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The NRA Wants To Prevent Physicians From Asking Their Patients About Guns

Should the government be able to dictate to a doctor what he or she is allowed to discuss with a patient? Yes, says the National Rifle Association (NRA), which is pushing state legislation to prohibit physicians from asking patients about firearms in their homes.

An NRA-supported bill in Florida originally would have made it a criminal offense—punishable by fines and/or jail—if physicians asked a patient about firearms. The Florida Medical Association (FMA) fiercely opposed the bill as an intrusion on the physician-patient relationship. Now, a compromise has been reached between the NRA and the FMA that “allow doctors to ask questions about gun ownership, as long as the physician doesn’t ‘harass’ the patient, and doesn’t enter the information into the patient’s record without a good reason.” Violations would be policed by the state licensing board instead of being subject to criminal prosecution.

A long-standing ACP policy encourages physicians “to inform patients about the dangers of keeping firearms, particularly handguns, in the home and to advise them on ways to reduce the risk of injury.” But this issue is much bigger than guns, it is about whether the government should be allowed to tell physicians what they can and can’t say to patients.

Bob Centor of DB’s Medical Rants calls the NRA bill an “outrageous” attack on the doctor-patient relationship. He links to a must-read blog from a gun owing ER physician from Texas who explains why no physician should support the NRA bill—including the compromise.

I am not going to second-guess the difficult decisions made by the Florida Medical Association. But I agree with Dr. Centor that it is “outrageous” that the government would even consider dictating to a doctor what he or she can say to a patient. If this isn’t big government at its worst, tell me what is?

If the government can ban physicians from asking patients about firearms, what’s next? Will legislators sympathetic to the cattle industry try to prohibit physicians from asking patients about their consumption of steaks? Will advocates for legalized marijuana try to prohibit physicians from asking patients about their use of drugs? Where does it stop?

And where are all of the “constitutional conservatives” who carry copies of the U.S. constitution in their pockets? Are they raising their voices against the NRA and its state legislature sycophants over this egregious attack on the first amendment right to free speech? If the NRA succeeds in Florida and other states in getting physicians thrown in jail if they violate a government-dictated speech, then how can I as a patient trust anything that my doctor tells me in the examination room?

Today’s question: What do you think about the NRA’s effort to pass laws to dictate to doctors what they can and can’t say to their patients?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*


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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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