Do you have guns in your home?

     I did my internal medicine residency training in Philadelphia from 2005-2008. The city of brotherly love is no stranger to gun violence. It's one of the reasons I was taught to always ask patients if there are guns in the home. If they did have guns, I was instructed to provide some counseling and literature on gun safety. But after 3 years, hundreds of patients of all sexes, ages and races, in a city notorious for crime, not once did a patient tell me they owned a gun. Nevertheless, the issue of gun safety seemed like an important patient education endeavor that I left Philadelphia with.
     After residency, I decided to travel by doing some Locum Tenens (contract) work.  Having grown up in New York City, then training in Philadelphia, my view of the world and medicine felt skewed. I decided to practice medicine a little off the beaten path.
    One of my many stops was rural Maine, near the Canadian border. Far from the lights of Rittenhouse Square, a small yet busy town of 15,000 lovely warm people showed me medicine was the same no matter where you are.  I was dealing with the same spectrum of chronic illnesses . I stayed true to my training and discussed wellness in all its forms. Obesity, diet, exercise, mental health, smoking cessation, addiction, prevention, I did it all. I also asked about guns. It's this question that showed me, I wasn't in "Kansas" (or in my case Philadelphia!) anymore.
    Many of  the patients had guns in their homes. I remember the first patient who admitted to owning a gun. I was rapidly going through a series of screening questions with little expectation of hearing "yes." When he said yes to owning guns, I stuttered, and asked again. My heart rate accelerated since I honestly didn't know what else to ask or how to counsel him appropriately. I only asked whether it was stored safely. He proudly mentioned a make and model and reassured me no one else could get their hands on it. I also sensed consternation and an immediate change in his demeanor when he asked me how that was relevant in an annual physical.

The momentum of what was an otherwise pleasant, efficient and successful visit came to a grinding halt.

I had more questions for myself than I did for him.

Does he own a  hand gun, hunting rifle or semi automatic weapon? Does it matter?

He seems nice enough, but how much do I really trust him with a weapon?

Was this my liberal bias creeping into my medical care in a conservative population?

Do I really know enough about this person from a 30 minute medical visit to predict if this gun in his home will ever be used for the wrong reasons?

Is it really stored safely?

Do I really trust the randomness of the cosmos enough to ensure me that this gun won't end up in the wrong hands ever?

Ultimately, these questions didn't matter. It was his legal right to own this weapon. And so I mentally moved on  just as I imagine, Nancy Lanza's physician may have had to if he or she were to ask the same question.