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[at-l] Dangerous Doctors?



I smell a troll under this bridge.
And it doesn't smell like an AT troll.



----- Original Message -----
From: "Jack" <elexious48@home.com>
To: "Orange Bug" <orangebug74@yahoo.com>; <at-l@backcountry.net>
Sent: Wednesday, June 20, 2001 11:35 PM
Subject: Re: [at-l] Dangerous Doctors?


> You asked for this one and here it is:
>
>
>
>
> Boundary Violation:
> Gun Politics in the Doctor's Office
>
> By Timothy Wheeler, MD
> {Appeared originally in the Medical Sentinel of the Association of
American
> Physicians and Surgeons, March/April 1999, pp. 60-61}
>
>
> Imagine this scenario: you visit your doctor for back pain. Your doctor
asks
> if you have firearms in your home. Then he announces that your family
would
> be better off (especially your children) if you had no guns at all in your
> house. You leave the doctor's office feeling uneasy, wondering what guns
> have to do with your backache. Does your doctor care about your family's
> safety? Or instead, did he use your trust and his authority to advance a
> political agenda?
>
> American families may soon find themselves in this scenario. Social
> activists are taking their war on gun ownership to a new battleground: the
> doctor's office. (1) The American Medical Association (AMA) (2), American
> Academy of Pediatrics (AAP) (3), and American College of Physicians (ACP)
> (4) are urging doctors to probe their patients about guns in their homes.
> They profess concern for patient safety. But their ulterior motive is a
> political prejudice against guns and gun owners. And that places their
> interventions into the area of unethical physician conduct called boundary
> violations.
>
> Doctor-patient sex is the most well-known and sensational example of a
> boundary violation. More recent literature recognizes a wide variety of
> nonsexual violations. (5) These cover such issues as finances,
> confidentiality, and gratification of the doctor's needs. Although
boundary
> violations were first addressed in the psychiatry literature, it has
become
> clear that they also occur in general medical practice. (6)
>
> Boundaries in the doctor-patient relationship derive naturally from the
> relationship's fiduciary nature. In general, "treatment boundaries can be
> defined as the set of rules that establishes the professional relationship
> as separate from other relationships and protects the patient from harm. A
> patient who seeks medical or psychiatric treatment is often in a uniquely
> dependent, anxious, vulnerable, and exploitable state. In seeking help,
> patients assume positions of relative powerlessness in which they expose
> their weaknesses, compromise their dignity, and reveal intimacies of body
or
> mind, or both." (7)
>
> Thus compromised, the patient relies heavily on the physician to act only
in
> the patient's interest and not the physician's. A doctor must put the
> patient's needs before his own. But a physician reverses the priorities
when
> because of passionate political beliefs he tries to influence his patient
> against guns. This physician puts his own need to "do something" about the
> perceived evil of guns before the needs of his patient. He crosses the
line
> from healer to political activist. Such doctor-on-patient political
activism
> is recognized in Epstein and Simon's Exploitation Index (8) as a boundary
> violation.
>
> Just as some physician sexual transgressors may insist their sex relations
> with a patient are therapeutic, the activist doctor may protest that he
only
> seeks to prevent "gun violence." However, the conduct of the medical
> activists strongly indicates that their interest in patients' guns is
> political, not therapeutic.
>
> The AAP, ACP, and AMA are members of the Handgun Epidemic Lowering Plan
> (HELP) Network, based in Chicago. HELP is an exclusive advocacy group
> dedicated to banning guns. Physicians who disagree with HELP's anti-gun
> agenda are barred from attending HELP's conferences, a policy unthinkable
in
> any scientific organization. HELP's founder and leader Dr. Katherine
> Christoffel has compared guns to viruses that must be eradicated. (9) The
> group's militant advocacy has no place for differing viewpoints on
firearms,
> and apparently neither do the medical organizations which have signed on
as
> HELP members.
