Gun Owner Advances Doc Group's Gun Safety Initiative

— Sue Bornstein, MD, offers expertise in broaching the subject with patients

Last Updated May 11, 2023
MedpageToday
A screenshot of Sue S. Bornstein, MD, speaking about firearm safety.

SAN DIEGO – The physician at the helm of the American College of Physicians' new initiative to help doctors talk with their patients about the delicate topic of gun safety is a proud rifle and handgun owner herself.

In fact, Sue S. Bornstein, MD, told MedPage Today that she uses her weapons for "varmint control" against feral hogs and other harm-causing critters that wander onto her cattle ranch in the Texas Hill Country. From time to time, she practices target shooting for fun.

Bornstein mentions she owns guns at the start of her conversations about firearm safety because, she said, it's important that physicians appreciate where some of their patients are coming from. Many, especially in her region, own firearms, and primary care providers are not going to talk them out of them. Rather, with tact and sensitivity, physicians are in a unique position to suggest ways their patients can prevent some of the catastrophic tragedies that are occurring so often these days.

It's important that doctors understand: her message isn't about whether doctors should talk with their patients about having these weapons. It's about getting patients to think about storing them safely so it's less likely they'll get in the hands of people -- especially at-risk children and adolescents -- who shouldn't have them.

Physicians' purpose is not just to treat illness. It's also to prevent injury and harm as well, she said. "We can prevent many of these injuries and deaths."

New Resources

The ACP has a long history of advocating for harm prevention. But over time, the large physicians' group has become more aggressive and specific about firearm issues such as red flag laws and ghost guns, Bornstein said. The initiative, announced here at the ACP's annual meeting last month, includes new online resources on gun safety, a video featuring Bornstein, a "Story Slam" with the voices of people impacted by firearm violence, and a physician's toolkit.

Now, there's a link to about 80 Annals of Internal Medicine articles, all in one place, to help doctors with published research.

Numerous factors have influenced the ACP's more dedicated stance today, Bornstein said. For starters, there are more shootings these days, especially a surge since the start of this year.

On April 28 this year, the day before Bornstein spoke with MedPage Today, a man took an AR-15 to the home of a neighbor and shot dead five people in Cleveland, Texas, about 55 miles north of Houston. It was the 176th mass shooting in the nation this year, according to the Gun Violence Archive, which defines a mass shooting as four or more victims injured or killed, not including the shooter. One week later, there would be another 25 instances of firearm violence across the country, including one on May 6 that left eight dead in Allen, Texas, the second highest number of firearm fatalities this year.

The official 2023 mass shooting gun violence death count as of May 8: 789 injured and 279 dead in 203 incidents.

There also has been a change in ACP members' attitudes. Some 10 years ago, "there were definitely members who would ask why the ACP was talking about this, saying, this is not 'in our lane,'" Bornstein said. But with the current frequency of individual and mass shootings, "most of our members do now recognize this is, in fact, a public health issue."

Membership is getting younger too, she acknowledged, and more willing to advocate for policy change.

Bornstein has a lot of experience. Though she is no longer in clinical practice, she has vivid memories of former patients who survived horrific gun injuries, and one was particularly traumatic.

He was 16 and had depression that wasn't recognized or treated but "had easy access to a handgun in his home and tried to end his life. Instead he ended up with a totally disfiguring injury to his face," she said. "Now, he can't eat on his own or talk. Now this is his life."

"You have to start thinking about the profound impacts that these injuries have on peoples' lives and when you do, it's pretty devastating," she said. These patients require follow-up psychological and medical care for a very long time, perhaps an underappreciated sequelae.

One event that Bornstein said shaped her views happened while she was growing up in Dallas. She was 10 when President John F. Kennedy was shot to death. "On that day I realized, like the rest of the world, what a gun can do not just to one person but to a whole country," she said. "It made me realize guns can change the course of history."

How to Talk Guns

In her video, Bornstein lists a number of dos and don'ts for doctors who talk with their patients about firearms.

One tip that's been a surprise, she said, is that doctors should not begin conversations by asking if the patient owns or possesses a firearm. Instead, they should ask if their firearms are securely stored. "Assure patients that you are not aiming to threaten their right to possess a firearm."

That has raised some eyebrows, she said. But the point she is trying to make is that some patients might see a direct question about gun ownership as accusatory or that the doctor is judging them, which puts the patient on the defensive.

It's important that they feel they're in a safe space, a "non-judgmental zone," she said.

If the patient seems amenable to a conversation, the doctor can offer suggestions. They can suggest the safest way to store a gun is unloaded, locked up using a locking device like a lock box, a gun safe with cable locks and trigger locks. And they can remind patients that guns should be stored in a different place than ammunition.

"It's important that any keys or combinations to firearm locking devices are inaccessible to children, unauthorized users, and others at risk," she said. She stores her guns unloaded in a gun safe.

She gives additional advice in the video, including not interrupting patients, tailor responses to patients' concerns, and suggest removing firearms if someone at home is at risk of self-harm.

"Nowhere are our voices more important than in the privacy of the examination room," she said.

Two Schools of Thought

In the months to come, ACP will develop guidelines for when and with whom doctors should raise the subject of firearm safety.

Under debate are two schools of thought. One is that gun safety should be raised in every clinical encounter just as doctors ask about other potentially sensitive issues such as sexual behavior. Proponents of this school argue that by asking every patient about firearm injury risk "we can break down barriers and get comfortable with asking necessary questions," Bornstein said.

The other school holds that gun safety should be raised just with those who are "at risk," such as those who abuse alcohol or drugs, or have suicidal ideation. Of course, there's the obvious problem: doctors don't always know.

Bornstein's take: "We need to develop our comfort level in asking our patients," she said. Now, there are even more resources to help doctors be "more confident and well-informed to do this important work."

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    Cheryl Clark has been a medical & science journalist for more than three decades.