What do guns and cigarettes have in common? Some doctors ask about firearm safety
Gun locks and light replacement vouchers wait for drivers at an event where officers with the St. Paul police department conduct mock traffic stops and hand out vouchers for head and tail light replacements in a parking lot near the Minnesota State Fairgrounds on Dec. 9, 2023.
Nicole Neri for MPR News
In wellness visits, primary care doctors have a few minutes with patients to check in about various issues related to their health, including smoking, drinking, medications and exercise.
Some physicians have added gun safety to the list. The move stems from the perspective, shared by the Minnesota Medical Association, the American Academy of Pediatrics and other groups, that gun violence is a public health crisis.
Dr. Thomas Kottke has been surveying doctors about their experiences speaking with patients about gun storage. Kottke is HealthPartners’ medical director for wellbeing and a board member of the group Protect Minnesota, which advocates for firearm restrictions and violence prevention programs.
MPR News host Cathy Wurzer talked with him about what he’s heard from physicians and what lessons he’s drawn from tobacco prevention.
Use the audio player above to listen to the full conversation.
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Audio transcript
CATHY WURZER: In wellness visits, you probably have noticed this. Primary care doctors have a few minutes with you to check in about various issues related to your health, things like smoking and drinking and your medications and do you exercise? Well, some physicians are adding gun safety to that list. This move stems from the perspective held by the Minnesota Medical Association and other groups that gun violence is a public health crisis.
Our next guest has been surveying doctors about what it's like to talk with patients about guns. Dr. Thomas Kottke is a board member of the group, Protect Minnesota, which advocates for firearm restrictions and violence prevention programs. He's also an internal medicine doctor and a researcher with Health Partners. Doctor, welcome.
THOMAS KOTTKE: Thank you.
CATHY WURZER: It's a pleasure. So how are your colleagues, the people you've been interviewing about this-- how are they talking to their patients about guns?
THOMAS KOTTKE: Well, the first thing they do is ask, are your firearms locked up unloaded? And what this does, it avoids the possible Second Amendment discussion about, do you have guns or not? And most people will either say, I don't have any firearms, which the response is, well, that's good. Or, yes, they're locked and unloaded. Or if they say no, I haven't locked them up, then the advice is, please lock them up for safety of your family and people who visit your home.
CATHY WURZER: Are people surprised they're being asked about this?
THOMAS KOTTKE: Not really. And there's-- I asked the doctors about pushback. Did anybody object? And they all were kind of puzzled. And they said, no. I've never had anybody object to me asking whether my guns were locked up.
CATHY WURZER: What do we know, Doctor, about evidence-- any evidence that asking about guns or gun storage, is that effective in getting people to start thinking about changing their behavior?
THOMAS KOTTKE: Well, we don't know whether about their thinking. But we do know from some trials, some randomized trials, that it does have some effect. And I think it-- I believe it starts people thinking. And they're reading the newspaper. And they hear that deaths from gunshot wounds are the leading cause of death in American children and adolescents now.
And they're also-- a gun changes a suicide gesture from being completed from about 5% to about 85%. And so they start thinking about it and decide, yeah, I'm going to lock up my gun. Plus, we've been working with the VA. And they make trigger locks and cable locks available.
CATHY WURZER: I asked you about the responses you get from patients. And there doesn't seem to be much in the way of any issue, you say. But as you also admit, it's a politicized issue. And there are some states that have considered laws to prevent doctors from asking their patients about firearms. Have you considered-- does it encroach on patient privacy when doctors ask this question?
THOMAS KOTTKE: No. There's-- the medical visit is confidential anyway. And particularly, pediatricians have an obligation to promote the safety of the children they see. And so they ask about car seats. They ask about other hazards in the home. And they're obligated to give immunizations.
And so as long as it's confidential between the physician and the patient-- and of course, the medical record is protected by HIPAA and by federal law. So it's not a violation of patient rights. And the patient can always just say, I'm not going to answer that.
CATHY WURZER: Sure. You mentioned you've talked to about a dozen of your colleagues. I was just reading this article in The Atlantic before you and I went on the air. Many doctors do think it's important to ask patients about guns, but not many are doing it because there's bunches of other things that they have to ask about. What are you hearing out there in terms of maybe other states, any other anecdotal evidence about the extent that this is happening?
THOMAS KOTTKE: Well, there are other states that-- we're developing a map of where guns can be stored. If it there's a feeling say a patient's at risk, they're depressed, they talked about suicide, they planned it, then the guns ought to come out of the home. And if the family can't store them anyplace else, we're developing a map so that they can find someplace to store them safely.
