Protecting You From Your Doctor

[WillNever]

I already provided a reference that would satisfy a reasonable observer. It's just too bad that you aren't one. In academia, it is acceptable to indirectly cite a fact by quoting another cited statement.

How do you interpret the idea that suicidal people are receptive to talking about the crisis, in any other way than what I said? All evidence points to it being better to ask than not asking. Trying to find subtle but meaningless differences in language doesn't strengthen your argument (whatever that even is).

 

[adoucette]

Because it doesn't matter if people often talk about it or often tell the truth.

They do in fact lie, so the answer to the question, "Do you own a gun?" is not relevent medically.

Which means it is of no value.

Which is one reason you text does not suggest asking that question.

Indeed, it suggests asking if they have a plan and if so what is it.

Arthur

 

[WillNever]

Because it doesn't matter if people often talk about it or often tell the truth.

They do in fact lie, so the answer to the question, "Do you own a gun?" is not relevent medically.

Which means it is of no value.

Which is one reason you text does not suggest asking that question.

Indeed, it suggests asking if they have a plan and if so what is it.

Arthur

So what if they lie? Asking hasn't been to shown to hurt anybody. The ability to lie to a question does not make the question "medically irrelevant." One question that patients usually do lie about is how many drinks/week do you consume? The answer is usually a lie, but it is still medically relevant. As a layperson, you aren't in a position to judge medical relevance adequately.

"Shooting myself" would be a logical answer to "do you have a plan?" So it follows that if you knew somebody owned a gun, that you would ask if they intend to use it. This kind of straw-grasping does not strengthen your argument.

 

[chimpkin]

Evidence has shown that most people with suicidal ideations admit when they have the plan and the means

I would, except I can't afford to miss work or to let my work know I have a psych diagnosis.
"Hi, I'm in the county psych ward...yeah, I'd like to come to work, but they won't unlock the door or give me my shoelaces..."
Boy I can really see THAT convo going over well with the supervisors.

 

[adoucette]

"Shooting myself" would be a logical answer to "do you have a plan?" So it follows that if you knew somebody owned a gun, that you would ask if they intend to use it. This kind of straw-grasping does not strengthen your argument.

Not grasping at straws at all, in fact earlier in this thread you already dealt with this specific issue:

It's framed in a way that maximizes risk assessment potential. "Do you own a gun?" doesn't elicit as much information as "do you have access to a gun?"

So we BOTH agree, in this narrow situation we are finally down to, when dealing with a potentially suicidal patient, even then the question, "Do you own a gun?" isn't the question that needs to be asked.

Arthur

 

[WillNever]

Both are acceptable. And nothing is wrong with either of them.

 

[Fraggle Rocker]

No, they certainly don't need that information.

So I presume you also don't believe they need to know if you have a motorcycle, a meth lab, or a Presa Canario breeding kennel. All of these have a high correlation with accidental death of self and children in the household--or permanent injury. It's your doctor's duty to maximize your life expectancy and minimize your likelihood of permanent injury. In order to do that he needs to counsel you on the best ways to avoid killing or maiming yourself in pursuit of your hobbies. He can't do that if he doesn't even know what they are.

Of course this all comes down to trust, and if you don't trust your doctor you should dump him and find a more trustworthy one.

If they are concerned that I'm suicidal then they have to presume that I might lie about having a gun anyway and that even if I don't currently own a gun there is nothing to prevent me from buying a gun and ammo on the way home, so the fact of my owning a gun at that particular time is not at all relevant to any medical treatment they would give me.

Suicide is only one way people die from bullet wounds. Accidents happen through negligence, drunkenness, lack of training, and letting a gun (or other instrument of death or permanent injury) fall into the wrong hands, such as those of a child. There's also the phenomenon of an armed person feeling cocky and mouthing off to someone who is quicker on the draw, walking into a neighborhood where he's likely to encounter one of those people even though he has no good reason to be there, or risking his life to avoid having fifty bucks cash and his credit cards stolen.

A straight-A student, football star, kindest kid in the neighborhood was recently killed in DC Southeast merely for wanting a gun. He saved up the cash, walked over to the house where his lowbrow friends told him guns were sold, and the dealer sized him up and decided to simply kill him and take the money without having to give him a gun in return.

If you claim it is, then simply tell me what specifically they would do differently if I answered YES to that question vs NO and why it would be appropriate to presume "Not Today" is the same as "I'll never own a gun".

