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How your child’s primary-care doctor can prevent gun injury and death

Safer gun storage could result in saved lives, and there’s an unexpected resource who can help you learn about firearm safety: your child’s primary-care doctor.

Rinad Beidas, Ph.D., is an associate professor at the Perelman School of Medicine at University of Pennsylvania.
Rinad Beidas, Ph.D., is an associate professor at the Perelman School of Medicine at University of Pennsylvania.Read moreCourtesy of Penn (custom credit)

Mass shootings and casualties happen far too often. A recent episode of 60 Minutes led with a piece on how those who are on the scene first, such as kids and innocent bystanders, can increase the chance of survival in mass shootings by integrating tactics from the battlefield.

The focus on mass shootings is understandable and important, but it may be distracting us from the leading cause of death by firearm: suicide.

The U.S. Centers for Disease Control and Prevention estimate that from 2006 to 2016, about 218,000 Americans died by suicide using a firearm. America’s young people are especially at risk: The rate of youth suicide doubled from 2007 to 2016. Firearms are among the most common, most lethal methods used by youth, especially males. Eighty-five percent of suicide attempts in which firearms are used end in death. The suicide risk is two to five times greater for adolescents who live in homes where firearms are present.

Safer gun storage could result in saved lives, and there’s an unexpected resource who can help you learn about firearm safety: your child’s primary-care doctor. The American Academy of Pediatrics, the American College of Physicians, the American College of Surgeons, and the Institute of Medicine all agree.

Doctors already discuss health and safety measures. When I take my children to their doctor, I’m typically asked whether my home has a smoke detector and whether I use car seats. But no one has ever asked me whether I have a firearm in my home and, if so, whether I store it safely. This kind of conversation could save the lives of my children and their friends.

A simple intervention involves primary-care doctors asking parents whether their children have access to guns and providing parents with mechanisms such as cable locks to help store the firearms more safely. In a 2008 study conducted in 137 pediatric primary-care practices across the country, families who received this brief intervention were more likely to store their guns safely than families who did not receive the intervention.

Our research over the last two years has focused on how to increase use of this intervention. In a recently published paper in Academic Pediatrics, we noted that physicians have positive attitudes about it, but that they use it inconsistently — particularly the element that provides parents with free mechanisms to store their guns safely.

Another recent study by our group, published in JAMA Open Network, interviewed 58 individuals about why more pediatric primary-care practices aren’t using the firearm-safety intervention. Those interviewed raised several issues.

First, doctors are increasingly being asked to do much more during brief appointments, so that many of them feel there is no way to discuss everything that should be discussed. In addition, some doctors feel uncomfortable, given the climate around gun ownership and previous legislation that raised questions about a doctor’s right to ask about firearms. (They can ask.) But our work and the work of others suggests that these concerns are not substantiated, and that the majority of parents would welcome discussions about their children’s safety.

There is growing national consensus that health systems and physicians can play a role here. In our own work, we found agreement that the time is now for health systems to help promote firearm safety.

One way to move this forward is partnership, despite the highly divisive conversation to date. Recently, in response to new guidelines from the American College of Physicians, the National Rifle Association published a piece on the need for doctors to stay out of the push toward firearm safety. Health-care clinicians have reacted strongly, and a number of op-eds, editorials, and tweets have passed back and forth. Recent work highlighting partnerships between gun-shop owners and researchers makes us hopeful about the future, however. More such partnerships are needed.

You can take action, as well.

Doctors, ask parents about guns in their homes. Try to identify local programs that provide free or at-cost firearm locks. Advocate for your health system to consider providing free locks. Partner with local firearm-safety instructors and shop owners to identify areas of common ground and referral sources for parents.

Parents, if you have a gun at home, store it safely. Follow the “20-2 rule,” coined by Graham Snyder, a physician at WakeMed Health and Hospitals: Store your firearms so that a 20-year-old with two hours of free time couldn’t get to them.

It’s time to come together. Discussing firearm safety with your child’s primary-care provider can lead to many lives saved.

Rinad Beidas, Ph.D., is an associate professor in the Departments of Psychiatry and Medical Ethics & Health Policy at the Perelman School of Medicine, University of Pennsylvania.