Breaking the Silence: The Role of Screening in Physician-Initiated Firearm Safety Conversations

This article expands and investigates what physicians perceive as facilitators and barriers to initiating preventive health education, also called anticipatory guidance or medical education, around secure firearm storage in the home (safe storage) and outside the home (Emergency Risk Protection Orders [ERPO]). We employ in-depth qualitative interviews with 36 New Jersey physicians randomly selected from two national physician panels. Participants were screened for inclusions based on their specialty (family medicine or internist, obstetrics/gynecology, or pediatrics), practice setting (office-based rather than hospital-based), and time spent (80% or more) on direct patient care. Based on interviews, we identify five physician-perceived barriers to providing secure firearm storage counseling: inadequate screening mechanisms to prompt conversations, physician perceptions of who is at risk for firearm injury, time pressures, concerns about patient receptivity, and a need for physician training. Our findings indicate that there are structural barriers to physician-initiated firearm safety guidance. Interventions designed to increase physicians' willingness to have these conversations must first address why these conversations fail to occur. Physician participants expressed the need for revised patient screening tools, training on approaching conversations about secure firearm storage, and a mechanism to allocate sufficient time in a well-visit, among the many other topics they must discuss. Interview participants had minimal understanding of ERPO and how to counsel patients on petitioning for ERPO.