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12:19 pm
Wed March 20, 2013

How A Patient's Suicide Changed A Doctor's Approach To Guns

Originally published on Fri March 22, 2013 6:11 am

Dr. Frank Dumont knew one of his favorite patients was getting depressed.

When Dumont first started seeing him in his family practice, the man was in his 70s. He was active and fit; he enjoyed hiking into his 80s. But then things started to change.

"He started complaining of his memory starting to slip," Dumont says. The man would forget where he had placed objects, and he'd struggle to remember simple words and phrases.

Dumont prescribed antidepressants and saw him every eight weeks or so.

Like a lot of people in the small town of Estes Park, 90 miles northwest of Denver, both Dumont and his patient were drawn to the ruggedly beautiful mountains there. One of them, called Longs Peak, is a cherished part of Dumont's life. He and the patient talked often about the picturesque mountain.

"He was one of those people where you see them on the schedule for the day and you just smile," Dumont says. "You just realize you get a chance to chat with someone who feels like a friend."

That's what their last visit was like. Dumont says he did ask the man whether he was having any thoughts of hurting himself, but got a very convincing no.

"What in hindsight struck me about that visit is that he brought me a gift, which was a geological survey marker from the top of Longs Peak," says Dumont. "It was a replica, but it was one of those things that was just another reminder to me of this connection that we had had."

"And at the time it just seemed like a very generous gift that touched me," Dumont recalls. "And what I didn't realize at the time was that that was, I think, a farewell gift, or a bit of a parting gift, from him. Because I did not see him again. And the next that I had heard of him was from an emergency phone call from his wife about a month later, and she called needing to be seen. .... She had to come in and talk to me with how to deal with the fact that her husband had committed suicide."

Dumont's patient shot himself in the head with a rifle. Dumont was stunned, and guilt-ridden.

He says he always asks his depressed patients about suicide, whether they've thought about how they'd do it. But he now regrets not asking this patient specifically whether he had guns in the house.

Suicide prevention researcher Dr. Matthew Miller, at the Harvard School of Public Health, says Dumont sounds like a great doctor. "He was doing everything he could to try to keep this guy from making a suicide attempt, but what he didn't do was the second step, which is make it hard for him to die if he did make an attempt," Miller says.

The second step, Miller says, is asking patients if they have guns in the house or access to guns. If someone tries to commit suicide without using a gun, they probably won't succeed.

"The likelihood of their dying is of an order of magnitude lower," he says. "Instead of there being a 90-plus percent chance of death, there's a greater than 90 percent chance that they'll live."

Miller wants to make it routine for family doctors to ask their patients about guns. One large study found that nearly half of all suicide victims had seen a primary care doctor within a month of killing themselves. So it's important for them to bring up suicide and possible means.

"We have to get people to stop thinking about these discussions as gun control in one way or another, but rather as a way of conveying useful information, so people make decisions that protect their family," Miller says.

There are lots of reasons family doctors avoid bringing up guns with their patients. They may not want to offend a patient, or they may be too busy checking off all the preventive screenings and tests on the list.

Not everybody wants gun advice from a medical professional. Edgar Antillon organized a pro-gun rally at the Colorado State Capitol earlier this year. He says he would resent a doctor bringing it up.

"Tell me to stay healthy, tell me my baby has colic, but I don't think it's their job to tell me about gun safety," he says. "They're not gun experts. They're not NRA members. ... And if they are, then I'll take it as advice from an NRA member."

But Dumont has spent a lot of time second-guessing himself since his patient shot himself. The doctor hopes small measures he can take will reduce the odds, just a fraction, that another one of his patients will die from suicide by gun.

"I have a lower threshold for asking follow-up questions, asking the same thing a different way," he says. "Or if I have any inkling, starting to push a little bit further, and say, 'Well, so you're not really thinking about it, but have you ever thought about how you would go about it if you were going to?' And I have a lower threshold for asking about a weapon in the home as well."

Dumont says he thinks more physicians would talk with their patients about guns if they got information about health risks associated with them. Medical journals and a federal board of experts regularly issue advice on prevention of obesity, car accidents and workplace injuries. But there's been a ban on federally funded gun safety research until President Obama restored it with an executive action.

This story is part of a partnership between NPR, Colorado Public Radio and Kaiser Health News.

Copyright 2013 Colorado Public Radio. To see more, visit http://www.cpr.org.

Transcript

ROBERT SIEGEL, HOST:

While Congress struggles to find consensus in the gun debate, Colorado took action today. Gov. John Hickenlooper signed into law tough, new measures to limit large-capacity magazines, and to expand background checks.

MELISSA BLOCK, HOST:

We're going to stay in Colorado now, to explore another grim statistic about gun violence. As we've heard in our coverage this week, suicides - not homicides - account for two-thirds of the country's gun deaths. Some researchers think family doctors can help prevent suicides by being more engaged with their patients in talking about guns. Colorado Public Radio's Eric Whitney has the story of one doctor who agrees.

ERIC WHITNEY, BYLINE: Like a lot of people in the small town of Estes Park, 90 miles northwest of Denver, Dr. Frank Dumont was drawn here by the ruggedly beautiful mountains. He loves the view from the porch of a historic hotel.

You can actually see Rocky Mountain National Park from here?