Why ask me? Surely you have a family physician who could give you a more accurate answer to that question. As I said earlier, he would probably ask about your training, the way you store the gun, under what conditions you take it out, where you go with it, etc. He probably already has a pretty good idea of whether you have any suicidal tendencies.

If he's a trained psychologist or counselor he would probably not need to ask the questions. He knows he'll get more accurate information by correlating information he gets from your conversations. It's hardly difficult to get someone with a gun to casually refer to it, and to the things he does and does not do with it.

Again, there is absoutly NO DIFFERENCE in how you would treat a patient based on their answer to the question, "Do you own a gun?" and thus it is not relevant to any medical treatment.

And as I have just detailed, you're dead wrong on that.

You claim there is, then tell me specifically how you would alter the treatment based on the answer to that question?

Doctors do more than "treat" patients. Assuming you're not one of those old reprobates who only consults his physician when he's on death's door. When you get your annual physical he asks you about all the medications and supplements you're taking, how much exercise you get, your eating and drinking habits, etc. Your avocations, habits, hobbies and living environment have as much bearing on your future health as your blood pressure, prostate size, colonoscopy and BMI.

Note, the answer to this has to come from a standard medical text indicating the different treatment based on the answer to this question.

You're pretending to be obtuse, which makes you look like a buffoon since scholars have much better ways of arguing. I'm sure you know better than this. This is not the Middle Ages and "treatment" is not your doctor's sole responsibility. "Prevention" is a major part of his job. Prevention of accidental death or homicide, or simply shooting off your toes, is included in that. Suicide is a straw man in this argument.

 

[adoucette]

Fraggle, I've been going to doctors for many decades.
Never once has the question of gun ownership come up.
Why?
There is no need for it.
It has nothing to do with my health.

Of all the things the doctor could talk to me about that DO have to do with my health it is so far down the list as to be ludicrous to spend what little face to face time I get with my doctor on this.

I go there when I'm sick and the doctor determines what I have and prescribes the medication or treatment I need. Guns do not cause sickness and so are not at all related to this process.

I go once a year for a checkup, I visit the lab the day before and they do all the tests, then the next day or so the doctor spends about 15 minutes with me, we talk about my health and the results of my lab tests and what are my serious risk factors, and vaccinations I need or other tests he would recommend.

That discussion will not include if I own a gun because it is such a TINY risk factor that it would never come up before the Dr has to hustle out to treat his next patient.

Why?

Because there is most definately a shortage of Doctors and there is no shortage of patients. His waiting room is always filled and he does not have time for this kind of pointless discussion of the minutia of my lifestyle.

So what SHOULD my doctor talk to me about?

Well remarkably it's what he SHOULD talk to me about, my major risk factors.

Which, in my age range the causes of death are:

315 from Cancer, and so he's going to make sure I don't smoke, and if I do, he's going to try to convince me to quit, because 1/3rd of the cancer deaths will be from lung cancer and since I'm a male he's going to not only check my Prostate but he's going to go over the results of my Colonoscopy and insure I schedule the next one because 10% of the deaths from cancer will be from that one cause.

250 from Heart, and so he's going to talk about my blood pressure and cholesterol levels and amount of exercise I get and the medications I take and other risk factors, and if I smoke he's going to hammer on the additonal risk I take since 40 people a year die from Lung disease.

30 from Diabetes, and so he's going to talk about my weight and diet and relationship to Type 1 diabetes

25 from Cirrhosis, and so he's going to talk to me about my drinking and suggest that I don't drink every day or too often

That's 75% of the causes of death, but in total disease represents 94% of my Risk Factors. Everything else will only account for 6% of the things that will kill me.

SO

If the doctor had more time and wanted to talk lifestyle and about this residual 6% then the top 3 issues would by Motor Vehicle Accidents at 15, Falls at 15 and Accidental poisonings at 10.

That would cover 70% of that remaining 6%

If the doc STILL had more time he could talk about the next two and ask about if I used Smoke Alarms as Fire causes TWO deaths a year or if I swim alone since Drowning causes ONE death per 100,000 people my age, or FIVE times as frequently as the chance of me accidentally killing myself with a gun (0.2).

Which is why my ownership of a gun is NOT medically relevant.

Arthur

 

[quadraphonics]

I go once a year for a checkup, I visit the lab the day before and they do all the tests, then the next day or so the doctor spends about 15 minutes with me, we talk about my health and the results of my lab tests and what are my serious risk factors, and vaccinations I need or other tests he would recommend.

That discussion will not include if I own a gun because it is such a TINY risk factor that it would never come up before the Dr has to hustle out to treat his next patient.

I somewhat agree with this for your general, average patient.

