Friggin' Liberal Doctors!

[Jose]

if you seek care and do not like the medical standards put in place at the Federal and State levels then you are out of luck. this is our standard of practice. it is what we follow in the USA. it is what is taught. for the most part, it works.

Contemplate the mangled bodies of your countrymen, and then say 'what should be the reward of such sacrifices?' Bid us and our posterity bow the knee, supplicate the friendship and plough, and sow, and reap, to glut the avarice of the men who have let loose on us the dogs of war to riot in our blood and hunt us from the face of the earth? If ye love wealth better than liberty, the tranquility of servitude than the animated contest of freedom, go from us in peace. We ask not your counsels or arms. Crouch down and lick the hands which feed you. May your chains sit lightly upon you, and may posterity forget that you were our countrymen!”

Just in case you missed the message

 

[NetDoc]

To put it a little more diplomatically/factually, they have co-mingled their medical function with that of law enforcement, thus forfeiting the position/relationship of trust between physician and patient that would be most beneficial to the field/society as a whole.

Excuse me? We are licensed by the state, and as part of that licensure we are mandated by law to report child abuse, elder abuse, rape, gunshot wounds, etc. at risk of losing our license and criminal penalties.

 

[Garys]

Taken as a whole, the preponderance of current evidence indicates that gun availability is a risk factor for suicide, especially among youth. This is precisely the conclusion reached by the American Association of Suicidology in their consensus statement on youth suicide, which provides a fitting conclusion to our review as well: “There is a positive association between the accessibility and availability of firearms in the home and the risk of youth suicide. Guns in the home, particularly loaded guns, are associated with increased risk of suicide by youth, both with and without identifiable mental health problems or suicidal risk factors.”

You can refuse treatment. I would treat you the same as anyone else. The gun question would concern me more with regards to home safety/children actually. A gun is just a gun and does not make someone act violent. People are going to be who they are regardless if they have a gun, knife, or bazooka. If someone showed serious signs (that MDs, NPs, PAs, etc. are trained to recognize) of being a danger to themselves or others then we are required to protect the person and the public.

These two statements would seem to contradict each other, but maybe that's just me. Interestingly, I've seen a lot of suicides, but only one or two by firearm. If I had to say the most common cause, I'd say hanging or maybe drug overdose. My guess is that neither of you gentlemen have seen nearly as many suicides as I have.

Physicians should ask about gun ownership, just as they should ask about seat belt usage and other issues. There have been many, many well done studies approaching this from many different directions and published in prestigious journals that demonstrate a very significant - 2-5 fold increase - in suicides in homes where guns are readily available. Depression is a very real issue for a substantial percentage of society, and thoughts of suicide are quite common. Of all the methods of suicide, guns are both rapid and effective. Suicidal thinking often passes or can be managed, but not if someone has already acted on the impulse. Before arguing with the points I have made, I suggest you read a relatively recent editorial in the NEJM - arguably the most influential medical journal in the world: http://www.nejm.org/doi/full/10.1056/NEJMp0805923

This is not about liberal doctors. It is about good doctors, doing their job properly. The responses to such a questionnaire aren't going to go in some "big brother" database. They are going to help guide your physician when he/she might wonder about depression or suicide risk.

First, the NEJM is notoriously anti 2A. As such their studies are tainted by definition. Same goes for JAMA for that matter. Much of the "public health" aspect of gun ownership, seat belt use, smoking, second hand smoke, and so on are driven by the public health lobby. Much of it is junk science, like the study that classified homicides as "gun accidents" to justify storage laws that make practical use of a handgun for self defense nigh impossible.

That many physicians have MPH or PhDs in public health just drives this more. The public health community has abdicated it's responsibility for eradicating communicable disease (the reason the USPHS as well as state and local analogs were created way back when) such as AIDS or TB and have decided to concentrate on pseudo public health crises instead. It's nannyism of the worst order.

