baldeagle wrote:There you go again, confusing me. The point VMI77 is making is that when a doctor attempts to impose ...information on [him], then he draws the line. That was essentially the same point I was making. In our discussions, you seemed to agree with that premise, yet you keep writing things like this that muddy the waters.
So do you agree or disagree that when a doctor tries to impose information on you that he or she has crossed the line? I thought you did, but now I'm not sure, so I'm asking.
Sorry to muddy the waters - but thanks for asking for clarification. Maybe the best thing to do is start with the parts that we probably do agree on. First, this doctor was clearly out of line. It probably would have been better if the mother had either said yes or no - even if one was a lie. The stumbling around confuses the issue slightly - only slightly. But I can easily see how that could happen because in the same moment that you are formulating the answer, you are trying to figure out why you are being asked and what are the ramifications. But either way, the doctor could use a good attitude adjustment and, hopefully, a lot fewer patients.
And if it is true that the American Academy of Pediatrics "urge[s] parents who have guns to remove them from the home", then I have a big problem with that also.
So, agreed here? I hope so.
I don't, however, have a problem with the American Academy of Pediatrics urging pediatricians "to inform parents about the dangers of guns in and outside the home and they recommend that they incorporate questions about guns into their patient history taking". Why not? Because pediatrician do have a role in helping to prevent accidental injury to children just as they have a role in treating and preventing illness in children. Neither of which they can do by themselves - that need a partnership with the parents and vice-versa. Please, take a moment and re-read Zero-G's post and think about things as a family doctor or a pediatrician must:
Zero_G wrote:I'm jumping into this discussion a bit late, but I want to throw something in from the doc's side.
I'm a physician, Family Practice, so I've done thousands of 'well child checks'. I have to disagree with those that have vocalized that inquiring about safety issues is outside the bounds of these visits.
A lot of medicine, especially in the well child visits, fall into the realms of preventive medicine and anticipatory guidance. Basically, it's trying to anticipate common problems and answer questions before they come up. Health and safety is as important as plotting the growth curve and listening to the heart an lungs -- probably even more important. The biggest killer of kids is accidents and injury. Car seat use is pushed from the moment the child leaves the hospital for the first time. The earliest thing that kids do is put small objects in their mouths, so that's a very early safety topic. As the kids get more mobile we move into the topics of climbing over the rails of a crib or pulling things down on themselves. Older kids ride bikes, so bike and traffic safety become big topics. Many checklists I've had included questions about guns in the home, and since my practices have been in rural areas and the military guns are common. The way I've handled them has been to mention if you have guns you need to keep them secured as kids can get into the darnedest places.I usually don't even ask the direct question "do you have guns in the house". It's not a big topic in my book as drownings and poisonings kill many more kids than accidental (or even intentional) firearm discharges. While the gang on this forum is very safety conscious, the average level of patient that you deal with in most physician offices tends to be socially challenged and often has never considered safety. (Consider that the recommendation from the American Academy of Family Physicians is to keep all patient handouts to the 7th grade reading level or below. Also most medical teaching institutions deal with an indigent population who are notoriously difficult to deal with given their social difficulties. This tends to bias a lot of the material coming out of academic centers)
I would certainly agree that he doc in Florida went way too far in pushing his political agenda and was out of bounds, but asking the basic question about firearm safety is very much in the framework of general child safety and an appropriate part of the well child check.
Keith
Notice the recommendation to keep patient handouts at the 7th grade level. The drawer is not filled with sharpest knives. I know handguns can be a hot button issue, so in a previous post I tried to draw analogies to other areas of injury prevention that pediatricians can be involved in. But you didn't like those other areas either.
baldeagle wrote:So do you agree or disagree that when a doctor tries to impose information on you that he or she has crossed the line?
So I will try answer this question as directly as possible. But it will have something to do with how your are defining 'impose'. I don't
generally see it as imposing when a doctor attempts to give me information. Now that can vary greatly depending upon the context - so I have to say generally. The line that I said I would draw is when the doctor attempts to impose themselves on my actions - or as you worded it before - tells me what to do.
So, generally speaking:
The doctor gives me information (even information that I haven't indicated that I wan't) that pertains to keeping my child safe and healthy? - That's ok - generally.
The doctor tells me that I have to do something (in the context of these types of issues) - That's not ok.
I know you didn't like my analogies earlier, but I will try them again.
