Long-time gun violence researcher, Garen Wintemute, MD, MPH, who runs the Violence Prevention Research Program at the UC Davis, and his emergency physician colleague from the University of Colorado, Marian Betz, MD, MPH, have written a very interesting opinion piece in the August 4, 2015 issue of JAMA. It’s titled, “Physician Counseling on Firearm Safety: A New Kind of Cultural Competence.”
In it, they call for physicians to learn how to personalize gun safety counseling based on their patients’, not their own, firearms beliefs and preferences. They say doing that starts with “developing cultural competence in firearm safety counseling.”
What is cultural competence?
The authors outline the components of cultural competence as follows:
- Respect for variation among cultures
- Awareness of your own beliefs and practices
- Interest in learning about other cultures
- Developing skills to enhance cross-cultural communication
- Acknowledgement that culturally competent practices support delivery of quality health care
So why talk about cultural competence when talking about gun safety counseling? Are gun owners really that different from non-gun owners? When it comes to how the two groups view guns ownership, I think (but cannot prove) that there is a significant cultural difference. Just think of the last time you got into a discussion with someone from the opposite side of the gun ownership debate. If your experience is like mine, you would probably say you were talking past each other and not really engaging in a way where either of you could learn from the other, right?
Betz and Wintemute suggest that the “gun culture” is not homogeneous, rather “…perspectives and preferences may vary based on [the] reasons for owning firearms.”
Personalizing the message
Rather than having a one-size-fits-all message about gun safety built off your personal belief system, the authors suggest finding out what kind of guns the patient (or spouse) has and why they have them.
That way, instead of saying “You have kids, you need to get rid of all of your guns,” you could talk to Mom about the risk to her toddler if she keeps a handgun loose in her purse and then suggest some safe alternatives, such as a holster that covers the trigger guard.
If, for example, Dad only has long runs for hunting, he could be counseled to put them in a combination gun safe when they are not in use. Or, if he says he needs a handgun for personal protection, it might be helpful to suggest getting a fingerprint operated lock box.
If the context of the counseling is a risk of suicide, a discussion of the “clear link between firearm access and elevated risk of suicide because of the high lethality of firearm suicide attempts” may be the appropriate framing.
Obviously, I am not an expert in all the different types of guns and gun safety options—and I am certainly not interested in becoming one—but I would be willing to learn more about guns and gun-safety counseling from people more knowledgeable than myself. For example, as the authors suggest, from my gun-owning colleagues.
Physicians who own guns
Somewhere between 13% to 41% of physicians own firearms according to two papers cited in the article. And, importantly, the paper suggests, “physicians who own guns may be more likely than those who do not to counsel patients about firearm safety.” Rather than thinking, geez, what’s wrong with those crazy gun-packing doctors, the authors suggest these gun-owning physicians could play an important leadership role in developing cultural competence in firearm safety counseling. Now, that’s an interesting take.
Call to action
The paper closes by saying that “Physicians are entitled to their own perspectives and political opinions, but to serve patients and protect them from disease and injury, it is important to counsel them in ways that are respectful, meaningful, and effective.”
Of course, this is true and physicians have had to learn to do this related to many different health-related issues that they may have found challenging, such as counseling gay men to practice safe sex during the height of the HIV epidemic or talking to heroin addicts about needle exchange. I think physicians will step up to the plate and acquire the necessary skills if they think it will help.
I, myself, like what these authors have to say. And though I hope they are right, I am not yet completely convinced it will work. That being said, it is clear doctors need a different approach to firearm safety counseling than we, by and large, have employed in the past.
That’s my two cents, what’s yours?