Doctors are trained to screen for depression, but that doesn't involve asking about gun ownership. Or seat belt use for that matter. It comes from doctors talking to their patients, not looking at forms. That comes from creating a mutually respectful and trustful relationship. Asking questions that patients or potential patients find offensive doesn't help that purpose. It comes from what my late mother used to call the "I AM THE DOCTOR AND YOU ARE MERELY THE PATIENT" mentality that still permeates too much of medicine. That's why I fired my old PCP, although he had a great deal of knowledge and sought out a new one. With my old doctor, there was no two way dialog and he disdainfully dismissed my one MD medical education and training. With my new doctor much of our conversation revolves around bikes and biking and how that fits into my medical care. It's a much better way to be. He doesn't ask me about drinking, smoking (he knows I smoke cigars), if I'm safe at home, or anything else that isn't pertinent.

That you think it's appropriate to do so tells me a lot about your attitude and approach to your patients.

 

[NetDoc]

after 10+ years of practice, nothing amazes me anymore. but, i do have to say i am shocked by a lot of the arguments in this thread. not by everyone, but by some. i have heard so many people rant about this and that. apparently, i have some ego and live to practice in a tyrannical manner; i guess to make people miserable and to take their guns away. NONE OF WHICH I EVER SAID. i am in a guns forum! clearly i am not anti-gun. i love going to the range and became a member of a rod & gun club recently. i am not trying to tell people what to do with their life. in fact, i was clear that i will not force anyone to seek medical care. if you are an adult of sound mind then it is your choice. you can smoke, drink, whatever. personally, if it does not hurt me then do as you like. professionally, it is my job.

police officers have their training and responsibility. i may not agree with all of it, but i respect it. i have been shown zero respect by most in this particular thread. i find that somewhat disappointing. especially since i stated that i do not wish to take away anyone's rights EXCEPT for those that are not mentally competent for whatever reason...acute or chronic. if you do not like that, oh well. I am sorry, but if you do not practice medicine and see what truly goes on in the minds of some people then don't preach to me because you simply do not have the experience. i would never tell someone how to fix my car. i don't know anything about that.

so, what is the point? not as grave as many here seem to make it. people here are so preoccupied with defending their rights that some fail to listen and truly think things thru before going on the attack. the reality is MDs, NPs, and PAs are charged with the responsibility to care for the health of those that seek their care. if you seek care and do not like the medical standards put in place at the Federal and State levels then you are out of luck. this is our standard of practice. it is what we follow in the USA. it is what is taught. for the most part, it works. certainly not every time, but it helps more people than hurts for sure. nobody says you have to answer anything. in the end, it only hurts you.

if someone was in acute renal failure and answers "No" to guns then a provider in the ER might spend hours searching for other causes when the actual problem could have been elevated lead levels. but, your "No" so protected you up until the point you needed to reveal that info for help. you see, we don't use info to hurt people. things are always kept confidential UNLESS you truly show signs of being a danger at that very moment in time. people do have mental illness and do show very serious signs of danger to oneself and others. should we turn away and allow them to injure some innocent person? if you say yes then you are so caught up in preserving the 2A that you lost sight of what is really important.

i hope people can see that Docs and nurses are there to serve you. We do our best. I don't want your gun. i want everyone to be happy, safe, and in good health.

sorry for the long post.

I couldn't have said it better.

 

[Garys]

Excuse me? We are licensed by the state, and as part of that licensure we are mandated by law to report child abuse, elder abuse, rape, gunshot wounds, etc. at risk of losing our license and criminal penalties.

You forgot stab wounds and dog bites, both of which you are required to report. I think you also have to report abuse of handicapped adults between 18-65. I know I do.

I notice that depression is absent from that list. Which would seem to undermine your argument.

 

[cekim]

Excuse me? We are licensed by the state, and as part of that licensure we are mandated by law to report child abuse, elder abuse, rape, gunshot wounds, etc. at risk of losing our license and criminal penalties.

So, is your response that you have no choice in the matter or that your function is not co-mingled with that of law enforcement by virtue of these policies as I have asserted?

 

[Palladin]

Doesn't this question get asked about every 6 months.

 

[NetDoc]

You forgot stab wounds and dog bites, both of which you are required to report. I think you also have to report abuse of handicapped adults between 18-65. I know I do.

