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[at-l] Dangerous Doctors?
> A psychiatrist is a physician. I also do forensic evaluations and
> consultation in malpractice cases. Primary care docs as well as specialists
> are occasionally sued following homicidal acts by patients. We see a
> increasingly common event of "suicide by police" in which the patient
> creates a crisis (such as a high school shooter) as a means of having
> others execute them. Frequently, these people have been seen by a physician
> within a few weeks of the crisis and the physician is seen as contributing
> to the tragedy.
> What do I do if a patient tells me that they have firearms? I get more
> information about how many, how are they stored, prior gun play, and lots
> of other history. The gun is not the problem. The gun can contribute to a
> very big problem, just as the slip rug can. I am really too busy to add gun
> control or interior decorating to my schedule. Yet, I will try to elicit
> the patient and the family's assistance long before I call the Sheriff's
> office for involuntary commitment or Adult Protective Services for a home
> Each state has laws regarding involuntary evaluation and treatment for
> conditions that pose danger to the patient and the public. These are most
> commonly encountered in mental health, but are also invoked in infectious
> disease, delirium, trauma, immunization of children, abuse and neglect of
> children or seniors as well as other situations. The goal is to provide for
> public health and reduce the costs to the patient and society of untreated
> illness. It is very inconvenient for a physician to invoke such laws, and
> even more inconvenient if the physician neglects to invoke such laws. I
> rarely treat a patient I commit to hospital, as I believe that the patient
> needs a doctor that they are able to cooperate with in developing a
> treatment plan. I also know that involuntary psychiatric commitment make
> gun ownership illegal for that patient under the Brady laws. I have used
> that as leverage to assist a patient in becoming voluntarily admitted to
> hospital in emergency.
> This is a difficult balancing act between individual liberty and
> responsibility against society's expectation of law and order and security.
> There is no way for competing interests of physicians, legislators, general
> public, law enforcement and others to be of one mind on this issue, much
> less every issue. The article cited in the journal for the American
> Association for Physicians and Surgeons (a very active and political group)
> was about as ill conceived as the JAMA article regarding adolescents'
> definition of "sex" before the Clinton impeachment. These were engaging
> op/ed pieces that should have been in the Spectator and New Republic
> respectively. They detract from the credibility of their guild publishers.
> There are good reasons for physician's to understand prevalence of guns in
> our patients' households, seat belt use, immunization history, exercise
> habits and other personal data. Patients always have the right to leave the
> questionnaire empty or to lie. However, outcomes are often less
> satisfactory with either ignorant physicians or unreliable patients.
There's little I can say to this. I'd like to think that
your reply has horrified at least a few readers, but I'm
sure that it hasn't.
Less than ten years ago, the medical community didn't see
any need to question everyone entering a doctor's office
on their gun ownership practices. It wasn't until the CDC
declared "gun violence" to be a public health issue (nay,
a crisis!), coincident with the arrival of an administration
possessing noted hostility toward private gun ownership,
that this "difficult balancing act" was deemed necessary.
It doesn't take an alpha-plus to see the political hand
It also isn't a stretch to predict that the day is fast
approaching when one's only assurance of privacy for their
medical records will be some smiling, oily bureaucrat
saying "trust me." Though defeated in 1993, the head witch
in the Senatorial coven is eventually going to have the
last laugh; philosophical issues being apparently too much
for Hasert and Devo-hair boy to handle (as if they really
differ philosophically from the More-statist Party).
Oh well, it ain't my pidgin. Y'all do what you gotta do.