>
> In fact, the AAP has adopted its "gun safety instruction" patient
materials
> from the gun-ban lobby Handgun Control, Inc. (HCI). The AAP and Handgun
> Control, Inc.'s informational wing the Center to Prevent Handgun Violence
> advise families in their STOP pamphlet, "The safest thing is to not have a
> gun in your home, especially not a handgun." (10) And a survey of
> pediatricians showed 76% supported a ban on handguns. (11) Patients who
seek
> objective advice on firearm safety should not look to pediatricians as a
> group. And any doctor should know that patient counseling based on these
> materials is politics, not medicine.
>
> Perhaps the most revealing aspect of organized medicine's anti-gun bias is
> its persistent refusal to address the criminology literature on guns. For
> over twenty years, criminologists have studied firearms, their use and
> misuse, their risks and benefits. Especially in the last two years
prominent
> researchers have found that firearm ownership is not the scourge that
> medical activists have claimed it to be. The best and latest research
finds
> that private gun ownership by responsible citizens not only is safe, but
> protects the individual as well as his community from violent crime. (12)
>
> One would think that medical firearm researchers would be intensely
> interested in this scholarship. But so far the editorial boards of the
> journals of the AAP, AMA, and ACP have neither responded to nor
acknowledged
> it. With their silence these editors have effectively ended whatever
> credibility they had in firearm research. That field of study is
apparently
> useful to them only as a vehicle for the advancement of their political
goal
> of gun prohibition. When the scientific process yields knowledge contrary
to
> that goal, activists either attack its author (13) or ignore it
altogether.
> Such conduct is inexcusable in any area of scientific endeavor. Honest
> scientists face conflicting data objectively. And honest doctors do not
use
> biased research to give false authority to their negative feelings about
> guns.
>
> So how can a patient tell if his doctor's advice about guns is good
> preventive medicine or political activism? Patients can assess a doctor's
> advice by keeping the following questions in mind:
>
> Does the doctor respect your right to keep guns? Or does he subtly send a
> message that guns are somehow bad? Moral judgments about the right to self
> defense, hunting, or other legitimate uses of guns are not acceptable
> subjects for a doctor talking to a patient.
> Does the doctor quote statistics from the American Academy of Pediatrics
or
> the American Medical Association about the supposed risks of guns in the
> home? Do you see anti-gun posters or pamphlets from these organizations in
> her office? These materials are based on the "advocacy science" of
anti-gun
> activists like Dr. Arthur Kellermann, much of which was funded by the
> federal Centers for Disease Control and Prevention (CDC). Congress cut off
> all the CDC's 1997 funding for gun research because of the CDC's anti-gun
> bias. (14) No doctor who knows firearms would base her advice on this
> frankly political literature.
> Is the doctor familiar with the National Rifle Association's (NRA) Eddie
> Eagle gun safety program for children, or other established gun safety
> education programs? If not, is she interested in learning about them?
Unlike
> the AAP's Stop program, Eddie Eagle educational materials for children
> contain no political or moral judgment about guns. This NRA program has
been
> honored by the National Safety Council, the American Legion, and the
> governments of 19 states. The Eddie Eagle slogan "If you see a gun, Stop,
> Don't touch, Leave the area, Tell an adult" was even endorsed by the
> generally anti-gun California Medical Association (CMA). (15)
> Despite intense publicity for the AAP's Stop program and similar
> initiatives, most doctors shy away from scrutinizing their patients' gun
> ownership. In a recent study 91% of surveyed doctors felt that firearm
> violence is a public health issue. But only 3% said they frequently talk
to
> patients about firearms in the home. Two thirds of the surveyed doctors
said
> they never talk to patients about the subject. (16) This may indicate that
> although they are generally concerned about firearm injuries, doctors do
not
> see politically motivated patient counseling as appropriate professional
> conduct.
>
> In a revealing section, the AAP's Stop speaker's kit warns would-be
> lecturers of "resistant audiences" who may disagree with them on
scientific
> or ideological grounds. One section offers talking points for dealing with
> these "challenging individuals." (17) The kit's authors seem to anticipate
> their audiences may recognize its political nature.
>
> Patients do have remedies for the boundary-crossing doctor. In today's
> competitive health care market most patients can choose from many doctors.