I notice that depression is absent from that list. Which would seem to undermine your argument.

I think the etc. covered those. I don't understand your point about depression - it doesn't follow from any argument I have made.

 

[davidgw]

Excuse me? We are licensed by the state, and as part of that licensure we are mandated by law to report child abuse, elder abuse, rape, gunshot wounds, etc. at risk of losing our license and criminal penalties.

What has this to do with whether or not I myself own(or not) any firearms?

 

[pernox]

police officers have their training and responsibility. i may not agree with all of it, but i respect it. i have been shown zero respect by most in this particular thread. i find that somewhat disappointing. especially since i stated that i do not wish to take away anyone's rights EXCEPT for those that are not mentally competent for whatever reason...acute or chronic. if you do not like that, oh well. I am sorry, but if you do not practice medicine and see what truly goes on in the minds of some people then don't preach to me because you simply do not have the experience. i would never tell someone how to fix my car. i don't know anything about that.

That's the core of the problem.

Trusting anyone to make that judgement is fallacy. With all due respect for the fact that you devoted a lot of time and effort to being what I assume is a good doctor, that doesn't change the fact that training, research, classes, and a monstrous tuition bill do not make you better suited than anyone else to decide who should and should not have their rights taken away from them by force. When you allow a subjective body to determine who lives free and who doesn't - barring those who are incarcerated - you open the door to that subjectivity being abused. The sacrifice of a few innocent lives, though it may sound callous to you, is worth maintaining freedom. It is important in a free society to err on the side of too much liberty rather than too little; it is one of the costs of living free. Those who want less freedom in exchange for enhanced security are free to move.

 

[Coyote33]

I've been asked 'do you feel safe at home?' but never about guns.

Don't more people die in hospitals than at home?

Nurses, doctors, social workers, etc. are all mandated reporters. This is a serious issue across the USA and not just with regards to those that practice medicine. Anything that is said is 100% confidential and protected unless, and only unless, there is very good reason to believe one may harm themself or others.

So much for HIPAA! So, how do we change this situation? Is it from elected officials, or private administrators in hospitals? Feel free to reply in the thread.

If some drugs are known to have such side effects, why would anyone blindly follow the doc's advice and take them? People need to do their own homework and stop running to Dr. every time they get a runny nose or have a stressful week at work.

The docs have no need to know if I have a gun, a knife, a rope, a belt, a razor blade, a car and garden hose, or a 4th floor balcony. If I am at the doctor's, it is for a legit medical reason. Treat the problem, send me a bill, MYOFB.

It sounds like the Doc's trying to make them depressed and suicidal. Death panels? What about the right to suicide?

... This reads like something out of the Brady group's playbook. Read it over again, and imagine Chuck Schumer saying it.

It probably IS from Chuck and Brady!

 

[NetDoc]

So, is your response that you have no choice in the matter or that your function is not co-mingled with that of law enforcement by virtue of these policies as I have asserted?

It is the responsibility of physicians under law, and it is no different than your responsibility as a citizen to report certain crimes, even if committed by a friend. Does that make you a snitch or co-mingle your responsibility as a friend with law enforcement?
http://www.malegislature.gov/Laws/GeneralLaws/PartIV/TitleI/Chapter268/Section40
Section 40. Whoever knows that another person is a victim of aggravated rape, rape, murder, manslaughter or armed robbery and is at the scene of said crime shall, to the extent that said person can do so without danger or peril to himself or others, report said crime to an appropriate law enforcement official as soon as reasonably practicable. Any person who violates this section shall be punished by a fine of not less than five hundred nor more than two thousand and five hundred dollars.

- - - Updated - - -

What has this to do with whether or not I myself own(or not) any firearms?

Nothing. I have no idea where your question is coming from.

 

[Jose]

Excuse me? We are licensed by the state, and as part of that licensure we are mandated by law to report child abuse, elder abuse, rape, gunshot wounds, etc. at risk of losing our license and criminal penalties.

Just following orders...is all.......

 

[cekim]

It is the responsibility of physicians under law, and it is no different than your responsibility as a citizen to report certain crimes, even if committed by a friend. Does that make you a snitch or co-mingle your responsibility as a friend with law enforcement?

