Take two Glocks and call me in the morning...

Even doctors have guns, ah reckon.

When Dr. J. was finishing up medical school at New Atlantis Ivory Tower School of Medicine and moving on to  a tony Ivy League academic medical center in the Northeast in the late 1990s,  the AMA issued its updated primary-care primary prevention screening guidelines.

Primary prevention is the process of being pre-emptive with regard to preventing disease. Thus, if you have hypertension and hyperlipidemia, and a family history of coronary disease, treating your BP and cholesterol is primary prevention of a heart attack. If you've already had your heart attack and we are treating you to reduce your risk of a subsequent heart attack, that is secondary prevention.

So, the AMA had this list of primary prevention screening recommendations which are recommendations for everybody, and not just disease or illness specific. These include asking about exercise, smoking, alcohol consumption, other drug use/abuse, asking if you wear a seatbelt, checking blood pressure, cholesterol, PSA (which has changed several times), colon cancer screening, etc., etc., etc. 

With this specific iteration, it was recommended that doctors ask to see if there are guns in the home. It was never specified what to do with an answer in the affirmative as opposed to an answer in the negative. 

So, Dr. J. was sitting in noon conference as a resident when the screening guidelines came up. Some hand-wringing lefty primary-care resident started asking, "What do we DO!!?!?!?!? Do we call child-services!?!?! The police?!?!?! Do we make a note to screen the spouse for being a victim of domestic violence at HER VISIT!?!?!?!EleV1nTY!?!??"

Dr. J., the snake-skin booted and blue-jean clad resident, who everyone knew was educated in the deep south, poked his Stetson above his brow and drawled in his best Doc Holliday impersonation, "There's this thing called the second amendment that reminds the government that the people have the rahght to keep and bear aaaahms. Dr. J. reckons that if the patient answers yes, you can then ask HER if she and her children have taken the appropriate gun safety courses and have been trained adequately in their use and have an appropriate place to store them, as the goal of reducing accidents, just like why you ask about rickety stairs and unworn seat belts, is the reason for the question, and no other reason. Furthermore,  Dr. J. keeps a list of places where they can get adequate training if they do not have it, and they rarely, if ever, need it." 

Dr. J.'s program director was appreciative of Dr. J.'s frank, forthright and very thoughtful answer. Whle his answer made them a little nervous, his maudlin handwringing lefty friends were left less maudlin that day.

Now that brings us to TODAY. 

Today, President Obama signed a decree declaring martial law. Wait, no, that was President Clark on Babylon 5. President Obama is urging physicians to become informants regarding their patient's ownership of firearms.

Here is there relevant passage from the President's press brief:

PRESERVE THE RIGHTS OF HEALTH CARE PROVIDERS TO PROTECT THEIR PATIENTS AND COMMUNITIES FROM GUN VIOLENCE: We should never ask doctors and other health care providers to turn a blind eye to the risks posed by guns in the wrong hands. 

 Clarify that no federal law prevents health care providers from warning law enforcement authorities about threats of violence: Doctors and other mental health professionals play an important role in protecting the safety of their patients and the broader community by reporting direct and credible threats of violence to the authorities. But there is public confusion about whether federal law prohibits such reports about threats of violence. The Department of Health and Human Services is issuing a letter to health care providers clarifying that no federal law prohibits these reports in any way. 

 Protect the rights of health care providers to talk to their patients about gun safety: Doctors and other health care providers also need to be able to ask about firearms in their patients’ homes and safe storage of those firearms, especially if their patients show signs of certain mental illnesses or if they have a young child or mentally ill family member at home. Some have incorrectly claimed that language in the Affordable Care Act prohibits doctors from asking their patients about guns and gun safety. Medical groups also continue to fight against state laws attempting to ban doctors from asking these questions. The Administration will issue guidance clarifying that the Affordable Care Act does not prohibit or otherwise regulate communication between doctors and patients, including about firearms.

So, in other words President Obama is reminding doctors AND the public that despite HIPPA protections, etc...that we are permitted to report direct and credible threats to the authorities.

This is true, as if one goes to the HHS website the following information is available discussing when a physician is permitted to disclose protected health information.

Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.³⁴ 

Serious Threat to Health or Safety. Covered entities may disclose protected health information that they believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone they believe can prevent or lessen the threat (including the target of the threat). Covered entities may also disclose to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal.⁴⁰

So, a couple of things to note, a physician is permitted to disclose protected health information to report direct and credible threats. That is not and has never been unreasonable. Therefore, the overwhelming majority of registered gun owners should therefore not be reported upon by their physicians. One worries about (1) as required by law and administrative requests. That clause gives Dr. J. pause even though it is to be applied for law enforcement purposes.

Secondly, President Obama suggests that Obamacare does not prohibit physicans from discussing guns and gun safety with their patients.

Sec. 2717. Ensuring quality of care. Requires the Secretary to develop guidelines for use by health insurers to report information on initiatives and programs that improve health outcomes through the use of care coordination and chronic disease management, prevent hospital readmissions and improve patient safety, and promote wellness and health. As added by Section 10101, protects Second Amendment gun rights by precluding the collection and disclosure of information related to gun ownership or use for purposes of determining premium rates. 

That is also true. The left, however would make it appear that the NRA put a poison pill in Obamacare to prevent this.

This is the text of the law:

First, while in the ideal setting a patient always tells his doctor everything, it is well within a patient's right to not disclose information, especially if it does not seem to be relevant for patient care. If it is relevant, the doctor should be able to explain why. For example, it would be wholly inappropriate for Dr. J. to take an exhaustive sexual history of a college co-ed who presented to his clinic with heart palpitations. It is not inappropriate for him to ask her if she is on oral contraceptives, if she didn't mention them when he asked about medications, because over-the-counter meds, herbal remedies and contraceptives are often not counted as meds by patients, and has some relevance with regard to medication interactions, and pulmonary emboli as a potential cause of said palpitations.

Second of all, this law states that the Federal Government can't make a doctor ask about or document lawfully owned fire-arms. Nor can it make him create a database of said information.

Third, like being an obese smoker, or a woman, owning a firearm cannot be construed as a preexisting condition by insurance companies anymore.

So this is not the NRA poison pill the liberals claim it is. It is a reiteration of current law in a different  way. Again, the President is correct. A doctor is allowed to discuss firearms and firearm safety with patients.

The law also states that Obama can't make them do it, nor are they required to report the conversations to authorities in any way, shape or form, with regard to law abiding citizens.

Like many of his initiatives from today, he is doing this hoping that liberal doctors will over-reach not understanding the nuances of the law. Or report 'clear and present dangers' that in the eyes of a conservative Doc would be laughable.