But there will come a time in everyone's life where their faculties become diminished (alzheimers or brain injury or just old age), and it is the rightful place of a doctor to offer medical advice on lifestyle changes to address the risks this poses. Your doctor wouldn't be out of line for suggesting that you install approriate safety bars in your shower, or not drive your car at night or on the freeway (or maybe at all), or refrain from activities like black diamond skiing, in response to (medical) changes in your mental and physical state. So why should he avoid the subject of guns? I have known a few families who very forcefully wished that someone would so intervene in the gun ownership of their elderly, senile relatives - the alternative has been for them to sneak around replacing live ammo with blanks.

That still doesn't really rise to justifying blanket inquiries into gun ownership, necessarily.

At the end of the day, this really comes down to trust between a doctor and patient. And I don't think that having the state come in and legislate what doctors can ask about - under threat of years in prison - advances that. Quite the opposite: it sends a strong message that all doctors, everywhere, are untrustworthy agents of some nefarious liberal plot to steal your guns. It's a political stunt, not a principled defence of some right.

 

[adoucette]

So I presume you also don't believe they need to know if you have a motorcycle, a meth lab, or a Presa Canario breeding kennel. All of these have a high correlation with accidental death of self and children in the household--or permanent injury.

No they don't.
Apparently you aren't too up on what kills us.
Here's a hint, it ain't Presa Canarios or Motorcylces, its smoking, obesity, smoking, drinking and smoking.

1 in 4 men will die from Cancer and Lung cancer, mostly caused by smoking, is by far the most common of those cancers. Prostate is second and Colon is third. All others pale in comparison to these three for men (put Breast in place of Prostate for Women)

http://www.cancer.org/Cancer/CancerBasics/lifetime-probability-of-developing-or-dying-from-cancer

The highest cardiovascular disease risk occurs in people who had diabetes at age 50 because 67% of diabetic men will have CVD by age 75 and obesity alone increases the risk to 58% for men and for both groups smokers develop CVD sooner than nonsmokers and die an average of five years earlier.

So those THREE key things are our primary risk factors.
In comparison to those the rest of our risk factors are very small.

Accidents happen through negligence, drunkenness, lack of training, and letting a gun (or other instrument of death or permanent injury) fall into the wrong hands, such as those of a child.

But in reality it is a rare occurrance. Indeed 3 times as many people die from Hernia than do from accidental shooting.

As I said earlier, he would probably ask about your training, the way you store the gun, under what conditions you take it out, where you go with it, etc.

What makes you think a GP knows the first thing about guns, or how to handle them?

as I have just detailed, you're dead wrong on that.

No I'm not.
If the doctor suspects you are suicidal they have to act on it and your answer to the question "Do you own a gun?" is irrelevant since the doctor can't presume a depressed suicidal patient is not going to lie and thus the treatment doesn't change based on the answer.

 

[adoucette]

I somewhat agree with this for your general, average patient.

But there will come a time in everyone's life where their faculties become diminished (alzheimers or brain injury or just old age), and it is the rightful place of a doctor to offer medical advice on lifestyle changes to address the risks this poses.

Except at no age does the level of accidental death from guns rise to the level of a medical issue.

Indeed, looking at the group you are talking about, the 75 - 84 age range (and by the way I support the right for people to end their own lives when they choose to do so), in that age range over 5,000 per 100,000 will die, almost all from medical reasons (97%), but only 1 per 500,000 will die by accidentally shooting themselves.

Indeed if the doctor wants to discuss those things that are the biggest threats, then it's really time to discuss CardioVascular Disease, which kills 229,000, or the various Cancers which kills 163,000, and then take time to discusss the Flu which kills 15,000 or Peptic Ulcers which get 9,000 or Septicemia which gets 10,000 etc etc.

But after dealing with these BIG issues and the Doctor has so much spare time thate he wants to get into the TWO percent of deaths that are due to accidents, then of the 13,736 accidental deaths nearly half, or 6,552 will be from falls so clearly that will be the big issue to be discussed, with details about changes to the home and ramps vs stairs and ways to summon help if you fall and about removing objects that can be tripped over, or things with sharp hard corners you could land on etc etc.

Time permitting, after all those detailed discussions, he could talk about driving and night vision and alternate means of transportation since 2,845 will die in a car accident. At this point, the doctor who takes this extraordinarly extra effort in patient education will have covered 89% of the known causes for the 2% of deaths that are due to accidents.

