Do You Own a Gun? In Florida, Doctors Can’t Ask You That

July 30th, 2014

A few weeks ago, I had my yearly physical. As part of her history-taking, my doctor asked if I was sexually active with my wife. Then she asked if I was sexually active with anyone other than my wife. She does this every year.

She’s not asking to be intrusive. Nor is she a voyeur. She knows that having multiple sexual partners significantly increases one’s chance of contracting a sexually transmitted infection. Asking about that allows her to see if I’m at risk, and then to address that risk with me.

I’m not offended that she asks me. Asking me is part of what makes her an excellent physician. Doctors are supposed to ask about sensitive things in order to help keep us safe. This is especially true for pediatricians. This kind of exchange is how we engage in prevention, sometimes called anticipatory guidance, and study after study shows it can prevent harm.

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When pediatricians ask you about using car seats, they’re trying to prevent injuries. When they ask you about how your baby sleeps, they’re trying to prevent injuries. When they ask you about using bike helmets, they’re trying to prevent injuries. And when they ask you about guns, they’re trying to prevent injuries, too.

Photo

Mario Whitehead feeding his niece, Jaylah Giles, at his home in Orlando, Fla., last year. He was paralyzed from the waist down in an accidental shooting earlier in the year. In 2011, more than 11,000 people were killed by firearms in the United States. Credit Gary W. Green/Orlando Sentinel, via Getty Images
But not, perhaps, everywhere. In Florida, in 2011, a law was signed that made it illegal for doctors to ask patients if they owned a gun. If doctors violate this law, they can be disciplined, leading to fines, citations and even a loss of their license.

A lower court struck down the law in 2012. But last week, a panel of judges on the United States Court of Appeals for the 11th Circuit upheld it. In their ruling, the judges declared that the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.” The clear assertion of the judges is that there is no legitimate health reason to be asking about gun ownership.

Almost 20,000 people committed suicide in the United States with firearms in 2011. More than 11,000 were killed by firearms that year, and more than 200 were killed in accidents with guns. In 2009, almost 7,400 children were hospitalized because of injuries related to guns.

Doctors who ask about guns aren’t doing so because they’re nosy. They’re doing so because the vast majority of those deaths and injuries are preventable.

It’s entirely possible to keep a gun in your home safely. But studies show that the majority of people who keep guns in their homes do so in an unlocked space. Few have any kind of trigger locks. More than 10 percent report keeping their guns loaded or near ammunition, in an unlocked area.

That’s often how children get hurt. Few people argue that young children should have access to guns or ammunition. But that’s what’s happening in far too many homes in the United States. Research shows that guns kept in the home are more likely to be involved in accidents, crimes, or suicides than in self-defense.

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When I ask patients and parents whether they own guns, if they tell me they do, I immediately follow up with questions about how they are stored. I want to make sure they’re kept apart from ammunition. I want to make sure they’re in a locked box, preferably in a place out of reach of children. Doing so minimizes the risks to children. That’s my goal.

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When we, as physicians, ask you if you drink or smoke, it’s not so that we can judge you. It’s so we can discuss health risks with you. When we ask you about domestic violence, it’s not to act like police detectives. It’s so that we can help you make better choices for your health. When we ask you about what you eat or whether you exercise, it’s so we can help you live better and longer. We’re doctors; it’s our job.

Please understand, you can calmly refuse to answer any of these questions. You can tell your doctor you’d rather not discuss this topic. You can choose to lie. You can even just not come to the doctor in the first place. There’s nothing stopping you from preventing us from helping you.

Of course, rejecting discussion of a risk-laden topic isn’t much different from rejecting discussion of what you eat, or what’s physically ailing you. You’re hurting only yourself. What this now-upheld Florida law does is prevent doctors from helping other people, who might want the assistance. Anticipatory guidance is about stopping injuries before they happen. This law, passed in the name of protecting privacy, prevents doctors from practicing good medicine.

Physicians are supposed to cover topics that can make patients uncomfortable. It’s why what you tell your doctor is confidential. Your privacy, your medical records and all your privileged information are still protected by the same laws that have always been there. None of that changed with the Affordable Care Act.

If the courts decide that people have the right never to be asked sensitive questions, they’re interfering with the relationship between doctor and patient. They’re deciding that some health risks are worth minimizing and others are not.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine. He blogs on health research and policy at The Incidental Economist, and you can follow him on Twitter at @aaronecarroll.

