This blog is not about gun control. While I certainly have an opinion regarding Second Amendment rights, I want to focus on the fallout that presidential politics may have on our ability to care for patients.
Obama’s executive action on gun control will have a significant and potentially long-lasting impact on the doctor-patient relationship.
Doctors have always been held to a high standard of conduct when it comes to protecting patient information. When a patient steps into the exam room, a physician cannot discuss anything (even with other physicians) that the patient discusses without the patient’s permission. Records cannot be released without a patient signature, and unless the patient makes statements that suggest that he or she is a danger to himself or herself or others — or communicates direct threats — a physician cannot report illegal activity to the authorities.
This “zone of confidentiality” is in place in order to encourage patients to interact with physicians honestly and develop trust with their healthcare providers. This is important as it provides doctors with accurate data when considering a diagnosis and treatment plan for a patient.
More importantly, it protects patients from any repercussions from employers, family, government, or others as a result of any information they voluntarily provide.
During his press conference, Mr. Obama outlined the specifics of his executive action (done without Congressional approval) regarding changes to gun control laws in the United States. While the specifics of the new law are a bit difficult to understand, it is clear that physicians are part of his plan for limiting access to guns.
As part of the action, physicians apparently are no longer held to the high standards of the Health Care Portability and Privacy (HIPPA) act when it comes to patients with mental illness. The action relieves physicians of the duty to maintain complete patient confidentiality when an individual provider notes that a patient may be mentally ill. In fact, physicians are encouraged to contact the National Instant Criminal Background Check System (NICS) and report the name of the patient.
The NCIS is a government organization that maintains a database for determining if prospective firearms buyers are eligible to make a gun purchase. It was mandated by the Brady Handgun Violence Prevention Act (Brady Law) of 1993 and launched by the Federal Bureau of Investigation (FBI) in 1998. As part of the reporting process to NICS, no actual diagnosis or other privileged medical information can be revealed — only a physician’s hunch that a patient may suffer mental illness is necessary for disarming a patient.
Any physician report, even without due process or investigation, will preclude a patient from purchasing a gun. More disturbing is the fact that any physician — even a cardiologist like me, who is definitely not trained in the diagnosis and treatment of mental disorders — can prevent a patient from purchasing a gun by filing such a report.
Don’t get me wrong — gun violence in the U.S. is horrific. Mental illness is widespread, and many patients go unnoticed, undiagnosed, and untreated. No one with mental illness should be allowed to own or possess a firearm. We must make changes to prevent senseless killing.
However, asking physicians to screen potential gun owners is not the answer. Our President should have thought more about the implications of using a “phone and a pen.” He may have forever changed the way doctors and patients interact, and his executive action may serve to erode the confidential nature of the doctor-patient relationship.
What’s more, his executive action is direct conflict with a Supreme Court ruling from July 2015, when the Court upheld a Florida law that prohibits doctors from asking patients and families about gun use or possession.
As physicians, our job is to provide our patients with the best possible care in order to produce the best possible outcomes. We should not be put in the middle of a political debate regarding guns and mental illness. We should not be put in a position to make a legal determination that could limit the rights of our patients.
The Affordable Care Act and Electronic Medical Record mandates have already overburdened medical professionals in every specialty. Primary care doctors certainly screen for mental illness as part of their routine wellness visits (and are trained to do so), but surgeons and other specialists have little or no experience with the diagnosis of mental illness and quite honestly rarely consider these issues during a patient interactions.
Psychiatrists and other mental health professionals are well-equipped to make such determinations, but are often in short supply, and unable to perform “emergency” consults outside of calls from emergency room staff.
The unilateral actions of our President are likely to have far reaching (and likely unintended) consequences for healthcare.
It is essential that there is a bond of trust between doctor and patient; this relationship must remain sacred. Patients should feel free to discuss anything with their physicians without fear of legal repercussion or limits to their constitutional rights. I fear that patients may not be as forthcoming with their physicians during regular visits due to a perceived lack of confidentiality. How do they know they will not be reported as mentally ill to the FBI?
This new interpretation of the law influences what doctors and patients may say to one another during the most critical part of the doctor-patient relationship, when the patient is most vulnerable — the private medical exam. Most importantly, patients may not follow up with their physicians due to a fear of being reported to government agencies and losing their right to bear arms.
The exam room is designed to be a safe place, where patients can share intimate details of their lives and health histories and develop a bond with their healthcare providers. I fear that this legislation will erode the sanctity of this very unique relationship, and ultimately impact health outcomes in a negative way.
While in my state physicians do have an obligation to report any patient who communicates threats to harm themselves or others, this new “law” calls on physicians to do something quite different: to report any patient suspected of having any type of mental illness — irrespective of any stated threat or imminent danger.
Doctors need to care for patients. Doctors must respect patient privacy. Doctors should not be FBI informants. Politics has no place in the exam room, and government should not be in the business of dictating the way highly trained medical professionals practice medicine.
As doctors, we must stand up for our patients’ rights. We must protect our privileged relationships, and we must leave gun control debates to the politicians and lawmakers.
Prevention of gun violence prevention should be focused on the communities in which they occur, and target the criminals who commit these heinous acts. But the law should never come between a doctor and patient.
So Mr. Obama, I implore you: Let doctors do what they do best — heal.
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