But if you have a doctor that REALLY has a lot of time on his hands and wants to cover 98% of the known accidental causes, then maybe he can discuss the many ways to cut down on the 436 deaths from Fires, or the 355 deaths from accidental poisoning or the 184 deaths from drowning, which should do it, because drowning is SIX times as likely to kill someone in this age range as death from an accident with a firearm (31).

http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_19.pdf

Arthur

 

[quadraphonics]

Except at no age does the level of accidental death from guns rise to the level of a medical issue.

How about accidental injury from guns?

The problem with your actuarial approach here is that it fails to distinguish easily preventable outcomes from stuff like cancer deaths. There are major differences in the approach to those two categories, before you even get into the incidence rates. The level of medical expenditure needed to deal with the easily preventable stuff (falls, driving, guns) is miniscule - a few minutes explaining to patients what steps they should prudently take, given their mental and physical state. This is very much in scale with the relatively lower incidence of accidents - preventing/treating those cancers and ulcers and what-have-you is big-ticket stuff. So from a treatment standpoint, it makes sense to spend a few minutes on those easily-preventable things, even if the incidence of such is fairly low (and has it occurred to you that the incidence is low exactly because various people are taking steps to address such low-hanging fruits? Your data there does not represent some controlled experiment that would show what outcomes occur in the absence of medical advice on them).

 

[adoucette]

How about accidental injury from guns?

Well I've never seen anyone break that information down in a usable manner. People who write about it invariably want gun safety to appear much worse than it is and thus lump homicides and suicides in with accidental injury.

We can extrapolate though, and in that case, accidental death is only 1/50th of intentional killing by gun, and thus the injury rates would likely be similar, and so we are looking at a relatively small number of accidental gun injuries as well, about 4,000.

Which is why it doesn't make the list for any age group:

http://www.cdc.gov/injury/wisqars/pdf/Nonfatal_2008-a.pdf

In comparison, even the bottom of the serious injuries are in the nearly Million per year range, and the biggies, are in the 2, 3, 4 million, with Falls at nearly 9 million.

The problem with your actuarial approach here is that it fails to distinguish easily preventable outcomes from stuff like cancer deaths. There are major differences in the approach to those two categories, before you even get into the incidence rates. The level of medical expenditure needed to deal with the easily preventable stuff (falls, driving, guns) is miniscule - a few minutes explaining to patients what steps they should prudently take, given their mental and physical state. This is very much in scale with the relatively lower incidence of accidents - preventing/treating those cancers and ulcers and what-have-you is big-ticket stuff. So from a treatment standpoint, it makes sense to spend a few minutes on those easily-preventable things, even if the incidence of such is fairly low (and has it occurred to you that the incidence is low exactly because various people are taking steps to address such low-hanging fruits? Your data there does not represent some controlled experiment that would show what outcomes occur in the absence of medical advice on them).

And I never said the doctors shouldn't be allowed to provide this information, it's just that accidental injury from guns is literally the bottom of the barrel.

Indeed, I'm happy with the compromise they came up with: the bill requires only that doctors, emergency medical personnel and other health-care providers not enter such information into a database

That said, having been going to doctors for many decades not one of them has ever addressed any of these non-medical issues with me, and certainly never collected any such level of household data on me.

But I've always had excellent doctors and we do in fact discuss the major MEDICAL risk areas that my medical history and current age suggests, and that has recently been around CVD, Cholesterol, blood pressure, Flu vaccines, Colonoscopies etc etc, but not once has my doctor gotten off of pure medical issues into things like poisoning, drowning, fire and falling and the reason is pretty simple, going over the above medical issues, done to a degree where the information is covered adequately takes up all the time the doctor has, and is in fact in line with his training and expertise.

 

[Fraggle Rocker]

Apparently you aren't too up on what kills us. Here's a hint, it ain't Presa Canarios or Motorcylces, its smoking, obesity, smoking, drinking and smoking.

You have the typical American weakness with math. Presa Canarios aren't a major cause of death for the U.S. population because they're not a very popular breed in the U.S. It's quite likely that none of us will ever see one. But they are extremely dangerous dogs and in a household that has one the odds of it killing someone or causing serious injury are extremely high. They make the American pitbull terrier look like a Maltese.

So if I were a doctor of course I would not ask every patient if he has a Presa Canario because statistically, it's a low risk and I need to concentrate on things that are more likely to kill a randomly selected citizen. But if I find out that he actually does own one, you can bet that I will be all over him, making sure he doesn't live in an apartment building, putting all of his neighbors at risk like those fools in San Francisco.