> Changing doctors is the simplest solution. A written complaint to the
health
> plan's membership services department can send a powerful message that
> boundary violations by doctors will not be tolerated. If the problem
> persists, patients can file a complaint with the doctor's state licensing
> board. Medical licensing boards are increasingly aware of the problem of
> boundary violations. Although state boards have addressed primarily sexual
> and financial misconduct, the broad principles they have developed to
guide
> doctors in these areas apply to the entire doctor-patient relationship.
(18,
> 19)
>
> The author cannot advise the reader to take a particular course of action.
A
> patient confronted with physician misconduct must decide for himself which
> action, if any, to take. But patients should realize they do have choices
in
> dealing with physician boundary violations involving political activism,
> especially in such personal matters as firearm ownership. And physicians
> should be aware of the personal risks they take when they bring political
> activism into the exam room.
>
>
> Endnotes
>
> HELP Network News, Winter / Spring 1998, p. 1. This quarterly newsletter
is
> published by the Handgun Epidemic Lowering Plan (HELP) Network.
> Ibid. p. 2.
> American Academy of Pediatrics Policy Statement, vol. 89, no. 4, April,
Part
> 2, 1992, pp. 788-790.
> American College of Physicians Position Paper, "Firearm Injury
Prevention,"
> Annals of Internal Medicine, 1998, vol. 128, no. 3, p. 238.
> Frick, D., "Nonsexual Boundary Violations in Psychiatric Treatment,"
Review
> of Psychiatry, vol. 13, (Washington, D.C.: American Psychiatric Press,
> Inc.), 1994, pp. 415-432.
> Hundert, E., and Appelbaum, P., "Boundaries in Psychotherapy: Model
> Guidelines," Psychiatry, vol. 58, November 1995, pp. 346-347.
> See reference 5, p. 416.
> See reference 5, pp. 418-419 reprinted with permission from the Bulletin
of
> the Menninger Clinic, vol. 56, no. 2, pp. 165-166, The Menninger
Foundation,
> 1992.
> Somerville, J., "Gun Control as Immunization," American Medical News, Jan.
> 3, 1994, p. 9.
> "Keep Your Family Safe From Firearm Injury," American Academy of
Pediatrics
> and Center to Prevent Handgun Violence, 1996.
> Olson, L., and Christoffel, K., "Pediatricians' Experience With and
> Attitudes Toward Firearms," Archives of Pediatric and Adolescent Medicine,
> vol. 151, April 1997.
> Lott, J., More Guns, Less Crime: Understanding Crime and Gun Control Laws,
> (Chicago: University of Chicago Press), 1998.
> Ibid. pp. 122-157.
> Report from the Committee on Appropriations, U.S. House of
Representatives:
> Departments of Labor, Health and Human Services, and Education, and
Related
> Agencies Appropriations Bill, 1997, p. 49.
> California Medical Association, Actions of the House of Delegates 1995,
San
> Francisco 1995, Resolution 109-95, p. 9. The Eddie Eagle slogan was
> originally introduced in a resolution crediting its creator, the National
> Rifle Association (NRA). But the CMA Delegates refused to mention the NRA
in
> the final version of Resolution 109-95, preferring instead to credit the
> California Department of Justice. This agency had adopted the Eddie Eagle
> slogan in its own gun safety program.
> Cassel, C.K., and Nelson, B., "Internists' and Surgeons' Attitudes Toward
> Guns and Firearm Injury Prevention," Annals of Internal Medicine, 1998;
vol.
> 128, pp. 224-30.
> American Academy of Pediatrics, "Preventing Firearm Injury: Protecting Our
> Children Speaker's Kit," tab 1, section 5, Elk Grove Village (Illinois),
> 1998.
> Medical Board of California Action Report, April 1996, p. 3, California
> Department of Consumer Affairs, Sacramento, California.
> Massachusetts Board of Registration in Medicine, "General Guidelines
Related
> to the Maintenance of Boundaries in the Practice of Psychotherapy by
> Physicians (Adult Patients)," Boston.
>
> --------------------------------------------------------------------------
--
> ----
>
> Timothy Wheeler, MD is Director of Doctors for Responsible Gun Ownership,
a
> project of The Claremont Institute.
>
>
>
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