Preparing to Counsel Patients

Before you make a plan for counseling patients, consider your firearms knowledge and prepare yourself for the firearms conversation. If you need further information, see the What You Can Do Resources page for more materials. Be ready to answer questions or refer patients to another source for more information when necessary.

Plan your approach based on what you already know about the patient you’re going to counsel and his or her risk group for firearm violence. We recommend an approach to firearm counseling that:1

  • Relates clearly to the patient’s health and wellbeing
  • Is unique to the patient and context-specific
  • Is respectful
  • Opens a conversation
  • Recognizes that changing circumstances in the home can change risk of firearm injury and death
  • Acknowledges local customs related to firearms and firearm ownership
  • Happens within an established patient-physician relationship, when possible
  • Is educational, rather than strictly for information gathering
  • Includes appropriate follow-up

To maximize receptiveness, take a respectful and collaborative approach. Patients’ ownership of firearms may be reflective of longstanding values and beliefs. You should keep in mind that many firearm owners take firearm safety seriously. Frame the discussion in the context of the patient’s wellbeing and involve the patient in the conversation.

Risk for firearm injury and death change as circumstances in the home change. Re-evaluating the risk of firearm injury and death in the home to reflect current circumstances—such as who lives in the home, and any frequent visitors or guests who belong to high-risk groups—is an important step for the safety of everyone in a home with firearms.

Information You Might Find Helpful

The information we recommend you collect from your line of questions about firearms includes:

  1. Is the patient, or is the patient’s caretaker, the owner of the firearm? What capacity does the person you’re counseling have to influence safe firearm storage habits?
  2. What are the current storage methods for firearms in the home? What changes could the gun owner make to store the firearms more safely?
  3. Is the patient at elevated risk of firearm injury or death, or is someone else in the patient’s home at elevated risk? If the patient himself is not the at-risk person, how can the patient help to reduce the risk of firearm injury or death for the at-risk person?
  4. Is anything different in the patient’s home since a gun was first brought there that changes the level of risk in the home? Maybe the patient has had a child, or maybe someone in his home has recently experienced thoughts of self-harm.
  5. What knowledge or tools can you equip the patient with to help him reduce risk of firearm injury and death for everyone in the home?

This conversation, as with other screening conversations, might be difficult for some patients. Be prepared to explain why you’re asking about firearms and what you will do with the patient’s answers. Reassure the patient that the information will remain confidential unless there’s an immediate emergency, and that your interest is at all times in the health and safety of the patient and the patient’s loved ones.

Review Your State and Institutional Policies

You might find it useful to know your state law and/or your institution’s policy regarding carrying firearms on hospital campuses. You can include this in your preparation to counsel patients.

Click here to continue to tips on how to start the firearms conversation with patients and to view suggested questions to ask.

1. Wintemute GJ, Betz ME, Ranney ML. Yes, you can: physicians, patients, and firearms. Ann Intern Med 2016;165:205-13.