And what's with listing "smoking" three times in your list of the top five causes of death? Are you an automobile enthusiast who doesn't want to admit that road accidents are in the top five or hovering right under it?

And how about specific demographic groups? Suicide and murder are in the top five for teenagers. In the cities the majority of the murders are gun deaths; I'm not sure about the suicides.

What makes you think a GP knows the first thing about guns, or how to handle them?

Depends on geography. If he's in the South or one of the other regions where every household has four guns plus one on a rack in the truck, he probably has one himself. In places where the statistical risk is lower it would reasonably not be on his radar.

 

[adoucette]

You have the typical American weakness with math. Presa Canarios aren't a major cause of death for the U.S. population because they're not a very popular breed in the U.S. It's quite likely that none of us will ever see one. But they are extremely dangerous dogs and in a household that has one the odds of it killing someone or causing serious injury are extremely high. They make the American pitbull terrier look like a Maltese.

My math skills are just fine thanks, but you mentioned deaths associated with Presa Canario Breeding Kennels and I can find no deaths associated with them at all.

From 1979 to 1996, there were 300 dog bite fatalities across the nation, according to a study by the Humane Society of the United States. Of those, Rottweilers were the most commonly reported breed involved, followed by pit bull-type dogs. Together, those two breeds were responsible for 60% of the deadly attacks.

So, we have about 16 killings by dog per year, and Rotweilers get about 6 and Pit Bulls about 4 and all the other breeds get the other 6.

But Presa Canarios are only down for two, ever. And none of those were associated with breeding kennels, which was your original assertion. (If you are going to get personal and claim my math skills aren't good, then remember that moving goal posts is a no-no in a debate)

The breed has been linked to only two fatalities, so even with your moved goal posts you haven't really supported your claim that the odds of being killed by one if you have one in your home are high since there are no reliable estimates of how many of the dogs are being kept. Not saying it isn't but I can't find any particularly reliable info on number of the dogs being kept, which is key to the statistic. I do find a lot of breeders for them though, so that argues that they aren't that uncommon anymore.

Then of course there is that known terror, the English Cocker Spanial.
http://www.abc.net.au/science/articles/2009/05/25/2579884.htm

http://www.realpresa.com/
http://en.wikipedia.org/wiki/Perro_de_Presa_Canario
http://sfdogmauling.com/HomePageLinks/PresaCanario/Presacanario.html

So if I were a doctor of course I would not ask every patient if he has a Presa Canario because statistically, it's a low risk and I need to concentrate on things that are more likely to kill a randomly selected citizen. But if I find out that he actually does own one, you can bet that I will be all over him, making sure he doesn't live in an apartment building, putting all of his neighbors at risk like those fools in San Francisco.

Absolutely, if something comes to your attention and you know there is a risk for it, of course, mention it.
Have I ever said otherwise?
And I've even said I'm fine with the doctor asking you if you have a gun, as long as that data isn't collected in a Database.
What more could you ask for?

And what's with listing "smoking" three times in your list of the top five causes of death? Are you an automobile enthusiast who doesn't want to admit that road accidents are in the top five or hovering right under it?

Because Smoking causes death from Lung Cancer (No 1 cancer), Heart Disease (# 1 Killer) and Stroke, high up there for both deaths and long term expensive hospitalizations AND because it is something we have nearly complete control over. \

Women who smoke are up to six times more likely to suffer a heart attack than nonsmoking women and also increase the risk of suffering a stroke. Cigarette smoking greatly increases the chances that a woman will develop lung cancer. Lung cancer has increased 500% in women in the last 20 years. More women die of lung cancer than breast cancer.

http://www.cardiac.sutterhealth.org/women/risk/wha_smoking.html

Unlike cars, where you can be driving safely and get wiped out by a drunk driver going the wrong way around a turn. By the way, I believe I did mention that MV Accidents were top of the list of causes of accidents several times. The statistic I find most compelling about MV accidents is that while only about 15% of people don't wear their seat belts in the US, 60% of those killed aren't wearing them (70% of teenagers), which means if you significantly want to reduce your chances of dying in a MVA then you have to do two key things: Wear your seat belt and don't drink and drive (31% fatalities involve drivers with .08 or higher BAC).

And how about specific demographic groups? Suicide and murder are in the top five for teenagers. In the cities the majority of the murders are gun deaths; I'm not sure about the suicides.

The focus of the discussion has been on preventing accidental deaths.
If you want to kill yourself, there are plenty of other methods besides guns, so there is no reason to believe that guns increase the likelihood that you will commit suicide. As to homicide, the person getting killed is usually the one without the gun.