety, and for how to start conversations on the topic,” said Nicole Damari, first author and third-year UNC School of Medicine student. “It is essential to make more CME classes available to practicing physicians to lessen the gap between what now occurs and what is necessary to help reduce gun violence in our society.
 
“Interestingly, a provision of firearm safety counseling need not be a partisan issue, as neither political affiliation nor gun ownership seemed to impact levels of firearm counseling,” Damari added.
 
Damari and fellow UNC medical student Karan Ahluwalia worked on the survey in the summer of 2017 with funding from a small grants fund from the UNC Department of Family Medicine. 
 
Written by Heather Wilson, UNC Department of Family Medicine.