No, and generally speaking, I bear no legal burden to report a crime. I cannot obstruct justice, become an accomplice after the fact or "harbor a fugitive," but I have no legal obligation to report.

Much as with religion and lawyers, we have a rather unique and sensitive relationship between patient and doctor - the modern, progressive police state has been increasingly intruding into this relationship for the "greater" good (they tell us). You are choosing to be willfully blind to this and asking that we "trust you" to be benevolent in your application of these powers. We are trying to tell you there is no such thing on the long timeline.

You don't need to quote the law to me, I am well aware of it, but I am unmoved by the existence of the law in determining if something is "good." The law only tells me what is legal. Ethics and morality determine whether it is "good."

 

[Jose]

It is the responsibility of physicians under law, and it is no different than your responsibility as a citizen to report certain crimes, even if committed by a friend.

Where did you and your kind come from, I wonder?

 

[feralchimp]

If I don't like a question on a form, I skip it. Same method I use during ballot season...

 

[Garys]

I think the etc. covered those. I don't understand your point about depression - it doesn't follow from any argument I have made.

I think you've lost your way in the debate here doctor. You said that asking about firearms ownership was related to depression and the risk of suicide. If that were the case, the logical progression would be your suspicion that a patient was depressed and MIGHT be suicidal. Then you'd ask the patient about suicidal ideation. Then you'd ask if he or she had a plan. THEN you'd ask about mean to implement the plan. Which is where asking about firearms in the house would come in to play. At least that's how I learned it, but doctors are imbued with powers we mere mortals lack, so you might have learned it differently.

Asking about firearms first infers that you (or the AMA) think that owning firearms automatically increases the likelihood of depression and suicide. By that logic, you should ask every patient if they have rope in the house.

The self style true libertarians here are quick to tell you to ignore the laws and regulations which govern your profession. It's easy for them to say, but I'd venture to guess that they wouldn't be there to contribute to your legal fees let alone provide for your family if you were to violate any of those laws and regulations. Some people live in their own bubbles, I guess.

Still, your arguments lack a certain validity, at least in the order you've presented them.

The Section 40 that you quote is quite vague in it's language, unlike the other requirements which apply to certain professions, including medicine. There is a world of difference. One is much easier to defend than the other and they are certainly not equal in intent.

 

[FrugalFannie]

Sometimes the word "principle" is used as a substitute for irrational rigidity.

- - - Updated - - -

You have your principles.
I have my principles.
Then we both have the law.
Hopefully neither one of our principles is in conflict with the law.

When the laws are in conflict with my principals I follow my principals.

 

[garandman]

TReischi, Ohio technically is in the Northeast part of the U.S.. Look at a map./

"Ohio - where the East peters out."

 

[bender73]

That's the core of the problem.

Trusting anyone to make that judgement is fallacy. With all due respect for the fact that you devoted a lot of time and effort to being what I assume is a good doctor, that doesn't change the fact that training, research, classes, and a monstrous tuition bill do not make you better suited than anyone else to decide who should and should not have their rights taken away from them by force.

do you think it is wrong for a police officer to place a person in cuffs when they are clearly acting in a manner that is a danger to oneself or others? they are taking away someone's rights at that moment, no different than i would. the Federal and State GOV also puts that burden on me and i must act accordingly. i can be held responsible if i do not.

THIS IS IMPORTANT: do you guys understand that if i do not take upon the responsibility to make the clinical judgement that someone requires possible detention, i can be held responsible for someone's actions. think about that. really think about that for a second. i have a DUTY. if i turn a blind eye, i can get into trouble. loss of license and potential lawsuit. you guys can armchair QB this in the comfort of this thread all night, but this is what i do. this is what nurses and doctors do every day.

seriously, if someone makes real threats of danger, what do you think is the proper thing to do? mind one's business and carelessly (and cowardly) watch horrible events unfold? i get the feeling that some people here would. that is tragic.

