don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

In this column, I have often suggested that doctors add self-management oriented questions to the traditional health and medical queries that are part of clinical history taking. For example, I think it would be wise for doctors to probe about exercise, nutrition, stress management and similar lifestyle matters, besides asking the usual questions about aches and pains, checking blood pressure and the like. In fact, I'd prefer to see doctors explore the quality of a patient's sense of humor, how much fun he/she is having and certainly whether the patient is getting enough DRBU equivalents on a daily basis!

How far should this trend be extended? For example, do you think doctors should ask, "Do you own a firearm?" This is a bit of a stretch beyond lifestyle questions, but most would agree that a firearm in the home does have potential health consequences, if mistakes are made.

It seems this question is causing quite a bit of controversy among physicians, according to a recent survey in Medical Economics. What is your opinion on the matter? At AARP's online magazine My Generation, a poll is being conducted with site visitors voting on the following questions (treated as one): "Is gun ownership a public-health matter? During your next physical, should your doctor ask you if you own a firearm?" Want to guess how people are responding?

So far, less than two percent (1.3 percent) agree that doctors should ask. They do not, in other words, agree that it is a public health issue. A whopping 98.7 percent voted "No, the doctor shouldn't ask -- it violates ethical boundaries." Are you surprised?

An article in AARP's magazine Staying Alive, written by Sue Woodman, explored this issue. It seems that about 1/3 of doctors are gun owners and most, if not all, of them do not want gun ownership probed as part of doctor/patient relationships. The existence of two competing medical associations further evidences the division among doctors themselves on this issue. One group, "Doctors Against Handgun Injury" promotes asking such questions. Another, "Doctors for Responsible Gun Ownership," takes the NRA position. These two groups have debated the question of whether doctors should ask patients about firearm ownership. Of course, it would be good to have more information about just what the doctor would do with the information once the patients declared their ownership or non-ownership of such weapons.

As with any issue, there are plausible arguments for both sides. Mirroring the patient poll, most doctors, even though not gun owners, do not want to be asking politically charged questions. Many see this particular issue as a minefield leading to explosive interactions with some patients, given the politically charged nature of the gun issue in this country. Some also ask how a doctor would have time to ask about gun ownership, given the brief interaction periods usually given over to patient counseling.

I don't think lifestyle questions are as politically charged as the gun ownership question. Furthermore, a doctor is usually in a better position to make suggestions and even recommend programs in the varied areas of self-management, much more so than is the case regarding the pros and cons of gun ownership. Thus, I think it's a fine and desirable idea to expand the role of physicians beyond matters of traditional medical care, but not initially in such charged areas as gun ownership. Let the doctors start off with questions about exercise, nutrition, stress management and the like -- and save the hot stuff (meaning and purpose, critical thinking and emotional intelligence) for later, after a bit of doctor/patient confidence and trust has been established. Then I might give it a try (if I were in a doctor's role), but only if I had a solid follow-up program to deal constructively with the kind of answers I might anticipate.

That's my take on this issue. What do you think? Be well. Look on the bright side.

(Note: This essay will be filed in the archives in the PHYSICAL DOMAIN under the skill area of lifestyle habits. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

 Send e-mail to Don Ardell