Ann Intern Med. 2016 Aug 2;165(3):205-13. doi: 10.7326/M15-2905. Epub 2016 May 17.
Physicians have unique opportunities to help prevent firearm violence. Concern has developed that federal and state laws or regulations prohibit physicians from asking or counseling patients about firearms and disclosing patient information about firearms to others, even when threats to health and safety may be involved. This is not the case. In this article, the authors explain the statutes in question, emphasizing that physicians may ask about firearms (with rare exceptions), may counsel about firearms as they do about other health matters, and may disclose information to third parties when necessary. The authors then review circumstances under which questions about firearms might be most appropriate if they are not asked routinely. Such circumstances include instances when the patient provides information or exhibits behavior suggesting an acutely increased risk for violence, whether to himself or others, or when the patient possesses other individual-level risk factors for violence, such as alcohol abuse. The article summarizes the literature on current physician practices in asking and counseling about firearms, which are done far less commonly than recommended. Barriers to engaging in those practices, the effectiveness of clinical efforts to prevent firearm-related injuries, and what patients think about such efforts and physicians who engage in them are discussed. Proceeding from the limited available evidence, the authors make specific recommendations on how physicians might counsel their patients to reduce their risk for firearm-related death or serious injury. Finally, the authors review the circumstances under which disclosure of patient information about firearms to third parties is supported by regulations implementing the Health Insurance Portability and Accountability Act.
医生有独特的机会帮助预防枪支暴力。人们越来越担心，联邦和州的法律或法规禁止医生询问或咨询患者有关枪支的问题，也禁止医生向他人披露有关枪支的患者信息，即使这可能涉及到健康和安全的威胁。但事实并非如此。在本文中，作者解释了相关的法规，强调医生可以询问有关枪支的问题（除了极少数情况），可以像对待其他健康问题一样就枪支问题对患者进行咨询，也可以在必要时向第三方披露信息。然后，作者回顾了在何种情况下，如果不常规询问枪支问题，询问枪支问题可能是最合适的。这些情况包括当患者提供信息或表现出行为表明其暴力风险急剧增加，无论是对自己还是对他人，或者当患者存在其他个人层面的暴力风险因素，如酗酒时。文章总结了目前医生询问和咨询枪支问题的做法方面的文献，这些做法的实施远不如建议的那样普遍。讨论了阻碍这些做法的因素、预防枪支相关伤害的临床努力的有效性以及患者对这些努力和参与这些努力的医生的看法。根据有限的现有证据，作者就医生如何向患者提供咨询以降低其因枪支相关死亡或重伤的风险提出了具体建议。最后，作者回顾了在何种情况下，根据实施《健康保险携带和责任法案》的法规，向第三方披露有关枪支的患者信息是合理的。
