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CHICAGO -- While the debate over gun violence is often overtaken by the more extreme views on either side, emergency physicians encouraged an evidence-based, non-judgmental approach to tackling the issue during a panel at the meeting on Monday.
"This isn't about confiscation and it's not about universal screening. It's about how we interface with our patients one-on-one to try to prevent harm," said Marian "Emmy" Betz, MD, MPH, associate professor of emergency medicine at the University of Colorado School of Medicine.
While the issue of whether or not physicians should talk to patients about guns is still divisive, Betz believes physicians should "absolutely" be talking to patients about guns, using evidence and science to guide them.
There are things physicians can do tomorrow to help tackle gun violence, explained Megan Ranney, MD, MPH, associate professor of emergency medicine at the Warren Alpert Medical School at Brown University.
Ranney, who is also chief research officer for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), said that even though research on gun violence risk factors is limited, "there are a few groups who are at eminently higher risk of being involved in a firearm incident."
She named three who should always be screened about firearm access: patients who are depressed and suicidal, victims of domestic violence, and youths who have been in a fight.
Fifty-nine percent of all firearm deaths are from suicide, Betz noted, and 90% of people who attempt suicide with a gun complete it.
When a person says that he or she is a victim of domestic violence, Ranney said, one of the biggest predictors of his or her death is the perpetrator's access to a firearm, she noted.
Finally, adolescents and young adults (ages 15-24) who come to the emergency room after an assault are at 40% greater risk for a firearm injury in the future, and those admitted to the hospital with a firearm injury are at 300 times the risk of a future firearm injury or death, she noted.
If those are the three groups that evidence suggests should always be screened about firearm access, there's three more that physicians should at least consider talking to about guns.
The latter three categories include elderly patients with cognitive decline or dementia, children, and individuals with substance use disorder or alcoholism.
With regard to elderly patients with dementia, Ranney pointed to her and her fellow panelists' May 2018 study in , which suggested that some elderly patients are in danger of shooting themselves or their caregivers, due to depression and paranoia.
With regard to children, while accidental injuries account for only 1.3% of overall deaths from guns, "they are completely preventable tragedies," she said.
Finally, research has shown significantly higher rates of suicide and homicide among people who have substance use disorders, Ranney added.
As for the legality of speaking with patients about guns, "there is no gag law," said Garen Wintemute, MD, MPH, of UC Davis Medical Center in Sacramento.
There was a law -- Florida's Firearm Owners' Privacy Act (FOPA) -- that for a time deterred physicians from asking patients about guns. However, key provisions of the so-called "gag law" were overturned in February of last year.
"The Second Amendment rights of patients do not outweigh the First Amendment rights of providers," Betz, Ranney, and Wintemute explained in another article, "Physician, Patients and Firearms: The Courts Say Yes."
There are a few states, such as Montana, where it is illegal to ask about firearms as a condition of receiving care, but those are not gag laws, he stressed.
Regarding disclosure of the information obtained in firearm screening, Wintemute explained that such disclosures are allowed under HIPAA if they are "necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public."
Physicians wanting to learn more about the gun laws in their states can look to the and the , he said.
But the issue of gun violence isn't only about legislation, it's also about culture change and about investing in research, Ranney said.
"To me the big thing is creating ways for physicians to have those conversations [about guns] more easily ... We don't have great evidence to say we should be taking our time doing this instead of any of the thousand of other issues we're trying to address," Ranney said. So more research and more research funding are both badly needed, she noted.
The biggest day-to-day hurdle for physicians, however, is "knowing that gun violence is a problem and wanting to do something about it, but not knowing how," Ranney said.
Wintemute has set up a website -- -- at UC Davis, which provides resources for patients and providers on preventing gun violence.
While advocacy isn't for everyone, Betz, who lost a relative to suicide, said one of the more rewarding experiences of her career has been her community collaborations on gun violence and suicide prevention, which have included conversations with gun shop owners. "It really drives home the point that nobody wants to lose a family member," she said.
"Many people who own firearms do it precisely to try to protect their families. We need to recognize that and see how we can work together ... [to] get beyond the partisan divide and find ways to share ideas and learn from each other," Betz said.
While not every doctor needs to own a gun, or even shoot a gun, she sees it as a way to learn about patients different from herself.
"I think it can feel a little intimidating to just walk into a [gun] store," she said. If you do, "go in with an open mind and a non-judgmental approach and go to learn."