Disarming Questions

Physicians like to think they operate outside the grubby commercial world where the customer is always right. That is why a medical examination, ostensibly a service that you purchase from a doctor, is actually a ceremony designed to put you in your place.

Although you arrive for your appointment on time, you have to sit in the waiting room for at least half an hour, which impresses upon you the important point that your time is much less valuable than the doctor's. Then you are brought to an examination room, where you are instructed to remove your clothing and put on a skimpy apron humorously described as a "gown."

You wait in the chilly room another half-hour until the (fully dressed) doctor deigns to visit you. He probes your private parts, asks you personal questions, comments on your weight, stares at your blemishes, and chides you for your unhealthy habits.

Jeremiah Barondess, president of the New York Academy of Medicine, apparently thinks this experience is not invasive and humiliating enough. He has come up with a way to make patients even more uncomfortable: ask them about their guns.

According to a recent story in The New York Observer, Barondess is the main instigator of a 13-group coalition called Doctors Against Handgun Injury. "To promote public safety," says the coalition, "health professionals and health systems should ask about firearm ownership when taking a medical history or engaging in preventive counseling….Patients should be provided with information about the risks of having a firearm in the home, as well as methods to reduce the risk, should they continue to choose to keep them."

The expectation that patients will think twice about owning a gun suggests the sort of "information" doctors are likely to provide. It will consist mainly of factoids that exaggerate the risks and discount the benefits of gun ownership.

Patients will be told, for example, that guns are used to murder people far more often than they are used to kill assailants; they won't be told that people who use guns in self-defense almost never need to fire them, let alone wound or kill the attacker. If patients actually have a question about reducing gun-related risks--such as how to store a weapon so it is accessible to the owner in an emergency but not to curious children--they will be much better off consulting a gun dealer.

Barondess insists he is not pushing a political agenda under the guise of medicine. "We are neutral politically, academically, and intellectually," he told the Observer. "Without politicizing this, it is possible for medical professionals to proselytize for this and point out the dangers of gun violence."

Yeah, and the doctor will be with you shortly. Let's put aside the fact that Barondess's coalition advocates stricter gun control laws along with nosier medical exams. The question is, given the multitude of ways in which people can be injured or killed, why focus on guns?

"Getting shot and dead is certainly a clinical issue," Barondess says. "Part of this mayhem is preventable, and doctors are in the prevention-of-premature-death business."

But since almost everything we do carries some level of risk, this reasoning would make just about any detail of our lives an appropriate topic for medical probing. Do you have a swimming pool? Do you ski? Do you cook with gas? Do you have scissors? Do you run with them?

If doctors decide whether to ask about a particular device or activity based on the number of deaths associated with it, surely automobiles are as worthy a topic as guns. Do you own a car? Do you wear a seat belt? Do you speed? How much braking distance do you allow for in the rain?

Patients probably would object to such questions, since doctors have no special expertise in this area. But the same is true about guns--even more so, since physicians are more likely to have personal experience with cars.

The absurd idea that physicians are authorities on anything that can cause death or injury reflects the arrogance of a cartelized profession whose members flaunt their power as official gatekeepers, restrict competition with the government's help, and routinely substitute their judgment for that of their customers. Given the seething resentment created by medical high-handedness, doctors would be well-advised to avoid broaching the subject of gun violence with their patients.