Original Article

Patients’ Perceptions of the Role of Physicians in Questioning and Educating in Firearms Safety: Post-FOPA Repeal Era

Authors: Laurie A. Boge, DO, Carlos Dos Santos, BA, Justin D. Burkholder, DO, Bradley R. Koschel, DO, Luigi X. Cubeddu, MD, PhD, David A. Farcy, MD


Objectives: In this study, we determined patients’ attitudes toward discussing firearms and issues of firearms safety with emergency department physicians. We assessed whether patients feel discriminated against should physicians discuss firearms safety, and whether they believed that physician counseling may change how patients store firearms.

Methods: From June to October 2017, we conducted a cross-sectional institutional review board–approved survey of 200 consenting adult patients (convenience sample) not requiring critical care presenting to the emergency department of Mount Sinai Medical Center in Miami Beach, Florida. The survey consisted of 22 questions about perceptions of physicians inquiring about firearms, demographics, firearms statistics, and firearms knowledge. Results on firearms owners and nonowners were compared with the Fisher exact test. P < 0.05 was considered significant.

Results: Ninety percent of patients said they felt comfortable discussing firearms safety with a physician (firearms vs no firearms owner, 100% vs 87.5%, P = 0.028). Ninety percent (firearms 90.7% vs no firearms owners 89.9%, P = 1.0) of patients did not believe that physicians were discriminating against patients who are firearms owners when discussing firearms safety. Seventy-six percent (firearms 76.4% vs no firearms owners 77.3%, P = 0.367) of patients believed that physicians should be educating their patients about firearms safety, and 71% (n = 142) believed that education provided by physicians will change how people store their firearms (firearms 75% vs no firearms owners 70.2%, P = 0.67).

Conclusions: Firearms safety is a difficult but important public health matter that requires significant intervention to help prevent future firearms incidents. This study supports physicians’ efforts to help educate patients about the dangers of firearms, along with proper firearms storage techniques, showing that patients are largely open to this discussion. We propose that training of physicians in strategies for initiating clinical discourse and addressing firearms safety is needed.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Murphy SL, Xu J, Kochanek KD, et al. Deaths: final data for 2015. Natl Vital Stat Rep 2017;66:1-75.
2. Priorities for research to reduce the threat of firearm-related violence. Mil Med 2016;181:291-293.
3. Hemenway D, Barber C, Miller M. Unintentional firearm deaths: a comparison of other-inflicted and self-inflicted shootings. Accid Anal Prev 2010;42:1184-1188.
4. Swanson JW, McGinty EE, Fazel S, et al. Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol 2015;25:366-376.
5. Afifi TO, Henriksen CA, Asmundson GJ, et al. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012;200:684-691.
6. Bagge CL, Lee HJ, Schumacher JA, et al. Alcohol as an acute risk factor for recent suicide attempts: a case-crossover analysis. J Stud Alcohol Drugs 2013;74:552-558.
7. Weinberger SE, Hoyt DB, Lawrence HC, 3rd et al. Firearm-related injury and death in the United States: a call to action from 8 health professional organizations and the American Bar Association. Ann Intern Med 2015;162:513-516.
8. Taichman DB, Bauchner H, Drazen JM, et al. Firearm-related injury and death: a US health care crisis in need of health care professionals. JAMA 2017;318:1875.
9. Wintemute JG. What you can do to stop firearm violence. Ann Intern Med 2017;167:886-887.
10. Betz ME, Wintemute GJ. Physician counseling on firearm safety: a new kind of cultural competence. JAMA 2015;314:449-450.
11. Price JH, Thompson A, Khubchandani J, et al. Perceived roles of emergency department physicians regarding anticipatory guidance on firearm safety. J Emerg Med 2013;44:1007-1016.
12. Betz ME, Miller M, Barber C, et al. Lethal means access and assessment among suicidal emergency department patients. Depress Anxiety 2016;33:502-511.
13. Roszko PJ, Ameli J, Carter PM, et al. Clinician attitudes, screening practices, and interventions to reduce firearm-related injury. Epidemiol Rev 2016;38:87-110.
14. Wintemute GJ, Betz ME, Ranney ML. Yes, you can: physicians, patients, and firearms. Ann Intern Med 2016;165:205-213.
15. 2017 Florida Statutes 790 338. Medical privacy concerning firearms prohibitions penalties exceptions. Chapter 70: weapons and firearms.
16. Bowman MS. Docs vs. glocks: speech, guns, discrimination, and privacy-is anyone winning? Florida Law Rev 2016;67:1455-1456.
17. Parmet WE, Smith JA, Miller M. Physicians, firearms, and free speech-overturning Florida’ firearm-safety gag rule. N Engl J Med 2017;376:1901-1903.
18. Betz ME, Azrael D, Barber C, et al. Public opinion regarding whether speaking with patients about firearms is appropriate: results of a national survey. Ann Intern Med 2016;165:543-550.
19. Albright TL, Burge SK. Improving firearm storage habits: impact of brief office counseling by family physicians. J Am Board Fam Pract 2003;16:40-46.
20. Carter PM, Walton MA, Newton MF, et al. Firearm possession among adolescents presenting to an urban emergency department for assault. Pediatrics 2013;132:213-221.
21. Dresang LT. Gun deaths in rural and urban settings: recommendations for prevention. J Am Board Fam Pract 2001;14:107-115.
22. Giggie MA, Olvera RL, Joshi MN. Screening for risk factors associated with violence in pediatric patients presenting to a psychiatric emergency department. J Psychiatr Pract 2007;13:246-252.
23. McManus BL, Kruesi MJ, Dontes AE, et al. Child and adolescent suicide attempts: an opportunity for emergency departments to provide injury prevention education. Am J Emerg Med 1997;15:357-360.
24. Zatzick D, Russo J, Lord SP, et al. Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial. JAMA Pediatr 2014;168:532-539.
25. Stanley IH, Hom MA, Rogers ML, et al. Discussing firearm ownership and access as part of suicide risk assessment and prevention: “ safety” versus “ restriction”. Arch Suicide Res 2017;21:237-253.