CATHY WURZER: You know, I'm wondering here in terms of having physicians ask about gun storage, tell me a little bit about why you think it's important to have doctors involved in this discussion.
THOMAS KOTTKE: I think the leading reason is a lot of people are dying from gunshot wounds. Like I mentioned, it's the leading cause of death in Americans under the age of 20. And this is new. And also, our suicide rates in Minnesota have been going up since about the year 2000. And physicians, one of the roles of physicians is to keep patients alive.
And a suicide gesture or an accident is frequently transient. Most people who make a suicide gesture do not go on to make a second one. And so preventing access to lethal means by locking up a firearm prevents that death.
CATHY WURZER: Mm-hmm. So I know you've worked in tobacco prevention. I think you and I have talked about this now for many, many years.
THOMAS KOTTKE: Yeah.
CATHY WURZER: Did you have you learned anything from those efforts that can apply to firearm safety?
THOMAS KOTTKE: We sure have. First of all, make it quick. Ask about, are your guns locked unloaded? And don't try to change somebody's mind. The long conversation disrupts the entire clinic flow. And eventually, the conversation will be dropped altogether. And so it's a quick-- are your guns locked up? And if they aren't, the advice to lock them.
What we learned in tobacco intervention is that the question, do you smoke? is the one question that leads to the biggest change in attempts to quit smoking. And so it's that-- when the doc says, are your guns locked up? it triggers a whole bunch of thought about, well, gee, this is important. And we-- everybody reads about the accidents, kids shooting each other or shooting their teachers or shooting their classmates.
And so I think it's fairly universal that people don't want their firearms used by somebody else to kill somebody, whether it's accidental or purposeful. And so there's a legitimacy to locking up guns.
CATHY WURZER: So a final question for you, because you've done some of this research already-- do you see doing a little more research into a more maybe a statewide research project around this? Or how do you want to take this forward, the information that you're getting?
THOMAS KOTTKE: The 12 doctors we've interviewed have just been the preparation for a larger research operation by the University of Minnesota, Protect Minnesota, The Minnesota Medical Association, and the VA. And so we'll be doing some trials up in Central Minnesota to see how physicians are doing talking to patients about locking up their guns. We'll be interviewing some patients to see what their reaction is.
And we'd like to make Minnesota a safer state. We're not about taking people's guns away. It's just that they should be locked up when they're unattended.
CATHY WURZER: Doctor, it's been a pleasure, as always, talking to you. Thank you so much.
THOMAS KOTTKE: OK. Thank you, Cathy.
CATHY WURZER: Dr. Thomas Kottke is Health Partner's Medical Director for Well-being. He's also a board member of the gun violence prevention group, Protect Minnesota. Now because we mentioned suicide, if you or someone you know is struggling with depression or thoughts of suicide, they can call or text 988. That's the National Suicide and Crisis Lifeline.
Our next guest has been surveying doctors about what it's like to talk with patients about guns. Dr. Thomas Kottke is a board member of the group, Protect Minnesota, which advocates for firearm restrictions and violence prevention programs. He's also an internal medicine doctor and a researcher with Health Partners. Doctor, welcome.
THOMAS KOTTKE: Thank you.
CATHY WURZER: It's a pleasure. So how are your colleagues, the people you've been interviewing about this-- how are they talking to their patients about guns?
THOMAS KOTTKE: Well, the first thing they do is ask, are your firearms locked up unloaded? And what this does, it avoids the possible Second Amendment discussion about, do you have guns or not? And most people will either say, I don't have any firearms, which the response is, well, that's good. Or, yes, they're locked and unloaded. Or if they say no, I haven't locked them up, then the advice is, please lock them up for safety of your family and people who visit your home.
CATHY WURZER: Are people surprised they're being asked about this?
THOMAS KOTTKE: Not really. And there's-- I asked the doctors about pushback. Did anybody object? And they all were kind of puzzled. And they said, no. I've never had anybody object to me asking whether my guns were locked up.
CATHY WURZER: What do we know, Doctor, about evidence-- any evidence that asking about guns or gun storage, is that effective in getting people to start thinking about changing their behavior?
THOMAS KOTTKE: Well, we don't know whether about their thinking. But we do know from some trials, some randomized trials, that it does have some effect. And I think it-- I believe it starts people thinking. And they're reading the newspaper. And they hear that deaths from gunshot wounds are the leading cause of death in American children and adolescents now.