DR. FRANK DUMONT: Yeah. And you're looking into the park. It's just a couple of miles that way. And you can actually see the outlines of Long's Peak up there; Mt. Lady Washington sitting in front of it, which you have to hike around to get up to the top.

WHITNEY: Long's Peak is a cherished part of Dumont's life. Climbing it has been a favorite part of his summers since childhood. And he had a favorite patient who shared his love for the mountain.

DUMONT: I think he felt that same sense of it being a part of his life and who he was.

WHITNEY: The patient was in his 70s when Dumont first started seeing him. He was active and fit, and still enjoyed hiking in the park into his 80s. But then, things started to change.

DUMONT: So he started complaining, after a few years, of his memory starting to slip; and remembering where he had placed objects; and maybe trying to think of an individual word that he was trying to come up with.

WHITNEY: Pretty typical stuff for the many older patients Dumont sees; also pretty typical for his patient to start feeling down about his mental and physical decline. Dumont started treating him for depression. Primary care doctors actually treat more people for it than psychiatrists. He prescribed antidepressants, and saw him every eight weeks or so.

DUMONT: He was one of those people where, you know, you see them on the schedule for the day and you just smile. You know, you just realize you get a chance to chat with someone who feels like a friend.

WHITNEY: That's what their last visit was like. Dumont did ask his patient whether he was having any thoughts of hurting himself, but says he got a very convincing no. Dumont felt he knew his patient well enough that he didn't think he was lying.

DUMONT: What, in hindsight, struck me about that visit is that he brought me a gift, which was a geological survey marker from the top of Long's Peak - and it was actually a replica of that. But it was one of those things that was just another reminder to me of this connection that we had had. And at the time, it just seemed like a very generous gift that touched me. And what I didn't realize at the time was that that was, I think, a farewell gift or a bit of a parting gift from him - because I did not see him again. And the next that I had heard of him was from an emergency phone call from his wife, about a month later. And she called, needing to be seen - she's also my patient - and she had to come in and talk to me with - how to deal with the fact that her husband had committed suicide.

WHITNEY: Dumont's patient shot himself in the head with a rifle.

DUMONT: And certainly, I felt guilt; you know, that if I'd have done something differently then, you know, maybe this wouldn't have happened.

WHITNEY: Dumont says he didn't see it coming. He says he always asks his depressed patients about suicide, whether they've thought about how they'd do it. But he now regrets not asking this patient specifically whether he had any guns in the house.

Suicide prevention researcher Dr. Matthew Miller, at the Harvard School of Public Health, says Dumont sounds like he did almost everything right.

DR. MATTHEW MILLER: He was doing everything he could, to try to keep this guy from making a suicide attempt. But what he didn't do was the second step, which is make it hard for him to die if he did make an attempt.

WHITNEY: The second step, Miller says, is asking patients if they have guns in the house, or access to guns. That's because if someone tries to commit suicide without using a gun, they probably won't succeed.

MILLER: The likelihood of their dying is, you know, of an order of magnitude lower. Instead of there being a 90-plus percent chance of death, there's a greater than 90 percent chance that they'll live.

WHITNEY: Miller wants to make it routine for family doctors to ask their patients about guns. One large study found that nearly half of all suicide victims had seen a primary care doctor within a month of killing themselves.

MILLER: This is not about gun control. This is about helping people make more informed decisions that are in their own, enlightened self-interest. And maybe that's another part of the equation; that we have to get people to stop thinking about these discussions as gun control in one way or another but rather, as a way of conveying useful information so that people make decisions that protect their family.

WHITNEY: Miller says there are lots of reasons family doctors avoid bringing up guns with their patients, even ones who are depressed - everything from not wanting to offend someone to simply being too busy, making sure they're checking off all the screenings and tests that are proven to extend their patient's lives - like asking about smoking and diet and exercise. Miller feels strongly that guns should be part of these routine questions. But not everyone wants gun advice from a medical professional. Edgar Antillon organized a pro-gun rally at the Colorado state Capitol earlier this year.

EDGAR ANTILLON: You know, tell me to stay healthy. Tell me my baby has colic. But I don't think it's their job to tell me about gun safety. They're not gun experts. They're not NRA members - maybe they are. And if they are, then I'll take it as advice from an NRA member.

WHITNEY: Dr. Frank Dumont has spent a lot of time second-guessing himself since his patient shot himself.

DUMONT: I have a lower threshold for asking follow-up questions - asking the same thing a different way. Or if I have any inkling, you know, starting to push a little bit further and say, well - you know - so you're not really thinking about it. But have you ever thought about how you would go about it, if you were going to? And I have a lower threshold for asking about having a weapon in the home as well.

WHITNEY: Dumont says he thinks more physicians would talk with their patients about guns if they got information about health risks associated with them, like they do for other health and safety concerns. Medical journals, and an independent board of experts, regularly issue advice to doctors on preventing everything from obesity to car accidents and workplace injuries. But there's been a ban on federally funded gun safety research until President Obama restored it with an executive action. Suicide prevention expert Matthew Miller says that should help chip away at the silence about guns between doctors and patients.

For NPR News, I'm Eric Whitney in Denver.

BLOCK: That story comes from a partnership between NPR, Colorado Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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