The doctor tells a parent that with the increase in the number of airbags in cars, they are discovering that children under 12 are at a greater risk of being injured because the airbags are designed for adults and children don't weigh as much. So they recommend that if possible, keep children under 12 in the back seat. - No problem for me. Now the doctor didn't ask a question first, but thats because pretty much everybody has a car - right?
How about this:
Doctor: How old is your baby crib?
Parent: I don't know, it was my hubby's crib when he was a child. His parents gave it to us.
Doctor: You may want to check the bar spacing. If you can pass a coke can through the bars, then the bars are too wide. The baby's head can get stuck in the bars.
Problem? Not for me. Now if the parents are financially strapped, maybe they can't afford to replace the crib. But I'll bet they at least try to keep a closer eye on the kid until the baby puts some size on and can no longer fit between the bars. Every parent has to make the best decisions they can for their child.
What about the question "Does anyone smoke in the home"?
What about "Do you have any pets"? Do they ask this so that they can be on the lookout for allergies or because they are looking for non-kid friendly pets? Both? I don't know?
As long as the result of a line of questioning is them giving me information - even if that information leads to recommended actions - then I am generally ok with it. The line is crossed if they demand, or perhaps, strongly recommend a set of actions.
Even with the handgun issue, I can envision a dozen different ways that could progress. Of course you have that Dr. in FL - I wouldn't have even been able to predict that one. What about this:
DR: Do you have any guns in the house?
PT: Yes
DR: How are they stored?
PT: Locked in a safe
That's pretty much what our doctor did - something to that effect - then he moved on. But what if we had answered differently:
DR: Do you have any guns in the house?
PT: Yes
DR: How are they stored?
PT: We keep it on a high shelf in the closet.
What comes next
might depend upon the age of the kid.
DR: You know he just starting to crawl now, but very soon he will be getting in to places you might not think he can reach. Every year over xxx children are killed by accidental shootings. You should consider finding a way to get that thing secured.
Would you have a problem with that? If I were that parent, I wouldn't like hearing it - but I probably needed to. Hopefully that parent will consider the comments and get a gun safe. How about this:
DR: Do you have any guns in the house?
PT: Yes
DR: The American Academy of Pediatrics recommends removing guns from any homes with children. Every year over xxx children are killed by accidental shootings. You should really consider that decision.
Did that cross the line? It for sure is getting close - he's kicking dirt over it. He still hasn't "told me what to do" and; right or wrong, he is only attempting to help me protect my child. I might follow-up with:
PT: Trust me, I understand. My weapon is either on my person or secured away in a safe.
If that did the trick, then I'm good. If not - if there was still pressure, then the line was most certainly crossed. But heck, who knows, I might be able to plant the seed about being able protecting my family. What about:
DR: Do you have any guns in the house?
PT: Yes
DR: You really need to get rid of that thing. You are putting your entire family at risk just having it in the home. Even in a criminal confrontation, weapons only escalate the level of violence.
Well, I think that one is pretty clear.
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My point here is that without context, it is impossible for me to say when that line of parental sovereignty is crossed. I don't mind them asking me and giving me information that I may not need because:
1. I think there are less informed parents out there who could use a reminder that a weapon is a powerful tool and should not be left unsecured. This is not a bad thing because, for one thing, my child might end up in that home. Try as we might, we can't know everything about our neighbors. Secondly, accidental shootings involving children are tragic AND preventable. Education is the key to preventing them. Third, every single incident hurts the 2A movement.
2. Whether about guns or seatbelt or helmets or ripsticks - whatever. There is bound to be some information I don't know or hadn't considered fully. Like I said, "There are very few occasions in life where I would prefer to make decisions based upon less information rather than more - especially decisions have a bearing on the health of my family." We can either assume we know everything about everything; or be a little bit humble and listen to what he or she has to say and remember that he knows very little about you and what you already know. It is not necessarily a personal attack or a rush to judgement. They are just trying to cover as many bases as possible to help you keep your child healthy. You may have to put up with hearing some junk you already know, but there just might be a gem of wisdom in there that you didn't.
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So I know that may not be the most popular view here - but it is mine.
If they are just giving information - I'm ok with that. I am not afraid of getting information - even if I don't agree with it.
If they are recommending a course of action - I might be ok with that depending upon the context.
If they are ordering me to do such and such - They have crossed the line.
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