He stood, dropped his pants and as one pocket crumpled, the other didn't. There it was: the creased outline of what appeared to be a pistol in the right hip pocket. I steeled and turned my attention to the specimen collection kit on the work shelf before me. The door was closed. We were alone in the exam room.
This would be just fine, I told myself. To which another part of my brain responded — well, if it isn't, are you prepared?
Ask me about my fears back when I first started volunteering to do sexually transmitted disease testing in a downtown Washington D.C. clinic for gay men, and my answer would involve an embarrassing lesson taught by a young patient in pumps and a halter top. Back then, not really knowing my patients — their backgrounds, social situations, lingo and interaction style — was pretty much my only fear.
Years later, I now generally feel as if I "know" my patients. So come this night, my intuition was telling me this man was an unknown — big guy, older than most, blue tattoos that said things I rarely see, one above a slash scar. To my questions, he volunteered few answers.
I kept talking, moved closer and completed the urethral swab procedure. That outlined thing in his back pocket had not crumpled, the object still pistol-sized and pistol-shaped. Then again, maybe it was simply a new type of bicycle lock or a quirky clump of keys. I made small talk, and once the session was done, my patient was out the door. In the nurse's station later I shook my head and mentioned to a co-worker that I first thought that last guy might have a gun.
"Crazy," I said, "the guy ultimately seemed just fine." What I didn't say was that many years back in another clinic, a patient killed a former colleague of mine with a shotgun blast to the chest. Given that experience, maybe my first thought wasn't so crazy after all.
Questions lingered for me that night. Maybe I should have called a security guard. What if I was wrong? What if I had been right — the guy had a gun and now had to surrender it, a confrontation in the making? My patient offered no real signs of a threat. Had the years taught me to instinctively profile my patients for the presence of guns?
Answering such questions and even considering gun violence are the last things I care to think about when I'm in a clinic, and I shouldn't have to. Prompted by my the nagging questions, I did some research and found that homicide in the health care setting is even more uncommon than I imagined; for example, among approximately 480 total workplace homicides estimated for the year 2012 in one government report, 19 deaths occurred in the health care and social assistance setting, not all of those with guns. Placed in the context of many millions of health care visits, the risks are far, far less than I had anticipated. Beyond the security guard and controls already present in my clinic, the risks for being hit by a bus on the walk home far exceeded any truly bad thing my clinic patient might do.
In late July, news came of a shooting in a Pennsylvania mental health facility. This time when the patient started shooting, the doctor fired back, wounding the shooter. News reports claimed the doctor had a concealed weapon permit and many regaled him a hero, which given the supplied facts, he was.
So, in a way, the tables have now turned, and the not unreasonable question has become: Is my doctor packing a gun?
Questions related to guns won't leave us alone even if we'd rather not think about them. A whole science of gun violence reduction is doing its best to provide evidence-based answers and risk minimization options even in the face of meager funding and a struggle for public health credibility. Objections from the National Rifle Association have effectively banned the federal funding of much gun violence research — the concern apparently being what the studies may show.
Gun violence studies have the potential to improve risk assessment and de-escalation techniques or even to help identify who should be armed in a clinical setting. As a physician, I use research results all the time to improve the health of my patients. Gun violence is a public health problem with some mighty tough medical and social questions for us all. To answer those questions, the research needs to get done.
Dr. Dwaine Rieves is a physician in Washington D.C. His email is DCRieves@msn.com.
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