 

[bender73]

There was this guy with a funny mustache waaaay back in the day. Very charismatic fellow, I think. He won an election with over 90% of the vote. I believe his government had some doctors who just did what was required by law. I mean, they were stand up guys, right? Just doing what was right in the eyes of the law. Being "good" doctors.

disgusting statement and poor analogy.

 

[bender73]

Wasn't an analogy, just stating history and hoping people realize that all it takes are baby steps to eventually get there.

no, it was in poor taste. this thread has really taken a bad turn.

 

[Jose]

seriously, if someone makes real threats of danger, what do you think is the proper thing to do? mind one's business and carelessly (and cowardly) watch horrible events unfold?

I would. I serve God, family, tribe, and self in that order. Society is not on the list.

 

[bender73]

I would. I serve God, family, tribe, and self in that order. Society is not on the list.

wow. thank goodness there are people like me.

 

[Rob Boudrie]

seriously, if someone makes real threats of danger, what do you think is the proper thing to do? mind one's business and carelessly (and cowardly) watch horrible events unfold? i get the feeling that some people here would. that is tragic.

The problem is the drawing of the line.

Consider the following things a patient could say:

- I am going to kill <insert name of person>
- Sometimes I get so mad I could just kill someone
- I am thinking of ending it all
- Sometimes I wonder if life is worth it
- Life just doesn't have the meaning it used to
- I really need to figure out a way to get out of this rut
- I need to do something, anything, to make this pain go away

Few would fault a doc for taking action on the first one. Things get a little grayer as you deal with some of the other items on the list and, in some cases, a patient who is legitimately looking for help with a medical problem will have things made worse by "helpful intervention" which may have less to do with helping the patient than inoculating the caregiver.

Curiously, society gives the clergy a "free pass" on mandated reporting of anything done in the context of a confession - even if the confessor announces he is about to commit a heinous crime.

wow. thank goodness there are people like me.

But, you spoke of being driven by mandated reporter requirements - which seems to indicate accepting a role of serving society.

So much for HIPAA!

In addition to the "mandated reporter" items discussed in this thread, note that the words "National Security" serve as an "Open Sesame" to medical records and HIPPA actually excludes any such "National Security" request from protection.

 

[LadySmith]

do you think it is wrong for a police officer to place a person in cuffs when they are clearly acting in a manner that is a danger to oneself or others? they are taking away someone's rights at that moment, no different than i would. the Federal and State GOV also puts that burden on me and i must act accordingly. i can be held responsible if i do not.

First of all, the lack of capitals and punctuation make it really difficult to read your posts, so would you please do us the courtesy of writing like an adult, rather than like a 13 year old girl?

Second, if you really are a physician, then your sense of self-importance, which oozes from your posts, underscores exactly why I will never, ever tell anyone in the medical profession that I am a lawful, licensed, gun owner, not even when they stand an inch away from the gun that's tucked in my waist, as some did last night.

A duty to report someone's dangerous behavior does not allow you people to collect data on your patients, for once that bell has been rung (and you know which of your patients are gun owners) you will jump to conclusions, assume the worst, and trigger events that lead to the person's license being taken away. You will do it smugly, "for the good of society," because you'd rather err on the side of caution.

I, for one, would appreciate it if you'd spend less time worrying about what I have in my house and more time studying some English books so that your future posts aren't as annoying to read. Of course, by writing that way you force those of us who read your posts to spend more time on each one, trying to decipher it, and that little bit of extra attention is just what a megalomaniacal doctor would love.

I've asked NetDoc if he or she owns guns and -- predictably -- he or she refused to answer. What about you, bender73? Are you a gun owner? If not, what the hell are you guys doing in a place like this?

 

[bender73]

But, you spoke of being driven by mandated reporter requirements - which seems to indicate accepting a role of serving society.

That is what I said. I do serve society in my job. He seems to be very antisocial.

 

[cekim]

That is what I said. I do serve society in my job. He seems to be very antisocial.

hmm, perhaps he is a danger to himself and others, better commit him before he hurts someone, right doc?

 

[LadySmith]

Doesn't this question get asked about every 6 months.

So what?

 

[Rob Boudrie]

That is what I said. I do serve society in my job. He seems to be very antisocial.

Yup, I misread your comment.