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Discusses Women's Health

I usually don’t go “legal” on this website but I couldn’t help but notice an article in this week’s New England Journal of Medicine which dealt with the First Amendment, physician speech and firearm safety. Next week, the full Eleventh Circuit Court of Appeals will hear arguments in Wollschlaeger v. Governor of Florida. Wollschlaeger is challenging a Florida law regulating physician’s speech related to patients’ gun ownership. The law that’s in place since 2011 is called the Florida Firearm Owners’ Privacy Act ( FOCA). It prohibits physicians from intentionally entering into a patient’s record information about firearm ownership that is not relevant to the patient’s medical care, safety or the safety of others. It prohibits physicians from asking patients about firearm ownership unless they believe that the information is relevant to the patient’s care. It also states that physicians should be prohibited from “unnecessarily harassing a patient about firearm ownership during an examination.”

The American Medical Association, the American College of Physicians and the American Academy of Pediatrics all recommend that physicians discuss firearm safety with their patients. This is based on the evidence that gun ownership in the home increases the risk of death, especially by suicide, for all household members (not to mention the carnage that was done because of ownership by that crazed individual in Orlando as well as all the other mass shootings in the US; don’t get me started, I diverge…). Studies have shown that recommendations by physicians about the dangers of gun ownership may not be significantly successful in promoting the removal of the firearm from the home but are successful in increasing safe firearm storage.

The decision by the Eleventh Circuit Court will have an impact on other states. Missouri and Montana already have laws similar to FOCA which have been strongly supported by the National Rifle Association; and in 2011 the West Virginia legislature considered a law that defined physicians’ questions about gun ownership as gross negligence! According to the authors of this NEJM perspective, “if FOCA is upheld, other states may enact laws regulating physicians’ speech pertaining to firearms”.

I have to admit that I have not routinely asked my patients about firearms in their homes, I did not consider it a necessary part of my history taking as a gynecologist. If I were to continue to practice, I might consider adding it to my template of questions.

There was one other sentence in this article that caught my attention that I want to share… “Pennsylvania, Ohio, Colorado, and Texas have laws requiring physicians to keep confidential information they obtain from drilling companies about the chemicals used in fracking. Several states now require physicians to provide women with medically questionable information prior to an abortion.” How untenable! We should not be limited in our doctor- patient relationships nor should our ability to preserve patients’ health be questioned and litigated. Hopefully the Eleventh Circuit Court will make the right decision.

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