Hitting a Nerve

Asking about gun ownership: A loaded question?


Recently there have been articles and discussions about how involved physicians should be in patient gun ownership.

There are valid points all around. Some of my colleagues, especially those in general practice, feel that they don’t have enough time to add more screening questions on top of those they already have. Others point out that routinely asking about gun ownership is none of our business. A third view I’ve seen is that very few doctors are in a position to teach issues of gun safety.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

In my field, with certain patients, I do ask. Namely, the demented.

Anyone with concerning cognitive deficits shouldn’t have access to guns. As their judgment fades and their impulsivity worsens, they often don’t realize right from wrong. They might open fire on family members thinking they’re burglars. Some of them see suspicious people out in the yard that are more likely hallucinations or simply passersby.

In more advanced cases of dementia, patients may not even realize what they’re holding, but that doesn’t make it any less dangerous. Probably more so, since they’re not going to be careful with it.

Another scary issue I sometimes encounter is when patients with dementia find a gun at home – usually one that belonged to a deceased spouse and that family isn’t aware of. No one really knows if it’s working, or loaded, though we have to assume it is. They find it and start carrying it out on walks, pointing it at the mailman who they think is trespassing, etc. Sometimes the police get called. These situations are extremely dangerous for all involved.

It’s pretty easy for someone to get shot under these circumstances. It’s like leaving a gun out and having a toddler find it. They don’t mean any harm, but they’re still just as deadly as someone who does.

These people also have access to knives, which can be equally deadly, but knives aren’t guns. They don’t have the range or hitting power that make firearms so dangerous. It’s a lot easier to disarm an elderly patient with a steak knife if need be.

So, like my colleagues in psychiatry, I ask about guns in certain situations that involve dementia. Are there any guns? If so, are they locked up safely where the person can’t access them?

I’m not making a statement for or against gun ownership here. But I think all of us would agree that someone with impaired judgment, cognition, self-control, reasoning, and memory shouldn’t have access to guns.

In neurology, that’s a decent chunk of my patients. So for everyone’s safety, I ask them (and, more importantly, their families) about guns.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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