ROCHESTER, Minn. — In the aftermath of a mass shooting, doctors become less likely to ask parents about safe gun storage practices in the home, according to a recent study published in the journal JAMA Pediatrics.
The study, conducted by researchers at University Pediatric Clinic in Salt Lake City, took advantage of a new Electronic Health Record template for well child visits, seizing the opportunity to measure the adherence of doctors to prompts that they ask parents about safe gun storage practices.
Though it is against the law for the state of Minnesota to keep records of individual gun ownership, health systems are not prohibited from asking, and doctors are free to ask patients any question they like.
Guns are the second leading cause of death for children, and 4.6 million children are believed to live in a home with a firearm that is loaded and unlocked.
"We know that it's a safety issue," says Dr. Carole Stipelman, an associate professor in pediatrics at the University of Utah School of Medicine and lead author for the paper. "We were redesigning our well child electronic medical record template, and we had a safety section, and we put this in as one of the safety questions."
What gave the study special insight on the behavior of doctors was the placement of a box to be checked for having asked whether the family had guns in the home, and if so, whether they were locked. The box sat adjacent to a question of whether the family had working smoke alarms.
"They were right next to each other," says Stipelman. "So if you asked one and didn't ask the other, it was either a conscious decision not to ask, or it was unconscious avoidance. Then we just looked at who was asking."
The researchers separately tabulated faculty and residents' checking of boxes signalling their having asked the questions. They did so for 16,576 clinic visits over an 18-month period, from January of 2017 through June of 2018.
The period would witness their compliance following three of the worst mass shootings in recent memory.
During the period in question, the nation reeled from the October, 2017 deaths of 58 at a music festival in Las Vegas, the November, 2017 killing of 26 parishioners at a church in Texas, and the deaths of 17 the following February at a Marjory Stoneman Douglas High School in Parkland, Florida.
As a rule, faculty doctors asked about guns far less frequently than did residents. Older clinicians asked about smoke alarms roughly 70% of the time, and guns 50% the time, with little variation.
The residents, on the other hand, asked about smoke alarms almost all of the time, and guns most of the time — right up until the first wave of mass shootings hit the news.
"In the year before the Las Vegas shootings, it was a pretty stable line," says Stipelman. "The residents were asking about smoke alarms in 90% of the visits throughout the study, and they never sank below that. But after Las Vegas, where they had been previously been asking about guns in about 70% of the visits, that decreased to just half of those visits."
“The physicians may be avoiding talking about gun violence to protect themselves or parents from thinking about these events. Parkland was really hard on my residents.”
The gun questions rose briefly among residents after the Parkland shooting, but quickly fell off again.
"I think the finding here is the variability of asking the question in relation to current events among younger doctors," says Stipelman, "but the stability of not asking it as much among the older doctors."
Though the study didn't ask why tragedy led to less willingness to ask about guns, the author has an idea.
"Avoidance is a common response to trauma," she says. "The physicians may be avoiding talking about gun violence to protect themselves or parents from thinking about this event. Parkland was really hard on my residents. These are young people who have devoted their lives to protecting children, and helping children thrive. This question tends to bring that event up."
"If you will recall," she adds, "there were a lot of statements in the press after Parkland of it being 'too soon to talk about it.' Do you remember that? So I think there's a 'too soon' factor here... when is it OK to talk about gun safety after a mass shooting?"
Stipelman believes it's never too soon.
"When you're talking to a gun-owning parent but you know nothing about how to store a gun safely, then you haven't done your homework," she says. "I would say most of my residents don't know how to tell a family where to buy a biometric gun locking device in our community. That needs to be a resource they can hand out just like telling them where to buy a bike helmet or car seat."