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Girls Suffer Worse Concussions, Study Suggests

April 11th, 2014

Researchers found they had more severe symptoms, longer recovery times than boys.
By Kathleen Doheny
HealthDay Reporter

THURSDAY, April 10 (HealthDay News) — Girls who suffer a concussion may have more severe symptoms that last longer compared to boys, according to new research that builds on other studies finding gender differences.

“There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms,” said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children’s Hospital of Wisconsin.

In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.

Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

He was due to present the findings this week at the annual meeting of the American Medical Society for Sports Medicine, held in New Orleans. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

A concussion is any brain injury that disturbs normal functioning. Concussions are typically caused by a jolt or blow to the head, often in collision sports such as hockey or football, according to the American Academy of Pediatrics (AAP).

In recent years, experts have advised coaches, players and parents that athletes should not return to play until they are seen by a doctor if a concussion is suspected.

In the new study, Fehr tracked patients aged 10 to 18, all treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.

In addition to reporting more severe symptoms, girls took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.

That duration of symptoms, Fehr said, is much longer than what people commonly think. “Commonly you hear that seven to 10 days [for recovery] is average,” he said.

Fehr did not find age to be linked with severity of symptoms. Most of the injuries — 76 percent — were sports-related, with football accounting for 22 percent of the concussions.

The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.

“This confirms what has been reported before,” said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children’s Hospital, who reviewed the findings.

While he said the 44-day recovery seems lengthy, he added that it probably reflects the boys and girls studied. They all went to a concussion clinic, so their injuries may have been more severe.

What’s not known, Fehr said, is why the differences exist and whether they are related to more reporting of symptoms right after the injury by girls or if girls are truly more significantly affected.

“I wouldn’t treat girls any differently than boys,” he said.

For both genders, it’s important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the AAP. Anyone with a history of concussion is at higher risk for another injury.

More information

To learn more about concussions, visit the American Academy of Pediatrics..

SOURCES: Shayne Fehr, M.D., board certified pediatric sports medicine specialist, Children’s Hospital of Wisconsin, and assistant professor of pediatric orthopedics, Medical College of Wisconsin, Milwaukee; John Kuluz, M.D., director of traumatic brain injury and neurorehabilitation, Miami Children’s Hospital; presentation, American Medical Society for Sports Medicine annual meeting, Apr. 5-9, 2014, New Orleans

Mother’s Diet May Reduce Child’s Allergies

February 24th, 2014

Peanuts and milk consumed during pregnancy reduced asthma and allergy in children

A team of researchers recently found that milk, wheat and peanuts eaten during pregnancy were associated with decreased rates of asthma and allergy in children.

“Talk to your obstetrician about foods to eat and avoid during pregnancy.”

Supinda Bunyavanich, MD, MPH, of the Icahn School of Medicine at Mount Sinai Hospital in New York led this research team.

Between 1999 and 2002, 1,277 mother-child pairs were recruited into the study. The pregnant mothers were interviewed and answered questionnaires when 10 weeks pregnant and again at 26 to 28 weeks of pregnancy.

Child health information was gathered at 6 months of age, 1 year and every year after. Data collected around 8 years of age was called the mid-childhood data.

The pregnant mothers completed diet surveys at the first and second trimester visits.

The researchers scored the amount the women ate, and consumption that was at least 68 percent more than average was called higher consumption.

Analysis of the data found that higher consumption of peanuts by pregnant women in their first trimester was associated with a 47 percent decreased odds of peanut allergic reactions in mid-childhood.

Higher consumption of milk in the first trimester of pregnancy was associated with a 17 percent decrease in chance of mid-childhood asthma.

In the second trimester, higher wheat consumption was associated with a 36 percent decrease in the odds of allergic skin reactions in mid-childhood.

The authors noted that their study was unique in that, “We found no other studies that examined maternal diet before 25 weeks, with most assessing diet for the last month or last trimester of pregnancy only.”

The association between a pregnant mother’s diet and asthma and allergy in her children is still controversial, but Dr. Bunyavanich and team concluded, “Our findings suggest potential benefits to including peanut, milk and wheat in the maternal diet during pregnancy.”

This study was published in the February issue of The Journal of Allergy and Clinical Immunology.

Grants from the National Institutes of Health funded the research.

The researchers disclosed potential conflicts of interest for receiving research support from the National Institutes of Health and Phadia Thermo Fisher. One of the study’s authors has received royalties from Springer Humana Press and UpToDate, Inc.

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