California Wants To Train Doctors To Prevent Gun Deaths

SCOTT SIMON, HOST:

The state of California wants doctors to be trained on how to counsel their patients about how to prevent gun deaths. It's giving nearly $4 million to the University of California, Davis to develop a program. Dr. Amy Barnhorst is a psychiatrist with UC Davis Health. She'll lead the training. Thanks so much for being with us.

AMY BARNHORST: Thanks for having me.

SIMON: What kind of advice can a doctor give that might prevent gun deaths?

BARNHORST: Well it's really dependent on the patient and the situation. As a couple of examples, you know, we often see patients who have depression and occasionally have suicidal thoughts. And some of those patients who have firearms in the home may be at risk of actually attempting suicide. And if they make an attempt with the gun, they are not likely to survive that attempt. And so being able to counsel patients, you know, if you're in a period of depression and you have other risk factors for suicide like heavy drinking or prior history of suicide attempts, maybe this is a time to get the gun out of the home for a little while until you're feeling better, until your drinking has abated a little bit, until your depressions improved.

SIMON: Many doctors these days will ask questions that are aimed at discovering anything about domestic abuse in the home. Is this similar?

BARNHORST: Absolutely. And it's definitely related. We know that more than half of female homicide victims are killed by romantic partners. So having a situation where there is domestic violence in the home, you want to be able to counsel people about what their options are. And particularly, if there's a gun involved, you want to be able let them know that's a situation that could become very lethal very quickly.

SIMON: Do I understand this correctly - all physicians are going to be given instructions on how to open up this line of inquiry?

BARNHORST: The way we're developing the program is not to mandate all physicians to go deep into this discussion with every patient they see. Our real target is that we want to make sure that all physicians are aware of the resources and how to access them should the time arise. So for medical students, we do want to incorporate it into the curriculum for everybody. I'm a psychiatrist, but I took cardiology, I did a surgery rotation, I studied for my oncology tests. Somewhere deep in the back of my brain, I have all that knowledge still.

So even people who go into very specialized practices, where this may not be something they're using on a day-to-day basis, we want them to have exposure to it in medical school because it is part of a public health and public safety curriculum. Once people are in residency training, the curriculum that is developed at that level will be more specialized for the particulars of that specialty. So pediatricians often focus more on accidental injury in the home. There's many, many homes that think that the kids in the house don't know where the guns are kept and about 75% of those kids actually do know where the guns are kept. And a significant number of those school age kids have handled the guns without their parent's knowledge.

So for pediatricians, it's going to be focused on things like safe storage, keeping firearms away from children. For psychiatrists, it's probably going to be focused more on suicide and threats against others. Family practice docs, they often see people who are struggling with depression and substance use, so it may be more focused on the risks that are associated with those things, which is mostly suicide.

SIMON: All right. I wonder if you've gotten any contrary reaction from doctors who say, either look, that's a patient's business or look, I've got enough to do.

BARNHORST: (Laughter) The overwhelming opinion among physicians is that this is our purview and we should be asking because gun violence is a public health epidemic. And we counsel patients all the time about their health and safety. We talked to them about cigarette smoking and alcohol use and the importance of a good diet and exercise. So mostly physicians think we should be doing this but mostly physicians don't do it. And time is one of the biggest barriers, especially in primary care. People have so much to screen for and talk about. We really want to educate providers on how to identify patients at risk and intervene appropriately in those situations.

SIMON: So if they sense a patient is depressed, contemplating doing something, that's when they follow up on that line of questioning.

BARNHORST: Exactly. But if somebody comes in for their allergies and they don't have problems with depression, and they keep their guns for hunting safely locked away in their storage unit, and there's no teenagers in the home, and nobody drinks, we don't really need to go a lot further down that line of thought.

SIMON: UC Davis psychiatrist Dr. Amy Barnhorst, thanks so much for being with us.

BARNHORST: Of course. Thanks for having me.

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