Learning to Talk with Patients About Firearms
Author: Eileen Barrett, MD, MPH
The first time I spoke with a patient about firearms in their home was with a young man admitted to the hospital with recurrent suicide attempts. He had consented to having his father present for our discussion and was on the hospitalist service awaiting evaluation by a psychiatrist. I remember asking him as gently as I could if there were firearms in his home, and him briefly looking relieved and then saying yes. I was surprised when his father interrupted me before I could make a follow up statement. His father asked sternly (and somewhat aggressively) why I would ask this question. Caught off guard, I replied that I would recommend against having a firearm at home for anyone who has a mental health diagnosis. I remember the other reactions that came to mind including ‘because your son could easily kill himself with those guns’ and ‘which is more important, your son’s life or your guns?’ but of course said neither – and am not proud that I thought of those. His father didn’t reply but sat with crossed arms and an irritated expression. I turned to the patient and said I recommended against having firearms in his home, and he said thank you. Later that day the patient was transferred to the inpatient psychiatric ward, and I didn’t see him again - yet the interaction has stayed with me.
In hindsight, I wish I had planned that conversation as thoughtfully as I plan those about addiction treatment, unexpected pregnancy, goals of care, and others that can be emotionally charged. If I had, I would have sought out and received training in how to speak about firearms ownership - likely including reading online resources and practicing with a peer. This way when the time came to have a conversation, I would have begun with asking if we could talk about his safety at home and proceeding from there with curiosity and future orientation about safety. I believe I would have used third person language (such as how sometimes it can be helpful for firearms to be stored outside the home while someone is going through a hard time), and paused often. Our state didn’t have an extreme risk protection law at the time, but I would be prepared to talk about that, too. Recently I’ve watched videos of physicians talking about speaking with patients on firearms and am participating in a telementoring program helping physicians understand gun safety. Both are incredibly helpful tools, whether we are new or experienced with possibly fraught conversations.
Since that time speaking with the young man with a suicide attempt, I have had many conversations with patients about firearms in their homes. Sometimes I include that my father was a police officer, so I grew up with a gun in my house – but sometimes I don’t. So far I've never disclosed that multiple people in my extended family have been shot. If asked if I have a firearm, I truthfully answer no, and if asked about my safety I talk about having dogs as well as safety-oriented structural elements to my home (such as deadbolt locks and strong doors). If it feels natural to do so, I mention how having a firearm in our home doesn't actually make us safer but instead increases our risk for injury (and death). The overwhelming majority of patients I’ve spoken with have been relieved to talk about safer firearm ownership, and are supportive of keeping their firearms unloaded, locked, and separate from ammunition. Others have disclosed that a family member has been storing their guns for them - and when I say how loving that is, they say how grateful they are for that family member doing this. I remember one man with severe depression and an alcohol use disorder becoming tearful with gratitude for his brother storing his firearms while he’s emotionally struggling. He felt this was such a kind act, which it is. Particularly with soaring firearms injuries and deaths, this provides me with comfort and hope that we can do better. But first we must try.
I know not all conversations about firearms will go well, but so far for me they generally have. I feel better prepared for when they don't go as hoped, too. All physicians deserve training in how to speak with patients about firearms, and I hope someone invests in you in this way.
About the author: Eileen Barrett, MD, MPH, SFHM, MACP, is an internist in Albuquerque. (Twitter: @EileenBarrettNM)
