28 July 2011

Annie Get Your Gun

When the ER is quiet I don't feel guilty for not being more productive. I get to be relieved that children are not sick and are not getting hurt. If it is busy, if a particularly noxious virus seems to be making its way through the ranks of the young, I still try to take the time to encourage good hand washing. Breaking the cycle of infection is essential to keeping others in the household and a child's group of friends healthy and well.

So what if my patient has instead come to be seen for a head injury after a car accident in which he was not wearing a seat belt, a broken arm after a fall from a trampoline, a bad laceration after being allowed to play unsupervised with a knife? It would be remiss of me to not address appropriate safety measures, but it is also (by this time) almost beside the point. The accident has happened and the pain that it caused is a better warning than any I could ever give to be careful next time around.

Other pediatricians, those who work in offices and see patients before they have accidents, have a better chance of preventing such injuries before they occur. Keep in mind that the most likely thing to kill a child over the age of 1 is an accident. Is a pediatrician really doing his or her job by doling out shots and prescriptions for antibiotics but ignoring this fact?


So regular well child visits at the pediatrician's office routinely involve discussion of age appropriate dangers. Mothers and fathers of infants are encouraged to be vigilant about not leaving children unattended on beds or changing tables, since falls in this age group can result in a skull fracture. When children get older, discussion turns to child proofing electrical outlets, use of bike helmets, rules about crossing the street. In 49 of 50 states discussions also include inquiries about whether anyone in the household owns a gun.

If a family answers in the affirmative then the pediatrician takes the time to cover the importance of gun locks, storing firearms and ammunition in separate places, and keeping guns locked up and in a place where children can not get them.

But in Florida, asking about exposure to guns is illegal. Under the auspices of protecting the privacy of households, pediatricians could now face jail time for this line of questioning. Theoretically the discussion of gun safety could still go forward in the hypothetical, but it's not likely to.

Pediatricians are already under extreme time pressures to discuss all of the necessary facets of development, injury and disease prevention, school readiness, and countless other topics of a typical well child visit within the time allotted by insurance companies. In Florida, not being able to ask which children are at risk of gun death will mean that counseling on safety is simply not done.

Had the parents of Seth Lasater not kept a loaded rifle in their home, the eleven year old would still be alive. Instead he died earlier this month. Would a frank discussion with his pediatrician have saved his life? Maybe, maybe not. We'll never know. But we'll unfortunately find out how many more children become statistics as the effects of this idiotic law play out over time.

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