And they're also-- a gun changes a suicide gesture from being completed from about 5% to about 85%. And so they start thinking about it and decide, yeah, I'm going to lock up my gun. Plus, we've been working with the VA. And they make trigger locks and cable locks available.
CATHY WURZER: I asked you about the responses you get from patients. And there doesn't seem to be much in the way of any issue, you say. But as you also admit, it's a politicized issue. And there are some states that have considered laws to prevent doctors from asking their patients about firearms. Have you considered-- does it encroach on patient privacy when doctors ask this question?
THOMAS KOTTKE: No. There's-- the medical visit is confidential anyway. And particularly, pediatricians have an obligation to promote the safety of the children they see. And so they ask about car seats. They ask about other hazards in the home. And they're obligated to give immunizations.
And so as long as it's confidential between the physician and the patient-- and of course, the medical record is protected by HIPAA and by federal law. So it's not a violation of patient rights. And the patient can always just say, I'm not going to answer that.
CATHY WURZER: Sure. You mentioned you've talked to about a dozen of your colleagues. I was just reading this article in The Atlantic before you and I went on the air. Many doctors do think it's important to ask patients about guns, but not many are doing it because there's bunches of other things that they have to ask about. What are you hearing out there in terms of maybe other states, any other anecdotal evidence about the extent that this is happening?
THOMAS KOTTKE: Well, there are other states that-- we're developing a map of where guns can be stored. If it there's a feeling say a patient's at risk, they're depressed, they talked about suicide, they planned it, then the guns ought to come out of the home. And if the family can't store them anyplace else, we're developing a map so that they can find someplace to store them safely.
CATHY WURZER: You know, I'm wondering here in terms of having physicians ask about gun storage, tell me a little bit about why you think it's important to have doctors involved in this discussion.
THOMAS KOTTKE: I think the leading reason is a lot of people are dying from gunshot wounds. Like I mentioned, it's the leading cause of death in Americans under the age of 20. And this is new. And also, our suicide rates in Minnesota have been going up since about the year 2000. And physicians, one of the roles of physicians is to keep patients alive.
And a suicide gesture or an accident is frequently transient. Most people who make a suicide gesture do not go on to make a second one. And so preventing access to lethal means by locking up a firearm prevents that death.
CATHY WURZER: Mm-hmm. So I know you've worked in tobacco prevention. I think you and I have talked about this now for many, many years.
THOMAS KOTTKE: Yeah.
CATHY WURZER: Did you have you learned anything from those efforts that can apply to firearm safety?
THOMAS KOTTKE: We sure have. First of all, make it quick. Ask about, are your guns locked unloaded? And don't try to change somebody's mind. The long conversation disrupts the entire clinic flow. And eventually, the conversation will be dropped altogether. And so it's a quick-- are your guns locked up? And if they aren't, the advice to lock them.
What we learned in tobacco intervention is that the question, do you smoke? is the one question that leads to the biggest change in attempts to quit smoking. And so it's that-- when the doc says, are your guns locked up? it triggers a whole bunch of thought about, well, gee, this is important. And we-- everybody reads about the accidents, kids shooting each other or shooting their teachers or shooting their classmates.
And so I think it's fairly universal that people don't want their firearms used by somebody else to kill somebody, whether it's accidental or purposeful. And so there's a legitimacy to locking up guns.
CATHY WURZER: So a final question for you, because you've done some of this research already-- do you see doing a little more research into a more maybe a statewide research project around this? Or how do you want to take this forward, the information that you're getting?
THOMAS KOTTKE: The 12 doctors we've interviewed have just been the preparation for a larger research operation by the University of Minnesota, Protect Minnesota, The Minnesota Medical Association, and the VA. And so we'll be doing some trials up in Central Minnesota to see how physicians are doing talking to patients about locking up their guns. We'll be interviewing some patients to see what their reaction is.
And we'd like to make Minnesota a safer state. We're not about taking people's guns away. It's just that they should be locked up when they're unattended.
CATHY WURZER: Doctor, it's been a pleasure, as always, talking to you. Thank you so much.
THOMAS KOTTKE: OK. Thank you, Cathy.
CATHY WURZER: Dr. Thomas Kottke is Health Partner's Medical Director for Well-being. He's also a board member of the gun violence prevention group, Protect Minnesota. Now because we mentioned suicide, if you or someone you know is struggling with depression or thoughts of suicide, they can call or text 988. That's the National Suicide and Crisis Lifeline.
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